Membership

Personal Information
Full Name*
First Name Last Name
Hebrew Name
Phone Number*

Area Code Phone Number
E-mail*
Check all that apply*

Born to a Jewish motherConvertKohenLevy
Spouse's Full Name
First Name Last Name
Spouse's Hebrew Name
Spouse's Phone Number

Area Code Phone Number
Spouse's E-mail
My Spouse

Was born to a Jewish motherConverted to Judaism
Family Members & Relationship to You Include names of dependents

Address*

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

Membership
Important: due to the circumstances all memberships have an added security fee this year of $180
I am paying*

MonthlyYearly
I would like the following membership:
Membership includes cemetery plots at the Pardes Chaim Cemetery (conditions apply)
Regular Membership

Family: $1,800 ($150 per month) Includes: 2 seats plus dependent childrenSingle Parent: $1000 ($83.33 per month) Includes: 1 seat plus dependent childrenSenior Family: $1,200 ($100 per month) Includes: 2 seatsSenior Single: $600 ($50 per month) Includes: 1 seat
New Members

New Family (1st year only): $1000 ($83.33 per month) Includes: 2 seats plus dependent childrenNew Single (1st year only): $600 ($50 per month) Includes: 1 seat
Newlywed Membership

First Year Marriage: $600 ($50 per month) Includes: 2 seats
Regular Membership

Family Membership $1,800 - Includes: 2 seats plus dependent childrenSingle Parent: $1000 - Includes: 1 seat plus dependent childrenSenior Family: $1,200 - Includes: 2 seatsSenior Single: $600 - Includes: 1 seat
New Members

New Family (1st year only): $1000 - Includes: 2 seats plus dependent childrenNew Single (1st year only): $600 - Includes: 1 seat
Newlywed Membership

First Year Marriage: $600 - Includes: 2 seats
Donation
I would like to make an additional donation of:

$770 Yahrtzeit Memorial Board - non member$613 Yahrtzeit Memorial Board - member discount$500 Eitz Chaim Tree Big Leaf$300 Eitz Chaim Tree Small Leaf$180$90$54$36$18
Special reason for donation:
Payment
Security Charge

$180 CAD
Total

$180.00 CAD

Payment Method*

Credit Card

We accept Visa, MasterCard
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Thank you for being a part of our community!
All payments will receive a full tax receipt

*We maintain Chabad’s policy to ensure you are welcome regardless of payment
Complete Service Schedule HERE
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