Bais Shmuel Chabad
Annual Membership
General Donations
Children’s Program
Building Campaign
Membership
Member Info
Name
(Required)
First
Last
Email
(Required)
Phone
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Membership: $1,200 Family
Membership includes a guaranteed seat for you and a spouse. If you would like to have additional seats or guaranteed seats for your children, please select below.
Minyan Preference
(Required)
Main Shul/Classic
Tent Shul/Express
Total Men & Boys Seats
Please indicate the
total number of seats —including any guaranteed child or guest seats added below—
desired on the men’s side (leave blank if you will be out of town). While not guaranteed, we will try to accommodate as much as possible.
Rosh Hashana
Yom Kippur
Total Women & Girls Seats
Please indicate the
total number of seats —including any guaranteed child or guest seats added below—
desired on the ladies side (leave blank if you will be out of town). While not guaranteed, we will try to accommodate as much as possible.
Rosh Hashana
Yom Kippur
Children’s Guaranteed Seats (+ $50 ea.)
Select an amount here if you want to guarantee seats for you children
Boy's Seat/s
Quantity
Price:
$50.00
Quantity
Girl Seat/s
Quantity
Price:
$50.00
Quantity
Additional Guest Guaranteed Seats (+ $180 ea.)
Men's guest seats RH
Quantity
Price:
$0.00
Quantity
Men's guest seats YK
Quantity
Price:
$0.00
Quantity
Women's guest seats RH
Quantity
Price:
$0.00
Quantity
Women's guest seats YK
Quantity
Price:
$0.00
Quantity
Notes
Total
Payment Method
(Required)
Credit Card
Cashapp
Paypal
Check
Crypto
If a method other than credit card is selected, instructions for payment will be provided on the next page
Payment Installments
One-Time Payment (pay now in full)
Monthly Payments (pay over 12 months)
Installments are for the membership only. Children’s and Guest’s seats will be part of initial charge.
Membership
Price:
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
Security Code
Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.