PERSONAL INFORMATION Full Name* First Name Last Name E-mail* Cell Number* Area Code Phone Number I would like to receive news and updates by email MEMBERSHIP PERKS * Seats for Rosh Hashanah and Yom Kippur * Super Member price for Shabbos Children's Programs * Special Member pricing for Shul programs and events * Discounted rate on Shul space rental for your Simcha. Subject to availability. * Discounted Men's Mikvah Entry * Exclusive discounted Friday night Shabbos Seuda Membership Plans - Please choose your membership option: $500 Single Membership - Includes 1 seat for Yom Tov$750 Senior Membership (65+) - Includes 2 seats for Yom Tov$950 Family Membership - Includes 2 seats for Yom Tov$750 First Year Family Membership - Includes 2 seats for Yom Tov$1,800 Chai Membership - Includes 6 seats for Yom Tov Seats for Rosh Hashanah and Yom Kippur must be ordered in advance Members:Please reserve for me: Men's Seats that come with my Membership: 1234 Women's Seats that come with my Membership: 1234 Additional seats for Men-Members: $100 per seat 12345 Additional seats for Women-Members: $100 per seat 12345 Seats for Boys under Bar Mitzvah-Members: $36 per seat 12345 Seats for Girls under Bas Mitzvah-Members: $36 per seat 12345 Non-Members:Please reserve for me: Non-Member seats for Men: $250 per seat 12345 Non-Member seats for Women: $250 per seat 12345 Non-Member seats for Boys under Bar Mitzvah $72 for members 12345 Non-Members seats for Girls under Bas Mitzvah $72 for members 12345 Please note any seating requests here. We will do our best to accommodate you. Please renew my membership annually Yes ADDITIONAL CONTRIBUTIONS Chai for Life - Optional A contribution of “chai” ($18) or multiples of “chai” per month is a great way to ensure a percentage of your ma'aser goes back to your community, to keep YOUR community thriving. The contribution listed will be charged to your credit card monthly. Your name will be displayed with other Chai Club members. $18$36$54$72$90$108$126$144 Building Facility Maintenance - Optional $1000 Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% Authorized amount to be charged Full AmountQuarterly10 Months Any specific instructions please include here: Payment 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 Month2023202420252026202720282029203020312032 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.