Membership Application

Everyone is welcome to be a part of the shul free of charge.
No affiliation or membership is required to attend services!
All Chabad programs are for Reform, Conservative, Orthodox, or any Jew that moves!  

We will contact you as soon as we are alerted of your submission.

First Name:  
Hebrew Name:  
Last Name:  
Birth Date:  
Spouse's Name:  
Spouse's Hebrew Name:  
Address 1:  
Address 2:  
Zip/Postal Code:  
Alternate Phone:  

Aliya Information

Parent's Hebrew Names:   Father: 
Spouse's Parent's Hebrew Names:   Father:
Are you a:   Cohen   Levi    Yisrael    Dont Know
Bar Mitzvah Portion:  


Please use commas to seperate the following information (a period "." after each child for more than one child): English Name, Hebrew Name, M/F, Birth Date, Grade.  


Please use commas to seperate the following information (a period "." after each person's info): English Name, Hebrew Name, Relationship, Date of Passing.  

Membership Dues

Type of Membership:   Family Membership $600.00
Single Membership $400.00
Payment Amount(s)   In Full
Installments (please indicate below):
Method of Payment:  
Checks Payable To: 
Chabad of Delray Beach
7495 W. Atlantic Ave
Delray Beach, FL 33446
Please print this application out, and send in with (first) payment.

Credit Card
Credit Card #:  
CVV Security Code  
Email Address*
Reconfirm Email Address*
You may acknowledge my gift to my email address
Please acknowledge my gift by mail to the above street address.
Please contact me to discuss additional giving opportunities.
 Recurring donation:
Please charge the above amount to my credit card each month for the next twelve months.