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. I'd like to* Become a memberRenew my membership Your Information Full Name* First Name Last Name Cell* Area Code Phone Number Email* Update Your Information Optional Check here to update your information if there have been changes since last year. Hebrew Name Father's Hebrew Name Mother's Hebrew Name Gender* MaleFemale Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Approx. time of birth Occupation Home Area Code Phone Number Work Area Code Phone Number 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 Birth Mother Jewish by BirthConverted Did you convert? NoYes For male members KohenLeviteIsraelite Marital Status* MarriedSeparatedDivorcedWidowed Date of Marriage* Month Day Year Spouse Information Update Spouse Information Optional Check here to update your information if there have been changes since last year. Full Name* First Name Last Name Hebrew Name Father's Hebrew Name Mother's Hebrew Name Gender* MaleFemale Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Approx. time of birth Occupation Home Area Code Phone Number Work Area Code Phone Number Cell Area Code Phone Number Email* Birth Mother Jewish by BirthConverted Converted? NoYes For male members KohenLeviteIsraelite Children's Information Update Children's Information Optional Check here to update your information if there have been changes since last year. No. of Children Name of Child #1 Hebrew Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School Name of Child #2 Hebrew Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School Name of Child #3 Hebrew Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School Name of Child #4 Hebrew Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School Yahrtzeit Information Update Yahrtzeit Information Optional Check here to update your information if there have been changes since last year. No. of Yahrtzeits Hebrew Name #1* Father's Hebrew Name* English Name* First Name Last Name Relation* Date of Passing* and approx. 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 Hebrew Name #2* Father's Hebrew Name* English Name* First Name Last Name Relation* Date of Passing* and approx. 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 Hebrew Name #3* Father's Hebrew Name* English Name* First Name Last Name Relation* Date of Passing* and approx. 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 Hebrew Name #4* Father's Hebrew Name* English Name* First Name Last Name Relation* Date of Passing* and approx. 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 I am interested in participating in the following areas Synagogue ServicesHoliday CelebrationsGan Israel Summer Day CampJunior CongregationYouth ZoneSeniors ClubAdult Education ClassesTeen ProgrammingMen's ClubWomen's ProgramsPreschool of the ArtsMikvah for LadiesSunday Hebrew SchoolFriendship Circle ProgramVolunteering Membership Options Membership is from Rosh Hashanah 5785/2024 to Rosh Hashanah 5786/2025 High Holiday seats (and other member discounts) included with all membership options. VIP Membership and above includes one sponsored deluxe kiddush lunch during the year and preferred seating at all events. Membership Levels: Builders of the Community - $26,000 Includes Shul Security, plaque in our lobby with your name, 4 High Holiday seats for adults, One deluxe Kiddush sponsorship, High Holiday Honor - Aliya, Trip for 2 to New York with Rabbi for Visit to the Rebbe's Ohel, One seat on Solidarity Mission to Israel. Founder of the Community - $18,000 Includes Shul Security, plaque in our lobby with your name, 4 High Holiday seats for adults, One deluxe Kiddush sponsorship, High Holiday Honor - Aliya, Trip for 2 to New York with Rabbi for Visit to the Rebbe's Ohel. Pillar of the Community - $10,000 Includes Shul Security, plaque in our lobby with your name, 4 High Holiday seats for adults, One deluxe Kiddush sponsorship, High Holiday Honor - Aliya Gold Membership - $5,000 Includes Shul Security, plaque in our lobby with your name, 4 High Holiday seats for adults, One deluxe Kiddush sponsorship Honorary Membership - $3,600 Includes Shul Security, plaque in our lobby with your name, 4 High Holiday seats for adults Family Membership - $2,000 Includes Shul Security, 2 High Holiday seats for adults Single Membership - $1,000 Includes Shul Security, 1 High Holiday seat for adult Select Membership Level Builders of the Community - $26,000 ($2,167 Monthly)Founder of the Community - $18,000 ($1,500 Monthly)Pillar of the Community - $10,000 ($833 Monthly)Gold Membership - $5,000 ($417 Monthly)Honorary Membership - $3,600 ($300 Monthly)Family Membership - $2,000 ($167 Monthly)Single Membership - $1,000 ($84 Monthly) Payment Schedule* Full Payment NowBi-Annual (Sept.1, Mar 1)Quarterly (Sept. 1, Dec. 1, March 1, June 1)Monthly (Sept. 1 - Aug. 1) High Holiday Seating & Services 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 October 2- 4, Yom Kippur October 12-13 Chabad of Parkland - 7170 Loxahatchee Rd (With Rabbis Yosef & Shuey Biston)Chabad of West Parkland - Marriott Hotel Heron Bay (With Rabbi Mendy Gutnick) Names for reserved seating (and any seating request) Names and ages for children attending designated Children's Services (Ages 2 - 12) Reservation Required Attending Other Services Family Service Rosh Hashanah - Marriott Hotel (Heron Bay) Thursday October 3rd - 1:00pm - 2:00pmFamily Service Yom Kippur - Marriott Hotel (Heron Bay) - Saturday October 13th 1:30pm - 2:30pmFamily Service & Tashlich Rosh Hashanah - Chabad of Parkland Thursday October 3rd 5:30pm - 6:30pm Total $0.00 I would like to pay today:Full amount$0.00 minimum$ Payment Credit Card Check or Payment Schedule 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 Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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