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Membership Application
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
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
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Wyoming
Zip Code
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
Fri, May 2 2025
4 Iyyar 5785
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Today's Sefirah Count Is 19
היום תשעה עשר יום שהם שני שבועות וחמשה ימים לעמר
Today's Calendar
Shaharit
: 7:20am
שיעור הלכה
: 8:30am
מנחה וקבלת שבת
: 7:00pm
Candle Lighting
: 8:04pm
This week's Torah portion is
Parshat Tazria-Metzora
Shabbat, May 3
Candle Lighting
Friday, May 2, 8:04pm
Pesach Sheni
Monday, May 12
View Calendar
Zmanim
Alot Hashahar
5:26am
Earliest Talit - Tefilin
5:58am
Sunrise
6:47am
Latest Shema
10:10am
Zman Tefillah
11:19am
Hatsot (Mid-Day)
1:34pm
Minha Gedola
2:08pm
Minha Ketana
5:32pm
Plag HaMincha
6:57pm
Candle Lighting
8:04pm
Sunset
8:22pm
Nightfall
9:01pm
More >>
Fri, May 2 2025 4 Iyyar 5785
