Creating a growing and dynamic community is a partnership and collective effort. Your membership and support over the past years is greatly valued and appreciated. Our partnership is even more critical as we move forward in these challenging yet exciting times. There are many benefits to being a member, including discounts and special gifts throughout the year, but the greatest benefit is the feeling of being a partner in a unique and warm community, with 2 convenient locations for services, that will serve as a spiritual home for you and your children to experience authentic Judaism in the most enjoyable and rewarding way.
Please fill out this membership form and please consider an increase in your membership level for the coming year, as your circumstances allow. Thank you so much for your support and partnership.

YOUR INFORMATION
Gender Male Female   Title
First Name   Last Name
Hebrew Name   Occupation
Mother's Hebrew Name   Father's Hebrew Name
Birth Date   Time of Birth (Approx.)
Cell Phone   Work Phone
Email   Home Phone
Address   City, State, Zip
City State Zip
Birth Mother Jewish by Birth Converted    
Did You Convert? No Yes      
For Male Members Kohen iLevite Israelite  
Marital Status  Married  Separated  Divorced  Widowed
If Married, Date of Marriage
         
YOUR SPOUSE'S INFORMATION
Gender Male Female   Title
Name   Hebrew Name
Mother's Hebrew Name   Father's Hebrew Name
Birth Date   Time of Birth (Approx.)
Occupation   Email
Cell Phone   Work Phone
Birth Mother Jewish by Birth Converted    
Converted? No Yes      
For Males Members KohenLevite Israelite  
       
YOUR CHILD/CHILDREN'S INFORMATION
1. Child's Name   Hebrew Name
Birth Date   School
2. Child's Name   Hebrew Name
Birth Date   School
3. Child's name   Hebrew Name
Birth Date   School
4. Child's Name   Hebrew Name
Birth Date   School
YAHRTZET INFORMATION
1. Hebrew Name   Father's Hebrew Name
English Name   Relation
Date of Passing   Time of Day (Approx.)
2. Hebrew Name   Father's Hebrew Name
English Name   Relation
Date of Passing   Time of Day (Approx.)
3. Hebrew Name   Father's Hebrew Name
English Name   Relation
Date of Passing   Time of Day (Approx.)
4. Hebrew Name   Father's Hebrew Name
English Name   Relation
Date of Passing   Time of Day (Approx.)

I AM INTERESTED IN PARTICIPATING IN THE FOLLOWING AREAS:
Synagogue Services Holiday Celebrations Gan Israel Summer Day Camp
Junior Congregation Youth Zone Seniors Club
Adult Education Classes Teen Programming Men's Club
Women's Programs Preschool of the Arts Mikvah for Ladies
Sunday Hebrew School Friendship Circle Program Volunteering

MEMBERSHIP OPTIONS

Membership is from Rosh Hashanah 5782/2021 to Rosh Hashanah 5783/2022
High Holiday seats included with membership. Please reserve your seats in the section below.   
$1,800 Full Membership $1,200 Basic Membership $770 Single or Seasonal Resident
$3,600 Visionary Membership $5,000 Pillar of the Community  $18,000 Chai Partner
I would like to pay the above membership amount per the payment schedule below:
Full Payment Now Bi-Annual (Sept.1, Mar 1)
Quarterly (Sept. 1, Dec. 1, March 1, June 1) Monthly (Sept. 1 - Aug. 1)

HIGH HOLIDAY SEATING & SERVICE OPTIONS
With membership you receive reserved seating for the High Holidays for your family and reservations for your children in the designated youth programs and services. Please select what you plan on attending: 

Select Your Location for Services and Seats [Rosh Hashanah Sept. 6-8. Yom Kippur Sept. 15-16] 

Chabad of Parkland Center for Jewish Life - 7170 Loxahatchee Rd (With Rabbis Yosef & Shuey Biston) - Also at this location Children's Services and Friendship Circle Service.

Chabad of West Parkland - Marriott Hotel Heron Bay - RH & PGCC Clubhouse - YK (With Rabbi Mendy Gutnick) - Also at this location Children's Services and Family Services.

Names for reserved seating:

    

    

Names and ages for children attending designated Children's Services (Ages 2 - 12) - Reservation Required.

 Age 

 Age 

 Age 

 Age 

Attending Other Services:

 Family Service Rosh Hashanah - Marriott Hotel (Heron Bay) - Tuesday September 7th - 1:00pm - 2:00pm 

 Family Service Yom Kippur - PGCC Clubhouse - Thursday September 16th 1:30pm - 2:30pm

 Teen Service Rosh Hashanah - Chabad of Parkland - Tuesday September 7th - 11:00am - 12:30pm                          Teen Service Yom Kippur - Chabad of Parkland - Thursday September 16th - 11:00am - 12:30pm

 Friendship Circle Service - Chabad of Parkland - Tuesday September 7th - 3:00pm - 4:00pm

PAYMENT INFORMATION
Name on Card   Exp. Date
Card Type   Card Code
Card Number   Comments