Aish Chaim Membership 2025/2026

Aish Chaim Membership Form
Name

First NameLast Name
I am a
QUESTIONS ABOUT THE HIGH HOLIDAYS
Do you plan to attend High Holiday services this year at Aish Chaim?
Will you have any children attending the kids programs this year during the High Holidays?
If planning to attend High Holiday services at Aish Chaim are you primarily likely to attend the learning program, or the traditional service?
Would you attend indoor services?
FAMILY INFORMATION
Address

Street Address

Street Address Line 2

CityState / 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 NameLast Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Adult #2

First NameLast Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Adult #3

First NameLast Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Adult #4

First NameLast Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Adult #5

First NameLast Name
Chosen Location (More than one option may be chosen as long as they do not overlap.)
Adult #6

First NameLast Name
Chosen Location
Where do you predominately see yourself spending the most time on the High Holidays?
If you answered "traditional service" in the question above, would you prefer to daven inside at JFCS or in a tent?
Do you have children who will attend any part of our services and/or programs?
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 NameLast NameSuffix
I am a
Hebrew Name
Mother's Hebrew Name
Father's Hebrew Name
Date of Birth

MonthDayYear
Date
Occupation
Business Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name (ADULT FEMALE - IF APPLICABLE)

First NameLast NameSuffix
I am Jewish by birth.
Hebrew Name
Mother's Hebrew Name
Father's Hebrew Name
Date of Birth

MonthDayYear
Date
Occupation
Business Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ADDITIONAL FAMILY INFORMATION
Would you like to share any information about your children?
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?
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?
Sign-up and payments can be made below in combination with membership, or separately at www.aishchaim.com/membership/
KIDDUSH SPONSORSHIP

Membership prices have been fixed for 10 years. Instead of raising membership we are requesting each member strongly consider sponsoring at least one kiddush (on a week of your choice) for $360.
Would you like to sponsorship a kiddush?
Sign-up and payments can be made at www.aishchaim.com/kiddush-sponsorships/
MEMBERSHIP PAYMENT

Associate memberships are intended for those with full memberships elsewhere.
Name 1

First NameLast Name
Name 2 (if applicable)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
PAYMENT BY CHECK
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.)

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Aish Chaim Membership Form

QUESTIONS ABOUT THE HIGH HOLIDAYS

FAMILY INFORMATION

ADDITIONAL FAMILY INFORMATION

SECURITY FEE

KIDDUSH SPONSORSHIP

MEMBERSHIP PAYMENT

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.)