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 Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Marital Status Single Married Divorced Widowed 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 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Name of Deceased Hebrew Name & Father's Hebrew Name Relationship Date of Passing (please give approximate time) Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM 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 Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Expiration Year Billing Address Street Address City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other 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.