Dear friend,

Chabad of Peabody's Jewish Centers service to the community depends on the support of generous people. Please consider partnering with us so that we can continue and increase our work in the community.

Please use the partnership opportunity form and select your choice of partnership.

Thank you,

R. Nechemia Schusterman

 

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   If Divorced: If divorced, do you have a
Jewish "Get" ?  Yes   No

 

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.
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 $125  Monthly - $1,500 Yearly
Associate Partnership $54  Monthly - $648 Yearly

 

SECTION VII: PAYMENT INFORMATION

Payment Method:

 Credit Card
 Check is in the mail
 Please 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:

  Card Number:
  Exp. Date      CVV Code:
 
   

TOTALS: 

 

    Partnership Total Amount:

    Total Amount to be charged: