Membership Form

Chabad Lubavitch of Greenwich Synagogue Membership
We welcome you to join our membership family and enjoy being part of our wonderful community!

Annual membership at Chabad corresponds to the Jewish Year. Membership should be renewed every year during August.

MEMBERSHIP BENEFITS:
- Complimentary High Holiday Seats for immediate family members - please reserve
- Family Member or Designee receiving an Honor during High Holidays
- Complimentary listings of departed loved ones in the Yom Kippur Yizkor booklet
- Complimentary Lulav & Etrog set for Sukkot (by request)
- Complimentary tickets to the Membership Shabbat Dinner - Friday Sukkot, October 10
- Complimentary Box of Shmurah Matzah for Passover (by request)
- Members' Discount on Programs and Events
- Holiday Gifts and Mezuzah mailed to your children at college
- Listing in the Community Membership Directory
- Rabbi Deren presiding over your family's lifecycle events (Bris, Upshern, Bar/Bat Mitzvah, Wedding, Funeral, Shiva)
- Belonging to an amazing Jewish community & building lifelong friendships!
MEMBERSHIP RATES**:
- ⁠$3,600 Family
- ⁠$2,500 Couple
- $1,800 Single
LAMPLIGHTER Membership:

The LAMPLIGHTER Members are the pillars of our community. It is because of you that we can continue to offer the highest level of educational, religious and social programming, made available to anyone in the regardless of their ability to pay. In appreciation, LAMPLIGHTER Members are entitled to a complimentary table of 10 at the Chabad Gala, and are invited to an exclusive LAMPLIGHTER annual Appreciation Dinner.
- $5,400 Lamplighter Donor
- $10,000 Lamplighter Partner
- $18,000 Lamplighter Rabbi's Circle
- $25,000 Lamplighter Patron Circle
- $36,000 Lamplighter Leadership Circle
PLEASE SELECT ONE:*

I would like to renew my membership. All my information remains the same.I would like to renew my membership. Please note the changes to my information below.I would like to become a member
SECTION I: YOUR INFO
Full Name*
First Name Last Name
Hebrew Name
Mother's Hebrew Name
Father's Hebrew Name
Birth Date

Month Day Year
E-mail*
Cell Number*

Area Code Phone Number
Occupation
Work Number
Jewish By:

BirthChoice
Father is:

KohenLeviYisroel
SECTION II: YOUR SPOUSE'S INFO
Full Name
First Name Last Name
Hebrew Name
Mother's Hebrew Name
Father's Hebrew Name
Birth Date

Month Day Year
E-mail
Cell Number

Area Code Phone Number
Occupation
Work Number

Area Code Phone Number
Jewish By:

BirthChoice
Father is:

KohenLeviYisroel
SECTION III: PERSONAL INFORMATION

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital Status
Anniversary Date

Month Day Year
If divorced, do you have a Jewish "get"?

YesNo
SECTION IV: CHILDREN
Full Name
First Name Last Name
Birth Date

Month Day Year
Full Name
First Name Last Name
Birth Date

Month Day Year
Full Name
First Name Last Name
Birth Date

Month Day Year
Full Name
First Name Last Name
Birth Date

Month Day Year
Full Name
First Name Last Name
Birth Date

Month Day Year
SECTION V: YAHRZEIT INFORMATION
Name of Deceased
Hebrew Name & Father's Hebrew Name
Relationship
Date of Passing (please give approximate time)

Month Day Year
at Hour Minutes
Name of Deceased
Hebrew Name & Father's Hebrew Name
Relationship
Date of Passing (please give approximate time)

Month Day Year
at Hour Minutes
Name of Deceased
Hebrew Name & Father's Hebrew Name
Relationship
Date of Passing (please give approximate time)

Month Day Year
at Hour Minutes
Name of Deceased
Hebrew Name & Father's Hebrew Name
Relationship
Date of Passing (please give approximate time)

Month Day Year
at Hour Minutes
Name of Deceased
Hebrew Name & Father's Hebrew Name
Relationship
Date of Passing (please give approximate time)

Month Day Year
at Hour Minutes
SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS
Membership Options*

$3,600 Family Membership$3,600 Family Membership - $360/mo. Sep-Jun$2,500 Couple Membership$2,500 Couple Membership - $250/mo. Sep-Jun$1,800 Single Membership$1,800 Single Membership - $180/mo. Sep-Jun$5,400 Lamplighter Donor$5,400 Lamplighter Donor - $540/mo. Sep-Jun$10,000 Lamplighter Partner$10,000 Lamplighter Partner - $1,000/mo. Sep-Jun$18,000 Lamplighter Rabbi's Circle$18,000 Lamplighter Rabbi's Circle - $1,800/mo. Sep-Jun$25,000 Lamplighter Patron Circle$25,000 Lamplighter Patron Circle - $2,500/mo. Sep-Jun$36,000 Lamplighter Leadership Circle$36,000 Lamplighter Leadership Circle - $3,600/mo. Sep-Jun
Please enable the option "Yes, I'd like to make this a monthly recurring payment." to automatically process the payment each month. The recurring payments will stop once the full amount has been paid.
Yes, I'd like to make this a monthly recurring payment.
Total Due Now

$0.00

Payment

Credit Card Mail in Check

Postal / Zip Code

Country

I would like to receive news and updates by email
Reminder: If you will be joining us for the High Holidays, please remember to RESERVE YOUR COMPLIMENTARY SEATS after submitting this Membership Form.

**All contributions are tax deductible and can be paid throughout the year. No one is turned away for lack of funds. If you cannot afford the full amount requested, please contact Rabbi Deren at [email protected] for a confidential arrangement.
Should be Empty:

Chabad Lubavitch of Greenwich Synagogue Membership

SECTION I: YOUR INFO

SECTION II: YOUR SPOUSE'S INFO

SECTION III: PERSONAL INFORMATION

SECTION IV: CHILDREN

SECTION V: YAHRZEIT INFORMATION

SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS