Membership Form

2016-17 Membership Application

Name:
Hebrew Name
Date of Birth
E-mail:
Cell Phone:
-
Reg Phone:
-
Business or Profession
Company Name
Company Phone:
-
Name2:
Date of Birth 2
E-mail2:
Cell Phone2:
-
Business of Profession
Business Name2
Business Phone2
Wedding Date:
Children Names & Dates of Birth
Address:

Yahrzeit Reminders

English Name
Hebrew_Name
Relationship
Death Date
Name2
Relatinship2
Death Date2
Hebrew Name2
Checkbox:
Enter Dues
 $ 
Building Fund
 $ 
Total:

Your info is submitted to the office when you hit submit. You will be taken to our secure payment processing page to pay online with Visa, MasterCard, Discover, American Express or your PayPal account.  If you do not want to pay online, you can call the office at 516-466-0569 to pay by phone. We are happy to receive your check in the mail as well.

THANK YOU!

Yahrzeit(Please list name,relationships and dates)

Lake Success Jewish Center

2018-2019 Membership 

Application/Dues

When you hit submit you will be taken to our payment page.  Please indicate "Membership Dues" in the memo area when making the payment. If you do not want to pay online, and just want send in the form and mail in a check, you can just click "submit" and you are done. Thank you!