B”H
CHABAD
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OCEANSIDE
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MEMBERSHIP APPLICATION
FIRST ADULT
ADDRESS
CITY / STATE / ZIP
HOME #
WORK #
CELL #
E-MAIL ADDRESS
BIRTH DATE
TIME OF BIRTH
AM/PM
HEBREW NAME
MOTHER’S HEBREW NAME
FATHER’S HEBREW NAME
CHABAD OF OCEANSIDE
3700 OCEANSIDE ROAD WEST
SECOND ADULT
WORK #
CELL #
OCEANSIDE, NY 11572
516-764-7385 P
[email protected]
WWW.CHABADOFOCEANSIDE.COM
E-MAIL ADDRESS
BIRTH DATE
TIME OF BIRTH
AM/PM
HEBREW NAME
MOTHER’S HEBREW NAME
FATHER’S HEBREW NAME
COMPLETE & SEND TO:
CHABAD OF OCEANSIDE • 3700 OCEANSIDE ROAD WEST
OCEANSIDE • NY 11572
CHABAD
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SERVING
THE
COMMUNITY
WITH:
LIFE CYCLE EVENTS
SHABBAT & HOLIDAY SERVICES
BAR/BAT MITZVAH PREPARATION
CHILD INFORMATION
CHILD’S FULL NAME
HEBREW NAME
BIRTH DATE
TIME OF BIRTH
SCHOOL
GRADE
AM/PM
CHILD’S FULL NAME
HEBREW NAME
BIRTH DATE
TIME OF BIRTH
SCHOOL
GRADE
AM/PM
WOMEN’S GROUP
SHABBAT DINNERS
CHILD’S FULL NAME
SOCIAL EVENTS
ANNUAL RETREATS
JUNIOR CONGREGATION
BEREAVEMENT SERVICES
HEBREW NAME
BIRTH DATE
TIME OF BIRTH
SCHOOL
GRADE
AM/PM
COUNSELING
ADULT EDUCATION
CHILD’S FULL NAME
HEBREW SCHOOL
BAT/ BAT MITZVAH CLUB
HEBREW NAME
BIRTH DATE
TIME OF BIRTH
SCHOOL
GRADE
AM/PM
CHILD’S FULL NAME
HEBREW NAME
BIRTH DATE
TIME OF BIRTH
SCHOOL
GRADE
AM/PM
CHABAD
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FAMILY YAHRZEITS
DECEASED NAME
DATE OF DEATH
HEBREW DATE OF DEATH
(IF KNOWN)
RELATIONSHIP
HEBREW NAME
MOTHER’S HEBREW NAME
(IF KNOWN)
FATHER’S HEBREW NAME
(IF KNOWN)
PEOPLE TO NOTIFY
o SELF
o OTHERS
NAME
ADDRESS
CITY / STATE / ZIP
We ask you to give us
information about loved ones who
have passed away. This is so
that we may send you and
others in your family
“Yahrzeit cards”- reminders close
to the Hebrew anniversary of
your loved ones death, so that
you can observe this date
according to Jewish tradition.
If you do not wish to share
DECEASED NAME
DATE OF DEATH
HEBREW DATE OF DEATH
(IF KNOWN)
RELATIONSHIP
HEBREW NAME
MOTHER’S HEBREW NAME
(IF KNOWN)
FATHER’S HEBREW NAME
(IF KNOWN)
PEOPLE TO NOTIFY
o SELF
o OTHERS
NAME
ADDRESS
CITY / STATE / ZIP
this information,
leave this section blank.
DECEASED NAME
DATE OF DEATH
HEBREW DATE OF DEATH
(IF KNOWN)
RELATIONSHIP
HEBREW NAME
MOTHER’S HEBREW NAME
(IF KNOWN)
FATHER’S HEBREW NAME
(IF KNOWN)
PEOPLE TO NOTIFY
o SELF
NAME
ADDRESS
CITY / STATE / ZIP
o OTHERS
TOTALS
MEMBERSHIP & OTHER BENEFITS PAYMENT FORM
In our effort to be inclusive for families of every income level, Chabad Membership Dues have been designed to be as low as possible. However,
if you are capable, please consider participating at a higher level of membership dues. This will allow us to cover our expenses and continue
to expand our programs, services and long-term goals. If you would like to earmark your higher membership towards a particular area, refer to
the Wish List and Dedication page.
Name: ___________________________________________________________________
Please include me / us as formal member(s) of Chabad of Oceanside family, at:
o Founder: $5,000
o Pillar: $3,500
o Benefactor: 1,800
o Family Membership: $770
o Junior Membership: $350
$
SPONSORSHIPS
THERE ARE A NUMBER OF WAYS YOU C AN MARK A PERSONAL EVENT OR HONOR
A LOVED ONE WHILE HELPING SUPPORT CHABAD OF OCEANSIDE. PLEASE
CHOOSE FROM THE FOLLOWING OPTIONS AND NOTE YOUR PARTICIPATION.
KIDDUSH SPONSORSHIP
There is no better way to commemorate a life cycle event, honor a friend, or celebrate a milestone that through sponsoring a Kiddush at Chabad.
Please refer to the enclosed listing of available Kiddush dates, note a date that you would like to reserve, and return it to our office along with your
membership forms.
$
o Please reserve _______ Kiddush(es) as noted on the attached sheet
(Each Kiddush sponsorship is $280 unless it is a larger Simcha • To arrange special payment options or more elaborate
kiddushes, Contact Mrs. Soshie Gurkov 516-764-7385.
SIMCHA BOARD
Mark a “Simcha’ - a special, joyous occasion (Bar/Bat Mitzvah, anniversary, birthday, graduation or whatever you’d like) on our beautiful new Simcha
dedication board in the Kiddush room. Each 4 x 4 bronze plaque can be customized with words of your choice for only $180 and is permanently
imprinted onto the Board. And, when purchasing a plaque along with a sponsored Kiddush, this customized plaque can be yours for only $100.
o I would like to mark an event with a dedication on Chabad’s Simcha Board
$180 per Plaque x _______= _______
$100 in conjunction with sponsored Kiddush x _______= _______
$
(Please write text for the plaque on a separate paper and enclose)
YAHRTZEIT MEMORIAL PLAQUES
Perpetuate the memory of a loved one with a beautiful plaque on our memorial board.
o Please reserve _______ Yahrtzeit Plaque (s)
$
$280 per Plaque x _______= _______
(Please write text for the plaque on a separate paper and enclose)
WISH LIST ITEMS
o I / We would like to sponsor the following Wish List Items:_____________________________
$
TOTAL MEMBERSHIP AND SPONSORSHIPS:
$
PAYMENT OPTIONS
Full Payment:
o Enclosed is a check for $ _______
- or -
Please charge my credit card: o Amex
o Visa
o MC
Name:________________________________Card Number: ____________________________Exp: ___/___
Incremental Payments:
I would like to split the total amount $_______, into _______ payments. o Enclosed are _______ head checks
- or - Please charge my credit card: o Amex
o Visa
o MC
Name:________________________________Card Number: ____________________________Exp: ___/___
CHABAD
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NAMES FOR YAHRTZEIT PLAQUES
Deceased:
Father’s Name:
Date of Passing:
Deceased:
Father’s Name:
Date of Passing:
INFORMATION FOR SIMCHA PLAQUES
In honor of:
Event:
Statement:
In honor of:
Event:
Statement:
DEDICATION AND SPONSORSHIP OPPORTUNITIES
IN RESPONSE TO NUMEROUS REQUESTS, WE HAVE CREATED THE FOLLOWING LIST, OUTLINING DEDICATION
OPPORTUNITIES, SPONSORSHIPS AND A CHABAD WISH LIST. IF YOU HAVE ANY QUESTIONS OR WOULD LIKE
MORE INFORMATION, PLEASE CALL OUR OFFICE @ 516-764-7385.
SANCTUARY - MAJOR DEDICATIONS
o *Torah Scroll
$35,000
o New Mechitza
$7,000
o Movable Walls
$3,600
Acknowledge on Torah’s outer coverings & dedication event
(with specialized fabric for one-way sight)
Acknowledged on Plaque
SANCTUARY - ITEMS SPONSORSHIP
o Psalms (30)
$15 each
o Chumash (30)
$40 each
Acknowledged in inside cover
Acknowledged in inside cover
ONGOING EXPENSES
o High Holiday Programming
Acknowledged on Plaque and Holiday Publications
$5,000
CHILDREN’S PROGRAM
o Weekly Program/Babysitting $50 per week
o Toys and Games
$500
Acknowledged on Plaque
CHABAD OFFICE
o Telephone System
$3,600
Acknowledged on Plaque
EVENT SPONSORSHIPS
o Friday Night / Family Shabbat
o Holiday Event
o Purim Event
o Women’s Circle Event
$350
$380
$380
$380
4 course, Sit-Down Meal (Offsets costs not covered by fees)
OTHER DONATIONS
Please apply my donation of $_______ to:
o Kiddush Fund
o Maintenance & custodial
o Building fund
o Books
o Please contact me regarding planned giving.
KIDDUSH SPONSORSHIPS
Celebrate simchas, observe significant life-cycle dates, and make a contribution to Chabad of Oceanside! Here are this year’s kiddush sponsorship opportunities.
Fill in the reservation code and the name of the person you’re honoring next to the date(s) you would like to reserve.
Reservation Code
Hebrew Date
English Date
RESERVED
Shabbos, March 31, 2007
12 Nissan-Tzav
RESERVED
Shabbos, Sept, 23, 2006 1 Tishrei-Rosh Hashanah
Wed, April 4, 2007
16 Nisan-Pesach 1
RESERVED
Sunday, Sept. 24, 2006
2 Tishrei-Rosh Hashanah
Thurs, April 5, 2007
17 Nisan-Pesach 2
Shabbos, Sept. 30, 2006
8 Tishrei-Ha'zinu
Shabbos, April 7, 2007
19 Nisan-Pesach 4
Monday, Oct. 2, 2006
10 Tishrei -Yom Kippur
Break-Fast
Monday, April 9, 2007
21 Nisan-Pesach 6
Shabbos, Oct, 7 2006
15 Tishrei-Sukkot1
Tues, April 10, 2007
22 Nisan-Pesach 7
Sunday, Oct. 8, 2006
16 Tishrei-Sukkot 2
Shabbos, April 14, 2007 25 Misan-Shemini
Shabbos, Oct. 14, 2006
22 Tishrei-Shemini Atzeret
Shabbos, April 21, 2007
3 Iyar-Tazria-Metzora
Sunday, Oct. 15, 2006
23 Tishrei- Simchas Torah
Shabbos, Aprilv 28, 2007
10 Iyar-Acharei-Kedoshim
Shabbos. Oct. 21, 2006
29 Tishrei-Bereishis
Shabbos, My 5, 2007
17 Iyar-Emor
Shabbos. Oct. 28, 2006
6 Cheshvan-Noach
Shabbos, May 12, 2007 24 Iyar-Behar-Bechukotai
Shabbos, Nov, 4, 2006
13 Cheshvan-Lech-Lecha
Shabbos, May 19, 2007 2 Sivan-Bamidbar
Shabbos, Nov. 11, 2006
20 Cheshvan-Vayeira
Wed, May 23, 2007
6 Sivan-Shavuot 1
Shabbos, Nov. 18, 2006
27 Cheshvan-Chayei Sara
Thrs, May 24, 2007
7 Sivan-Sahvuot 2
Shabbos, Nov. 25, 2006
4 Kislev-Toldot
Shabbos, May 26, 2007 9 Sivan-Naso
Shabbos, Dec. 2, 2006
11 Kislev-Vayeitze
Shabbos, June 2, 2007 15 Sivan-Behaalotcha
Shabbos, Dec. 9, 2006
18 Kislev-Vayishlach
Shabbos, June 9, 2007
Shabbos, Dec. 16, 2006
25 Kislev-Vayeishev
Shabbos, June 16, 2007 30 Sivan-Korach
Shabbos, Dec. 23, 2006
2 Teves-Mikeitz
Shabbos, June 23, 2007
Shabbos, Dec. 30, 2006
9 Teves-Vyigash
Shabbos, Jan. 6, 2007
16 Tevet-Vayechi
Shabbos, July 7, 2007
Shabbos, Jan. 13, 2007
23 Tevet-Shmot
Shabbos, July 14, 2007 28 Tamuz-Matot-Massei
Shabbos, Jan. 20, 2007
1 Shevat-Va'eira
Shabbos, July 21, 2007
6 Av-Devarim
Shabbos, July 28, 2007
13 Av-Va'etchanan
Shabbos, Aug 4, 2007
20 Av-Eikev
RESERVED
RESERVED
RESERVED
RESERVED
RESERVED
RESERVED
5
Shabbos, Jan. 27, 2007
Shabbos, Feb. 3, 2007
RESERVED
RESERVED
8 Shvat-Bo
15 Shvat-Beshalach
23 Sivan-Shlach
7 Tamuz-Chukat
Shabbos, June 30, 2007 15 Tamuz-Balak
21 Tamuz-Pinchas
Shabbos, Aug 11, 2007
Shabbos, Feb. 10, 2007
22 Shvat-Yitro
Shabbos, Feb. 17, 2007
29 Shvat-Mishpatim
Shabbos, Aug 18, 2007
4 Elul-Shoftim
Shabbos, Feb. 24, 2007
6 Adar-Teruma
Shabbos, Aug 25, 2007
11 Elul-Ki Teitze
Shabbos, March. 3, 2007 13 Adar-Tetzaveh
Shabbos, Sept 1, 2007
18 Elul- Ki Tavo
Shabbos, March 10, 2007 10 Adar-Ki Tisa
Shabbos, Sept 9, 2007
Shabbos, March 17, 2007
27 Adar-Vayak'hel-Pekudei
Shabbos, March 24, 2007
4 Nissan-Vayikra
RESERVED
n
26 Av-Re'eh
25 Elul-Nitzavim-Vayelech
2
Thurs, Sept 13 2007
1 Tishrei-Rosh Hashanah
Friday, Sept 14 2007
2 Tishrei-Rosh Hashanah
CODE
OCCASION
A of _______
ANON
Bar of ________
Bas of _________
BDAY of ________
E of __________
GO__________
Anniversary
Anonymous
Bat Mitzvah
Bas Mitzvah
Birthday
Engagement
Going Away
GRAD of _______
NH __________
NOR
THANX to _______
3 YRS of _______
W of __________
WEL __________
Y of __________
Graduation
New HOUse
NO Reason
Thank You
Upshernish/Beginning
of Candlelighting
Wedding
Welcome
Yahrtzeit