Membership Form

Full Name

First NameLast Name

Hebrew Name

Birth Date

MonthDayYear

E-mail

Occupation

Jewishness

From BirthConvertNot Jewish

Family

KohenLeviYisroel

Cell Number

Area CodePhone Number

Work Number

Area CodePhone Number

Home Number

Area CodePhone Number

Full Name

First NameLast Name

Hebrew Name

Jewishness

From BirthConvertNot Jewish

Family

KohenLeviYisroel

Occupation

Cell Number

Area CodePhone Number

Work Number

Area CodePhone Number

Home Number

Area CodePhone Number

Birth Date

MonthDayYear

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital Status

Anniversary Date

MonthDayYear

1. Name of Deceased

First NameLast Name

Date of Passing

MonthDayYear

Hebrew Name & Father's Hebrew Name

Relationship

2. Name of Deceased

First NameLast Name

Date of Passing

MonthDayYear

Hebrew Name & Father's Hebrew Name

Relationship

3. Name of Deceased

First NameLast Name

Date of Passing

MonthDayYear

Hebrew Name & Father's Hebrew Name

Relationship

4. Name of Deceased

First NameLast Name

Date of Passing

MonthDayYear

Hebrew Name & Father's Hebrew Name

Relationship

Security Fee

The Yardley shul takes security very seriously. As a result of the tragic synagogue shootings in Pittsburgh and California, The Yardley Shul has hired armed security during services and large events. This adds approximately $12,000 To the Shuls annual budget. To help offset this tremendous cost we are asking supporting members for a $200 security fee in addition to the $1000 membership dues.

If you would like to add to this amount or need to adjust it, please call us at 215-666-0698. If you would like to discuss this with Rabbi Blecher, he would be more than happy to meet with you. All discussions will be held in confidence.

Membership Options*

I would like to pay now in full.Please charge me over the next 12 months - $100/month.

Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

I would like to receive news and updates by email

100% of the proceeds of this donation or payment benefit Chabad Lubavitch of Yardley.

Yardley Shul

ADULT MALE

ADULT FEMALE

PERSONAL INFORMATION

YARZHEIT

Suggested Membership - $1,200