Membership

Membership in Chabad at La Costa means that you partner with us in bringing authentic Jewish values to our area, whether that be financially or through volunteering. The money we raise via Membership covers much of our operating budget. Every penny contributed stays right here, working in our community, benefiting everyone. Literally thousands of lives were touched in a positive way through our activities this past year. But there is so much more to do.

Chabad at La Costa is a 501(c)(3) nonprofit organization. All charitable contributions are tax-deductible. You will receive a tax receipt by email or direct mail unless otherwise noted below.

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Head of Household
Full Name*

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
E-mail* For Your Receipt
Occupation
Jewishness

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Family

KohenLeviYisroel
Cell Number

Area Code Phone Number
Work Number

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Home Number

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Spouse
Full Name

First Name Last Name
Hebrew Name
Jewishness

From BirthConvertNot Jewish
Family

KohenLeviYisroel
Occupation
Cell Number

Area Code Phone Number
Work Number

Area Code Phone Number
Home Number

Area Code Phone Number
Birth Date

Month Day Year
E-mail
PERSONAL INFORMATION

Address If Different From Billing Address

Marital Status
Anniversary Date

Month Day Year
CHILDREN
Full Name

First Name Last Name
Birth Date

Month Day Year
Full Name

First Name Last Name
Birth Date

Month Day Year
Full Name

First Name Last Name
Birth Date

Month Day Year
Full Name

First Name Last Name
Birth Date

Month Day Year
Yarzeit Information

For Yizkor and Memorial Plaques
Full Name

First Name Last Name
Hebrew Name

Full Hebrew Name Father's Hebrew Name
Date of Passing Include Time if Known

Month Day Year
at Hour Minutes
Relationship
Full Name

First Name Last Name
Hebrew Name

Full Hebrew Name Father's Hebrew Name
Date of Passing Include Time if Known

Month Day Year
at Hour Minutes
Relationship
Membership Plan

Please choose your membership option.
Membership Options Enter Monthly Amount in 'Other' Box and Select Recurring

$5400 Platinum Membership $450/month$3600 Gold Membership $300/month$2400 Silver Membership $200/month$1800 Family Membership $150/month$1200 Individual Membership $100/month$800 Senior Membership $67/month$36 Chai Membership $36/monthStudent Membership $15/monthSubsidized Membership, No Questions Asked
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Volunteering

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Total

$0.00

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PERSONAL INFORMATION