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 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 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 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 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 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 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 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School Name of Child #2 Hebrew Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School Name of Child #3 Hebrew Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School Name of Child #4 Hebrew Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 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 123456789101112 Hour001020304050 MinutesAMPM Hebrew Name #2* Father's Hebrew Name* English Name* First Name Last Name Relation* Date of Passing* and approx. time Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Hebrew Name #3* Father's Hebrew Name* English Name* First Name Last Name Relation* Date of Passing* and approx. time Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Hebrew Name #4* Father's Hebrew Name* English Name* First Name Last Name Relation* Date of Passing* and approx. time Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM 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 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 Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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