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Membership Application
Membership Prices
Single
- $75 per month
Families
- $150 per month
*All membership prices can be split up to 12 payments*
Membership Application Form
(Only the information with a
*
is required to fill out)
1. Family Information
*
Family Name
Address
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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District of Columbia
Florida
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2. Husband Information
*
First Name
*
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Convert
Adopted
*
Father Hebrew Name
*
Mother Hebrew Name
*
D.O.B
Home Phone Number
Mobile
*
Email
Occupation
3. Spouse Information
First Name
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Convert
Adopted
Father Hebrew Name
Mother Hebrew Name
D.O.B
Home Phone Number
Mobile
Email
Occupation
4. Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Married, Anniversary Date
Synagogue Where Married
Widowed, Date
Divorced, Date
5. Children (Married and Single)
Select the Number of Children in the Family
Please Select One
1
2
3
4
5
6
7
8
Children Information
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
*
Full Name
Hebrew Name
Convert
Adopted
*
D.O.B
Gender
N/A or Unknown
Male
Female
School
6. Yahrtzeits
Select the Number of Yahrtzeits to Register
Please Select One
1
2
3
4
*
Full Name
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Father's Hebrew Name
Mother's Hebrew Name
Date of Death
Hebrew Date of Death
Relationship
*
Full Name
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Father's Hebrew Name
Mother's Hebrew Name
Date of Death
Hebrew Date of Death
Relationship
*
Full Name
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Father's Hebrew Name
Mother's Hebrew Name
Date of Death
Hebrew Date of Death
Relationship
*
Full Name
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Father's Hebrew Name
Mother's Hebrew Name
Date of Death
Hebrew Date of Death
Relationship
7. Membership & Payment Types
*
Yes, I would like to become a member of the Chabad Israeli Center of Atlanta. I choose the following membership:
Please Select One
Partnership---3600-for-the-first-year-towards-the-building
Membership---1800-per-year
Single---900-per-year
*
Choose the Payment Type:
Please Select One
Partnership- Full payment of 3600 or
Partnership---12-Payments-of-300-Towards-the-3600
*
Choose the Payment Type:
Please Select One
Membership - Full Payment of $1800 or
Membership---12-Payments-of-150-Towards-the-1800
*
Choose the Payment Type:
Please Select One
Single - Full Payment of $900 per year or
Single---12-Payments-of-75-Towards-the-900
*
Recurring donation: I am going to split the above amount to each month for the next twelve months.
Recurring donation: I am going to split the above amount to each month for the next twelve months.
*
Full Name
I agree to the terms of the membership and agree to pay the yearly / monthly membership
*
Date
Donations Opportunities
Children Program - $36
Security - $180
Facility - $180
Total
Tue, April 23 2024
15 Nisan 5784
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Today's Calendar
Pesach
שיעור הלכה
: 8:30am
שיעור וארוחת ערב
: 7:30pm
Mincha and Arvit
: 7:56pm
Candle Lighting
: 8:57pm
Candle Lighting
Tuesday, Apr 23, 7:57pm
Pesach
Tuesday, Apr 23
View Calendar
Zmanim
Alot Hashahar
5:37am
Earliest Talit - Tefilin
6:08am
Sunrise
6:56am
Latest Shema
10:15am
Zman Tefillah
11:22am
Hatsot (Mid-Day)
1:36pm
Minha Gedola
2:09pm
Minha Ketana
5:29pm
Plag HaMincha
6:52pm
Candle Lighting
8:57pm
Sunset
8:15pm
Nightfall
8:54pm
More >>
Tue, April 23 2024 15 Nisan 5784
