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Donate Chabad Partnership

Partnership Form

ADULT MALE
Full Name
First NameLast Name
Hebrew Name
Birth Date
MonthDayYear
E-mail
Occupation
Jewishness
From BirthConvertNot Jewish
Family
KohenLeviYisroel
Cell Number
Area CodePhone Number
Work Number
Area CodePhone Number
Home Number
Area CodePhone Number
ADULT FEMALE
Full Name
First NameLast Name
Hebrew Name
Jewishness
From BirthConvertNot Jewish
Family
KohenLeviYisroel
Occupation
Cell Number
Area CodePhone Number
Work Number
Area CodePhone Number
Home Number
Area CodePhone Number
Birth Date
MonthDayYear
E-mail
PERSONAL INFORMATION

Address

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

Marital Status
Anniversary Date
MonthDayYear
CHILDREN
Full Name
First NameLast Name
Birth Date
MonthDayYear
Full Name
First NameLast Name
Birth Date
MonthDayYear
Full Name
First NameLast Name
Birth Date
MonthDayYear
Full Name
First NameLast Name
Birth Date
MonthDayYear
Membership Plan
Please choose your membership option.
Membership Options
Chai Founder Partnership - $1800 ($150 monthly)Chabad Gold - $3600 ($300 monthly)Chabad Platinum- $5400 ($450 monthly)Chabad Founder - $8400 ($700 monthly)Chabad Diamond - $10,800 ($900 monthly)Benefactor- $12,000 ($1,000 monthly)Visionary - $18,000 ($1,500 monthly)Legacy - $25,000 ($2,083.33 monthly)
Please charge my partnership*
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Payment

Credit Card Check

Postal / Zip Code

Country

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