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Yes! I would like to become a member of the Chabad at UW Chai Club.

I would like to become a

 Chai Member, by contributing $18.00 a month to the work of Chabad at UW

 Chai Plus Member, by contributing  a month to the work of Chabad at UW.


First name*

Last name*

Address Line 1* 

Address Line 2    



Postal Code*       


This is my  Home  Business address.

Phone Number*  

E-mail address*

Card Type*         

Card Number*     

Expiration Date*  

CVV Security Code*

Amount*:  monthly.

Please charge my card on the  of every month. (You can leave this field blank and you card will get charged when you submit this form and on the first of every month following).