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: 1 2 3 4 Women's Seats that come with my Membership: 1 2 3 4 Additional seats for Men-Members: $100 per seat 1 2 3 4 5 Additional seats for Women-Members: $100 per seat 1 2 3 4 5 Seats for Boys under Bar Mitzvah-Members: $36 per seat 1 2 3 4 5 Seats for Girls under Bas Mitzvah-Members: $36 per seat 1 2 3 4 5 Non-Members: Please reserve for me: Non-Member seats for Men: $250 per seat 1 2 3 4 5 Non-Member seats for Women: $250 per seat 1 2 3 4 5 Non-Member seats for Boys under Bar Mitzvah $72 for members 1 2 3 4 5 Non-Members seats for Girls under Bas Mitzvah $72 for members 1 2 3 4 5 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 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 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 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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