Invitation to Membership/Partnership

We would like to welcome you to our Jewish Center. Tucked in between the ‘Miami Design District’ and the ‘Wynwood arts District’, Chabad at Midtown serves as a Spiritual oasis for many who live and work in this vibrant neighbourhood.

We are a “Jewish Space” where young dynamic people meet and connect and a place to reconnect to your soul and spirit.

Whether you would like to join us for Shabbat Services, Holiday celebrations, women’s group or Judaism classes we trust that you will enjoy our special, inclusive environment where everyone feels comfortableand welcome.

We invite you to join us as a member and look forward to sharing many meaningful experiences together.

Please feel free to contact us at 305-573-9995 should you need assistance filling this form or more information.

“Happy are those who dwell in your

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: MEMBERSHIP CONTRIBUTIONS - ANNUAL
Family: $1200 ~ Single: $750*

Payment Options:

 One full payment of:  

Please chage my:

 Visa M/C AMEX
  Quarterly payments, each   Card #:
  Monthly payments of each   Exp. Date

Payment Method:

Credit Card
Check is in the mail
Please bill me		   Optional Comments:

*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.