Mikvah Member Appointments | www.chabadpaloalto.com

Welcome to the Mikvah member appointment system!

This form is for paid mikvah members only, non members please click here to schedule your appointment.

For any questions please call Dena Levin at 650-302-0072.

Mikvah Member Appointments

After submitting this form you will be contacted at the number below to set an appointment time.

First Name *

Last Name *

Phone *

Email *

Appointment Date: *

Prep Room: *

Shower Room, 30 Min Full Prep Room, 1 Hour

Have you tested positive for the Covid-19 virus in the past? *

Yes No

Have you been exposed to anyone who tested positive for the Covid-19 virus in the past 14 days? *

Yes No

Comments

Membership & Donation

Membership *

I am a paid mikvah member

I would like to sign up for a new annual membership ($300 per year)

Additional Donation (Optional)

$18

$36

$54

Additional Donation (Other)

Total Fee(s)

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *