Information Form to Join Chabad of Austin

Personal

Name:
Religion:
Hebrew Name (approx):
Father's Hebrew Name (approx):
Mother's Hebrew Name (approx):
Hebrew Birthday or Date of Birth:
From (Email Address):

Affiliation with Chabad:

Home Address (Permanent address if a student)

Street: Apt #:
City: State: Zip Code
Telephone No.

Business Address (Campus address if a student)

Street: Unit #:
City: State: Zip Code
Telephone No.

School Information (if applicable)

Major: Status:
Year of Graduation:

Jewish Interests

Check all that apply. This will not obligate you to any activities. It will only help us to notify you in case of events and activities of particular interest to you.

Community Service

Senior Citzens
Children's Programs
Hospitals & Prisons
Kiruv

Jewish Studies

Hebrew
Torah
Mysticism
Philosophy
Law
Ethics
Other:

Services

Shabbat
Weekday
Can Read Torah
Can Lead Services

Social

Parties
Distribution of Menoras, Matzah, etc.
Shabbatons
Speakers

Kashrut

Meals Programs
Meats, Breads, & Provisions
Advice on Keeping Kosher

Miscellaneous

Library
Newspaper & Calendar
Sports (teams, etc.)
Camp Gan Israel Counselor
Other

Chabad of Austin
4210 Spicewood Springs Road
Suite A-100
Austin, Texas 78759
Ph: (512) 472-3900

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