New Shliach Application - Merkos LInyonei Chinuch

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Merkos L'Inyonei Chinuch - New Shliach Registration

Application Instructions:

1. Complete and submit this completed application. Please note that this form is only for registering a new shliach; if there is a need to also register a new associated mosad, please download, print, fill out, sign and fax this online form.

2. Print the Head Shliach approval form, have the Head Shliach named below sign it and fax it into the Merkos office.The Head Shliach Approval form will be accessible from the next screen.

3. Once the signed Head Shliach Approval form has been received, you will be emailed your MyChabad.org login information giving you full access to MyChabad.org and the complete range of features and services available to shluchim, including the ability to update your personal and mosad profiles.

1. Registration Type:

This application is for myself.
My Head Shliach is:

My Employer is: [This is the shliach whom you work directly under.]

I am the Head Shliach of this applicant, registering on his behalf.
[ You must be logged in as a Head Shliach to use this option. ]

2. Shliach's Personal Information:
Title:
First Name:
Last Name:

Hebrew First Name:
Hebrew Last Name:
Mother's Hebrew Name:

Birthdate:

Mobile Phone:
Email Address:	This will be the Shliach's MyChabad.org login name.

Kohen / Levi:

Preferred Language

3. Home Information:
Address Line 1:
Address Line 2:
City:
State:	Post Code:
Country:

Home Phone 1:
Home Phone 2:
Home Fax:

Please continue to next column...

4. Shluchah's Personal Information:
Title:
First Name:

Hebrew First Name:
Mother's Hebrew Name:

Birthdate:

Mobile Phone:
Email Address:	This will be the Shluchah's MyChabad.org login name.

Preferred Language

5. Shlichus Information:
Year went on Shlichus:	e.g. 1972

Mosad Name*:
Position:
* If this mosad does not yet exist in the directory, you must complete the separate New Mosad Application.

6. Notes / Comments: