Membership - Form - Congregation Khal Chasidim

* First Name

* Last Name

* Primary Phone Number

* Email Address

* Address

* City

* State

* Zip

1. Membership

Please choose a membership option below.

Please Select OneFull Membership ($750) - includes one seat in the men’s section and one seat in the Ezras Nashim.Full Membership with a Table Shtender ($1000) - includes one seat with a table shtender in the men’s section and one seat in the Ezras Nashim.Full Membership with a Standing Shtender ($1500) - includes one standing shtender plus seat in the men’s section and one seat in the Ezras Nashim.Associate Membership ($400) - includes one seat in either the men’s section seat or the Ezras Nashim.

2. Seating

(One Men's Section seat and one Ezras Nashim (Women's Section) seat included in Full Membership).

Please indicate which seats you will be using for the Yamim Noraim, as well as any additional seats you would like to purchase.

* I will require a seat in the Men's Section for the Yamim Noraim (included in membership).

Please Select OneYesNo

* I will require a seat in the Ezras Nashim for the Yamim Noraim (included in membership).

Please Select OneYesNo

Additional Men's Section seats required ($75 each).

Additional Ezras Nashim seats required ($75 each).

Notes

Total charge for membership plus any additional seats: