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

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 $500.00 per adult:

Pensioner/Student $250.00:

Child (under 13) $100.00:

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*

Card Number*

Expiration Date* CVV Security Code

Please click submit only once.
Please wait for the acknowledgement message that your information was received.