Printed from ChabadLubavitch.org

Membership Form

Membership Form

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“Your Home Away From Home”

 Lubavitch on the Palisades Membership Form

 

Mailing Address

Address                         

 

City, State and Zip

 

Telephone (home)

                               

 

 

 

Member Information  

Member Full Name & Hebrew Name                                         

 

Date of Birth (mm/dd/yy)

Time of Birth (hh:mm)

 

E-mail

 

Profession

 

Cell

                        

 

Spouse Full Name & Hebrew Name

 

Date of Birth (mm/dd/yy)

 

Time of Birth (hh:mm)

 

E-mail

Profession

 

Cell

 

 

Children’s Information

 

 Name of Child (English/Hebrew)

 Sex

M/F 

  Age

 Date and Time of Birth

  Name of School/Grade

 

 

 

 

 

Yahrzeits about which you wish to be notified: (Please specify the name of the person,

relationship and to whom related and date and time of the death (mm/dd/yy; hh:mm)

                                                                                                              

 

 

 

 

Please indicate below the activities in which you are interested:


 

Adult Education

Bar Mitzvah Club

Bat Mitzvah Club

Camp Gan Israel Younger and Older Division

Hebrew School

Holiday Programs

Israeli Programs

JLI – Jewish Learning Institute – lectures/classes

Judaica Services – Tefillin and mezuzah checks,

     mezuzah purchases, koshering home

Junior Congregation – shabbos morning services for

     children

Mikvah

Nursery School

TEEN770 – weekly programs for Teens

 Elementary School

  Middle School

Women’s Circle

YAM – Young Adult Minyan

Youth Zone – after school program for children

 

All of the Above


 

 Click here to download the form in PDF format. The form can be brought or mailed to

our office at 11 Harold St, Tenafly NJ 07670