Membership Registration

Lubavitch Aventura South

Section I Your Information

First Name

Last Name

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Occupation

Birth Date [MM / DD / YYYY]

Day or Night

Jewish by

I am a

Cell Phone

Work Phone

Section II Spouse's Information

First Name

Last Name

Father's Hebrew Name

Mother's Hebrew Name

Occupation

Birth Date [MM / DD / YYYY]

Day or Night

Jewish by

I am a

Cell Phone

Work Phone

Section III Personal Information

Address

City

State

Zip Code

Marital Status

Anniversary Date

Divorce Date (if applicable)

If divorced, do you have a Jewish Get?

Who was Get administered by?

Widowed Date (if applicable)

Section IV Children

Child 1

First Name

Last Name

Hebrew Name

School

Gender

Birth Date

Day or Night

Add another child

Section V Yahrtzeits

Yahrtzeit 1

Name [English / Hebrew / Father's Hebrew / Last]

Date of Passing

Day or Night

Relationship

Add another Yahrtzeit

Section VI Membership Opportunities

Membership Level

Payment Schedule

All membership fees can be made in one payment, or in quarterly or monthly installments.

Section VIII Payment Authorization

Payment Method

Card Type

Card Number

Exp Month

Exp Year

Code

Comments / Special Requests

Please submit a proof of Jewishness file to this email address info@jewishaventura.com after submission.

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Membership Registration

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Child 7

Child 8

Yahrtzeit 1

Yahrtzeit 2

Yahrtzeit 3

Yahrtzeit 4

Yahrtzeit 5