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 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**: $3600 Family $2500 Couple $1800 Single 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 CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Marital Status SingleMarriedDivorcedWidowed 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 123456789101112 Hour001020304050 MinutesAMPM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM SECTION VI: ANNUAL MEMBERSHIP CONTRIBUTIONS Membership Options* $3600 Family Membership (pay in full)$3600 Family Membership (billed $360/monthly)$2500 Couple Membership (pay in full)$2500 Couple Membership (billed $250/month)$1800 Single Membership (pay in full)$1800 Single Membership (billed $180/month) Total Due Now $0.00 Payment Credit Card Mail in Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country I would like to receive news and updates by email Submit 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: This page uses TLS encryption to keep your data secure.