Shul Membership Form

Thursday, September 09, 2010 - 1 Tishrei 5771


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Shul Membership Form

Welcome to Chabad of Central Florida. To serve the Tampa Bay area, we have three Congregations working together to meet all of your needs. We encourage you to become a member of the Shul of your choice. As a member of any of the three Synagogues, you enjoy the benefits of all three.

Merkos Chabad Lubavitch of Central Florida
Cong. Bais (Temple) David
Rabbi Lazer & Devorah Rivkin
Regional Directors
2001 W. Swann Ave.
Tampa, FL 33606
Tel. 813-966-8770
info@chabadofcentralflorida.com
www.chabadofcentralflorida.com

Chabad House Jewish Student Center USF, Wesley Chapel, Tampa Palms, Temple Terrace
& New Tampa
Rabbi Uriel & Dvorki Rivkin
5205 E131st Ave, Tampa FL, 33606
Tel. 813-832-3018, 813-983-9770
chabadusf@gmail.com
www.chabadhouseusf.org

Cong. Bais Menachem Chabad

University of Tampa Jewish Student Center,Stetson Law School, Hillsborough Community College, Downtown Tampa, Harbor & Davis Islands
Rabbi Levi & Chana Rivkin
8913 Eastman Dr.

Tampa, FL 33626
Tel. 813-504-4432
bmchabad@gmail.com
www.bmchabad.com
www.chabadut.org

Name		Hebrew Name
Spouse		Hebrew Name
Address
City		State/Zip
Home Phone		Work Phone
Cell		Cell (spouse)
	Child/ren in Hebrew School		Child/ren in Pre School

ALIYAH INFORMATION

Father's Hebrew Name		Mother's Hebrew Name
Spouse's Father		Spouse's Mother
	Kohen	Levi	Yisrael
Date of Birth		Spouse D.O.B
Bar Mitzvah Parsha		Wedding Anniversary

CHILDREN

1) Name	Hebrew Name	Date of Birth
2) Name	Hebrew Name	Date of Birth
3) Name	Hebrew Name	Date of Birth

YAHRTZEIT INFORMATION

1) Name of Deceased	Date (M/D/Y)	Hebrew Date (if known)
2) Name of Deceased	Date (M/D/Y)	Hebrew Date (if known)
3) Name of Deceased	Date (M/D/Y)	Hebrew Date (if known)

MEMBERSHIP DUES

	Family Membership	$1200.00		Couple's Membership	$1000.00
	Single Membership	$800.00		Seasonal/Associate Membership	$600.00

*Type the code you see in the picture below.(Letters are not case-sensitive)

©Copyright Merkos Chabad Lubavitch of Central Florida
2001 W. Swann Ave. Tampa, FL 33606 - Rabbi Lazer Rivkin, Regional Director - 813-966-8770
Email: info@chabadofcentralflorida.com