Contact Information
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Title
Title
Mr.
Mrs.
Ms.
Dr.
Mr. & Mrs.
Dr. & Mrs.
Rabbi
Rabbi & Mrs.
First
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Last
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Address
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City
State
Zip
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Phone
Email
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Payment Information
Yes! I would like to support the activies of Chabad
Amount
$54
$180
$360
$770
$1,000
$1,800
Other
*
I'd like to be a Chai supporter by donating the above amount monthly, for the next 12 months.
Purpose
Purpose
General Donation
High Holiday Donation
Maftir Yonah
Chanukah
Jewish Chaplaincy Services
Shabbos Kiddush
Maos Chittim - Passover Fund
Jewish Men's Club
Miscellaneous
Year End Campaign
Private Class
Group Class
In honor of
In memory of
Credit Card Information
Type
Card Type
Visa
MC
Amex
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*
Number
*
Expiration
Month
1 - January
2 - February
3 - March
4 - April
5 - May
6 - June
7 - July
8 - August
9 - September
10 - October
11 - November
12 - December
*
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
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Code
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Use contact info above.
Name
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Address
*
Zip
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