Aish Chaim Membership Form
Name
First Name
Last Name
I am a
*
Returning Member. My information is the same as last year.
Returning Member. I would like to update the following information.
New Member.
QUESTIONS ABOUT THE HIGH HOLIDAYS
Do you plan to attend High Holiday services this year at Aish Chaim?
Yes
No
Will you have any children attending the kids programs this year during the High Holidays?
Yes
No
If planning to attend High Holiday services at Aish Chaim are you primarily likely to attend the learning program, or the traditional service?
I'm most likely going to attend the learning program.
I'm most likely going to attend the traditional service.
Would you attend indoor services?
Yes
No
FAMILY INFORMATION
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
How many adults (18 and over) plan to attend High Holiday Services?
Number of adult seats
How many children (17 and under) plan to attend High Holiday programs?
Number of seats for children
If you will have children attending High Holiday programs, please list their names and ages below.
Adult #1
First Name
Last Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Traditional Minyan Service at the Jaron's Home 8:30AM to 1:00PM
Highlighted High Holiday Service at the Willner Home 10:15AM to 11AM
High Holiday Speaker at the Willner Home 11:15AM to 12:15PM
High Holiday Speaker at the Willner Home 12:30PM to 1:15PM
Alternative Class at the Lipstein's 10:15AM to 11:00AM
Adult #2
First Name
Last Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Traditional Minyan Service at the Jaron's Home 8:30AM to 1:00PM
Highlighted High Holiday Service at the Willner Home 10:15AM to 11AM
High Holiday Speaker at the Willner Home 11:15AM to 12PM
High Holiday Speaker at the Willner Home 12:15PM to 1PM
Alternative Class at the Lipstein's 10:15AM to 11:00AM
Adult #3
First Name
Last Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Traditional Minyan Service at the Jaron's Home 8:30AM to 1:00PM
Highlighted High Holiday Service at the Willner Home 10:15AM to 11AM
High Holiday Speaker at the Willner Home 11:15AM to 12PM
High Holiday Speaker at the Willner Home 12:15PM to 1PM
Alternative Class at the Lipstein's 10:15AM to 11:00AM
Adult #4
First Name
Last Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Traditional Minyan Service at the Jaron's Home 8:30AM to 1:00PM
Highlighted High Holiday Service at the Willner Home 10:15AM to 11AM
High Holiday Speaker at the Willner Home 11:15AM to 12PM
High Holiday Speaker at the Willner Home 12:15PM to 1PM
Alternative Class at the Lipstein's 10:15AM to 11:00AM
Adult #5
First Name
Last Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Traditional Minyan Service at the Jaron's Home 8:30AM to 1:00PM
Highlighted High Holiday Service at the Willner Home 10:15AM to 11AM
High Holiday Speaker at the Willner Home 11:15AM to 12PM
High Holiday Speaker at the Willner Home 12:15PM to 1PM
Alternative Class at the Lipstein's 10:15AM to 11:00AM
Adult #6
First Name
Last Name
Chosen Location
Traditional Minyan Service at the Jaron's Home 8:30AM to 1:00PM
Highlighted High Holiday Service at the Willner Home 10:15AM to 11AM
High Holiday Speaker at the Willner Home 11:15AM to 12PM
High Holiday Speaker at the Willner Home 12:15PM to 1PM
Alternative Class at the Lipstein's 10:15AM to 11:00AM
Where do you predominately see yourself spending the most time on the High Holidays?
Traditional service
Alternative learning tent
If you answered "traditional service" in the question above, would you prefer to daven inside at JFCS or in a tent?
JFCS
in a tent
Do you have children who will attend any part of our services and/or programs?
Yes
No
We will be having a younger kids program from 10:00AM to 11:00AM on Shabbos, September 19th at the Goldman's. If planning to attend, please indicate the number of children.
If you have children ages 12 and above please write how many teens do you foresee attending our TEEN PROGRAM at the Lipstein Home from 11:15AM to 1PM?
If you have children between ages 9-11, how many children do you foresee attending our TWEEN PROGRAM at the Willner home from 11:15AM to 1PM?
CHILDREN 17 AND UNDER ARE ENCOURAGED TO ATTEND THE HIGHLIGHTED HIGH HOLIDAY SERVICE AND THEN MOVE TO THEIR DESIGNATED TEEN/TWEEN PROGRAM. How many teens/tweens intend to attend the Highlighted High Holiday Service at the Willner's Home from 10:15AM to 11AM?
Name (ADULT MALE - IF APPLICABLE)
First Name
Last Name
Suffix
I am a
Kohen
Levite
Israelite
Jewish by birth
Hebrew Name
Mother's Hebrew Name
Father's Hebrew Name
Date of Birth
-
Month
-
Day
Year
Date
Occupation
Business Phone
-
Area Code
Phone Number
Home Phone
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name (ADULT FEMALE - IF APPLICABLE)
First Name
Last Name
Suffix
I am Jewish by birth.
Yes
No
Hebrew Name
Mother's Hebrew Name
Father's Hebrew Name
Date of Birth
-
Month
-
Day
Year
Date
Occupation
Business Phone
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Home Phone
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
ADDITIONAL FAMILY INFORMATION
Would you like to share any information about your children?
Yes
No
CHILD 1
English/Hebrew Name
Age/Date of Birth
English/Hebrew Name
Time of Day When Born (approx. if not sure)
English/Hebrew Name
School/Grade
English/Hebrew Name
CHILD 2
English/Hebrew Name
Age/Date of Birth
English/Hebrew Name
Time of Day When Born (approx. if not sure)
English/Hebrew Name
School/Grade
English/Hebrew Name
CHILD 3
English/Hebrew Name
Age/Date of Birth
English/Hebrew Name
Time of Day When Born (approx. if not sure)
English/Hebrew Name
School/Grade
English/Hebrew Name
CHILD 4
English/Hebrew Name
Age/Date of Birth
English/Hebrew Name
Time of Day When Born (approx. if not sure)
English/Hebrew Name
School/Grade
English/Hebrew Name
CHILD 5
English/Hebrew Name
Age/Date of Birth
English/Hebrew Name
Time of Day When Born (approx. if not sure)
English/Hebrew Name
School/Grade
English/Hebrew Name
ADDITIONAL CHILDREN (not listed above)
If any of your children are attending college, please list their college address, phone and email:
Would you like to share any information about family yahrzeits?
Yes
No
YAHRTZEIT 1
Hebrew Name & Father's Hebrew Name (e.g. Baruch ben Avraham)
English Name
Relation
Date of Yahrtzeit
YAHRTZEIT 2
Hebrew Name & Father's Hebrew Name (e.g. Baruch ben Avraham)
Time of Day (AM/PM)
English Name
Relation
Date of Yahrtzeit
Time of Day (AM/PM)
YAHRTZEIT 3
Hebrew Name & Father's Hebrew Name (e.g. Baruch ben Avraham)
English Name
Relation
Date of Yahrtzeit
Time of Day (AM/PM)
YAHRTZEIT 4
Hebrew Name & Father's Hebrew Name (e.g. Baruch ben Avraham)
English Name
Relation
Date of Yahrtzeit
Time of Day (AM/PM)
SECURITY FEE
Aish Chaim has taken the security of our members and guests very seriously over the past two years and as you may know, we hire an armed guard for most of our larger events and all of our prayer services. We spend around $25,000 a year on security costs. Please STRONGLY CONSIDER partnering with us this year to help us with these costs.
Would you like to contribute to Aish Chaim's Security Fee?
*
Yes
No
Sign-up and payments can be made below in combination with membership, or separately at www.aishchaim.com/membership/
MEMBERSHIP PAYMENT
Associate memberships are intended for those with full memberships elsewhere.
Name 1
First Name
Last Name
Name 2 (if applicable)
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
PAYMENT BY CHECK
Family Head of Household Over 35 ($720 annually)
Young Family, Single, or Single Parent ($540 annually)
Associate Membership ($500 annually)
Friend of Aish Chaim ($180 annually)
If paying by check, please indicate which of the following memberships you would like to purchase. We will contact you regarding payment arrangements.
PAYMENT BY CREDIT/DEBIT CARD (If paying by check, please indicate above. There is no need to fill this section out if paying by check.)
prev
next
( X )
FAMILY MEMBERSHIP PLUS SECURITY
(
$
1,080.00
for each
year
)
Full payment now.
SINGLE FAMILY MEMBERSHIP PLUS SECURITY
(
$
900.00
for each
year
)
Full payment now.
ASSOCIATE MEMBERSHIP PLUS SECURITY
(
$
860.00
for each
year
)
Full payment now.
FAMILY HEAD OF HOUSEHOLD OVER 35 (Annual)
(
$
720.00
for each
year
)
Full payment now.
FAMILY HEAD OF HOUSEHOLD OVER 35 (Semi-Annual)
(
$
360.00
for each
six months
)
Accounts charged twice a year.
FAMILY HEAD OF HOUSEHOLD OVER 35 (Quarterly)
(
$
180.00
for each
three months
)
Accounts charged four times a year.
FAMILY HEAD OF HOUSEHOLD OVER 35 (Monthly)
(
$
60.00
for each
month
)
Accounts charged once a month.
YOUNG FAMILY, SINGLE, OR SINGLE PARENT (Annual)
(
$
540.00
for each
year
)
Full payment now.
YOUNG FAMILY, SINGLE, OR SINGLE PARENT (Semi-Annual)
(
$
270.00
for each
six months
)
Accounts charged twice a year.
YOUNG FAMILY, SINGLE, OR SINGLE PARENT (Quarterly)
(
$
135.00
for each
three months
)
Accounts charged quarterly.
YOUNG FAMILY, SINGLE, OR SINGLE PARENT (Monthly)
(
$
45.00
for each
month
)
Accounts charged once a month.
ASSOCIATE MEMBERSHIP (Annual)
(
$
500.00
for each
year
)
Full payment now.
ASSOCIATE MEMBERSHIP (Semi-Annual)
(
$
250.00
for each
six months
)
Accounts charged twice a year.
ASSOCIATE MEMBERSHIP (Quarterly)
(
$
125.00
for each
three months
)
Accounts charged four times a year.
ASSOCIATE MEMBERSHIP (Monthly)
(
$
40.00
for each
month
)
Accounts charged once a month.
ASSOCIATE SINGLE/YOUNG FAMILY MEMBERSHIP
(
$
360.00
for each
year
)
Full payment now.
ASSOCIATE SINGLE/YOUNG FAMILY MEMBERSHIP
(
$
180.00
for each
six months
)
Accounts charged twice a year.
ASSOCIATE SINGLE/YOUNG FAMILY MEMBERSHIP
(
$
90.00
for each
three months
)
Accounts charged four times a year.
ASSOCIATE SINGLE/YOUNG FAMILY MEMBERSHIP
(
$
30.00
for each
month
)
Accounts charged once a month.
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: