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Membership Application

Membership Application

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CHAI Learning Center of West Houston
A Home for Jewish Living & Learning
14133 Memorial Drive #1 Houston, TX 77079
Phone: 281-589-7188     email:
info@westchabad.org

MEMBERSHIP APPLICATION
August 1 2012-July 31, 2013

PERSONAL INFORMATION: (if unknown-put "unknown") 
First Name Hebrew Name
Last Name Birthday (Mo/Day/Yr)
Spouse's Name Hebrew Name
Spouses's Birthday (Mo/Day/Yr) Anniversary  (Mo/Day/Yr)  
Marital Status If Divorced, do you have a Jewish "Get"?
Address
City, State, Zip
Home Phone  Cell Phone
Email

MI SHEBEIRACH/ALIYA INFORMATION:
Parents' Hebrew Name (Father)
(Mother)
Spouse's Parents' Hebrew Name (Father)
(Mother)
Are you, your spouse, or either of your parents converts? (please specify)

CHILDREN:
Name Hebrew Name M/F Birthdate Grade
         
         
         
Are any of your children adopted? if so, was there a conversion? (please specify)

YARTZEITS: (Date of the passing of loved ones)
English Name Hebrew Name Relationship Date of Passing
     
       
       

MEMBERSHIP PAYMENTS - Check one of the following:
Family Membership $613/yr (includes 2 High Holiday Seats)
Supporter Membership $1800/yr (includes 2 High Holiday Seats & lulav and esrog set)
Pillar Membership $5000/yr (includes 4 High Holiday Seats, & Five Books of Moses-Gutnick Edition)

I wish to make Membership Payments:One Payment  Two Payments   Three Payments
Credit Card Payments - Click Here    
OR send all checks to CHAI Learning Center -  14133 Memorial Drive #1 Houston, TX 77079

BUILDING FUND:
CHAI LEARNING CENTER will, G‑d Willing, have its own building. To plan for this, we ask you express what you feel you may be able to contribute toward this end. As CHAI flourishes, this is not a commitment but an expression of how you may participate when the time comes.    When we attain such a building, you will be pillars both spriitually and factually.

I would like to see CHAI LEARNING CENTER provide the follwing services/programs:

Date you are submitting this form:

Comments:

Thank you for supporting
CHAI Learning Center of West Houston!

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