Membership/Shul Seats Simply complete the form below and click the button to submit your membership and shul seat payment. *denotes a required field. Title - Mr Mrs Ms Dr First Name* Last Name* Address Line 1* Address Line 2 City* State * Postcode* Home Phone Mobile Phone Email Address Date of Birth Membership/Shul Seats Membership $550.00 per adult: 0 1 2 3 4 5 6 7 Pensioner/Student $300.00: 0 1 2 3 4 5 6 7 Child (under 13) $125.00: 0 1 2 3 4 5 6 7 TOTAL $ Please provide us with the names of your family members included in your membership/seat purchase: 1. Title First Name : Last Name : Male Female Date of Birth 2. Title First Name : Last Name : Male Female Date of Birth 3. Title First Name : Last Name : Male Female Date of birth 4. Title First Name : Last Name : Male Female Date of Birth 5. Title First Name : Last Name : Male Female Date of Birth 6. Title First Name : Last Name : Male Female Date of Birth Form of Payment: Credit Card (continue below) Cheque/Cash - Please mail cheque to Chabad on Carlisle (fee) Inc - 366 Carlisle St, Balaclava VIC 3183 Card Type* - Visa Mastercard Card Number* Expiration Date* CVV Security Code Please click submit only once. Please wait for the acknowledgement message that your information was received. If you're a new member or a former member with changes to your information, please click here. This page uses 128 bit SSL encryption to keep your data secure.