Partnership  
        

                     Opportunities 

 

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      

 

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: PARTNERSHIP OPPORTUNITIES
In our effort to be inclusive for families of all income levels, Partnership Opportunities have been designed within a wide range. However, if you are capable, please consider participating at a higher level. This will allow us to cover our expenses and continue to expand our programs, services and long term goals. All Partnership gifts can be made in one installment or in 12 monthly installments. Please check the option of your choice. Nobody will be turned away due to lack of funds.
Platinum Partnership $1,000 Monthly - $12,000 Yearly
Gold Partnership $500 Monthly - $6,000 Yearly
Double Chai Partnership $360 Monthly - $4,320 Yearly
Silver Partnership $300 Monthly - $3,600 Yearly
Chai Partnership $150 Monthly - $1,800 Yearly
Family Partnership $90  Monthly - $1,080 Yearly
Associate Partnership $54  Monthly - $648 Yearly
Other

 

SECTION VII: PAYMENT INFORMATION

Payment Method:

 Credit Card
 Check is in the mail 
  Bill Me:
  		Optional Comments:
  Please charge my:  

I wish to pay the full annual donation
I wish to pay 12 Month Installments
You will be charged at the beggining of each month.
Begin payments on:
Other:

  Card Number:
  Exp. Date     CVV Code:
   

TOTALS: 

 

    Partnership Total Amount:

    Total Amount to be charged:



 


* 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 Rabbifor a confidential arrangement.