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Membership Renewal & High Holiday Form

Membership Renewal & High Holiday Form

SECTION I: YOUR INFO

*Last Name

 

First Name

*Cell Number   Email Address

SECTION II: HIGH HOLIDAY IMMEDIATE FAMILY SEATING

Please list your name and your IMMEDIATE family members
(includes children living at home or in college) who will be attending High Holiday Services.
(Children past Bar/Bat Mitzvah age have a reserved seat).

Last Name 1

 

First Name 1

Last Name 2

 

First Name 2

Last Name 3

 

First Name 3

Last Name 4

 

First Name 4

Last Name 5

 

First Name 5

Last Name 6

 

First Name 6

Last Name 7

 

First Name 7

SECTION II: HIGH HOLIDAY EXTENDED FAMILY SEATING

The following space is for EXTENDED family members who will be attending High Holiday services. The cost is $152.00 per person for seating for all days.

Last Name 1

 

First Name 1

Last Name 2

 

First Name 2

Last Name 3

 

First Name 3

Last Name 4

 

First Name 4

Last Name 5

 

First Name 5

Last Name 6

 

First Name 6

Last Name 7

 

First Name 7

SECTION III: HIGH HOLIDAY CHILDREN'S PROGRAM

$15.00 PER CHILD PER DAY FOR SUPERVISION AND SERVICES (Reservations Required)

Child's Name

Age

RH1 (Sept. 21)

RH2 (Sept. 22)
 YK1 (Sept. 29)
YK2 (Sept. 30)

SECTION IV: MEMBERSHIP/ PARTNERSHIP OPPORTUNITIES

All payments must be received at our office no later than August 23, 2017. Payments can be made in full or in 12 monthly installments (Monthly Installments: credit card or post-dated checks. Checks should be dated the 1st or 15th of each month from September 2017 thru August 2018. Credit Cards will be charged the beginning or middle of each month). A discount for payment in full is reflected in the payment options below.

MEMBERSHIP/PARTNERSHIP TYPE

MONTHLY PAYMENT

FULL PAYMENT

Family Membership*

$146

$1650

Seniors (65+)/Single Parent*

$80

$850

Associate Family **

$65

$695

Associate Single/Seniors **

$40

$410

Chai Gold*

$180

$1800

Chai Platinum*

$360

$3600

*Includes High Holiday seats for immediate family members only

**Does not include High Holiday seats

SECTION V: PAYMENT DETAILS

 

 

 

Please charge my:

Visa M/C AMEX
      Card #:
CVV
      Exp. Date

Payment Method:

Credit Card
Check is in the mail
  Optional Comments:

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