Printed from ChabadofKendall.org

Partnership Form

Partnership Form

partnership_promoLARGE.jpg

SECTION I: YOUR INFO

SECTION II: SPOUSE'S INFO

Name

Name

Hebrew Name Hebrew Name
Father's Hebrew
Name
Father's Hebrew
Name
Mother's Hebrew
Name
Mother's Hebrew
Name
Occupation Occupation
Birth Date / /
MM / DD / YYYY format
Birth Date / /
MM / DD / YYYY format
Jewish by: Birth Converted Jewish by: Birth Converted
Check One: Cohen Levi Israel Check One: Cohen Levi Israel

SECTION III: PERSONAL INFORMATION

Address Email 1
City/State/Zip Email 2
Home Phone Marital Status
Work Phone Anniversary Date / /
MM / DD / YYYY format
Work Fax If Divorced: If divorced, do you have a
Jewish "Get" ? Yes No

SECTION IV: CHILDREN

Name

Birth Date

/ /
MM / DD / YYYY format

Name

Birth Date

/ /
MM / DD / YYYY format

Name

Birth Date

/ /
MM / DD / YYYY format

Name

Birth Date

/ /
MM / DD / YYYY format

Name

Birth Date

/ /
MM / DD / YYYY format

Name

Birth Date

/ /
MM / DD / YYYY format
Are any children adopted? Yes No If yes, give details, including any coversion info:

SECTION V: YAHRZEIT INFORMATION

Name


English / Hebrew / Father's Hebrew / Last
/ /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
/ /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
/ /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
/ /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
/ /
Date of Passing: MM / DD / YYYY
Relationship

Name


English / Hebrew / Father's Hebrew / Last
/ /
Date of Passing: MM / DD / YYYY
Relationship

SECTION VI: PARTNERSHIP OPPORTUNITIES
In our effort to be inclusive for families of all income levels, Partnership Opportunities have been designed within a wide range. However, if you are capable, please consider participating at a higher level. This will allow us to cover our expenses and continue to expand our programs, services and long term goals. All Partnership gifts can be made in one installment or in 12 monthly installments. Please check the option of your choice. Nobody will be turned away due to lack of funds.
Platinum Partnership $1,000 Monthly - $12,000 Yearly
Gold Partnership $500 Monthly - $6,000 Yearly
Double Chai Partnership $360 Monthly - $4,320 Yearly
Silver Partnership $300 Monthly - $3,600 Yearly
Chai Partnership $150 Monthly - $1,800 Yearly
Family Partnership $90 Monthly - $1,080 Yearly
Associate Partnership $54 Monthly - $648 Yearly
Other

SECTION VII: PAYMENT INFORMATION

Payment Method:

Credit Card
Check is in the mail
Bill Me:
Optional Comments:
Please charge my:

I wish to pay the full annual donation
I wish to pay 12 Month Installments
You will be charged at the beggining of each month.
Begin payments on:

Other:

Card Number:
Exp. Date CVV Code:

TOTALS:

Partnership Total Amount:

Total Amount to be charged:


* All contributions are tax deductible and can be paid throughout the year. No one is turned away for lack of funds. If you cannot afford the full amount requested, contact the Rabbi for a confidential arrangement.

Secure This page uses 128 bit SSL encryption to keep your data secure.