Membership

Membership 2025/2026

Please complete our membership form.
PERSONAL INFORMATION
Full Name*
First Name Last Name
Cell Number*

Area Code Phone Number
Home Number

Area Code Phone Number
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

FAMILY SECTION
If you are a current member and there are no changes from last year, there is no need to fill out the family information section
Family Section

I am a current member with no changes from last yearI am current member and would like to update my informationI am a new member
Hebrew Name*
Father's Hebrew Name*
Mother's Hebrew Name*
Birth Date*

Month Day Year
Born*

DayEvening
Family*

CohenLeviYisroelConvert
Spouse (If applicable)
Full Name
First Name Last Name
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Family

CohenLeviYisroelConvert
Cell Number

Area Code Phone Number
Home Number

Area Code Phone Number
Birth Date

Month Day Year
Born

DayEvening
E-mail
Marital Status
Do you have a Jewish Get?*

YesNo
Who was Get administered by? *
Anniversary Date

Month Day Year
Children (If applicable)
How Many Children*
1.Full Name*
First Name Last Name
Birth Date*

Month Day Year
Born*

DayEvening
Please check*

MaleFemale
2. Full Name*
First Name Last Name
Birth Date*

Month Day Year
Born*

DayEvening
Please check*

MaleFemale
3. Full Name*
First Name Last Name
Birth Date*

Month Day Year
Born*

DayEvening
Please check*

MaleFemale
4. Full Name*
First Name Last Name
Birth Date*

Month Day Year
Born*

DayEvening
Please check*

MaleFemale
Anymore Children*
Yahrzeits (parents or children)
I have Yartzeits*
1. Full Name*
First Name Last Name
Hebrew Name*
Relationship*
Date of passing*

Month Day Year
Time of Day*

DayEvening
2. Full Name*
First Name Last Name
Hebrew Name*
Relationship*
Date of passing*

Month Day Year
Time of Day*

DayEvening
3. Full Name*
First Name Last Name
Hebrew Name*
Relationship*
Date of passing*

Month Day Year
Time of Day*

DayEvening
Any other Yartzeit*
MEMBERSHIP PLAN
Please choose your membership option.
I would*

Seniors/Students $600 & upRegular Membership $1800Benefactor Membership $3600 & up
Membership Options*

$1800 Family Membership (Includes 2 High Holiday seats for adults)$900 Single Membership (Includes 1 High Holiday seats for adults)$900 Senior Couple (Includes 2 High Holiday seats for adults)$600 Senior (Includes 1 High Holiday seats for adults)$600 Student (Includes 1 High Holiday seats for adults)$1000 Seasonal Membership
BENEFACTOR MEMBERSHIP
Please choose your membership option.
Membership Options*

$3,600 Honorary Membership (Includes 4 High Holiday seats for adults)$5,400 Gold Membership (Includes 4 High Holiday seats for adults)$10,000 Pillar of the Community (Includes 4 High Holiday seats for adults)$18,000 Founder of the Community (Includes 4 High Holiday seats for adults)$26,000 Builders of the Community (Includes 4 High Holiday seats for adults)
Membership to be paid:*

In Full12 monthly payments
Membership auto renewal*

YesNo
Comments
Security Fund
I would like to contribute towards Shul Security

$540$250$180$1000
CHAI FOR LIFE
A contribution of "chai" ($18 or multiples of "chai" per month is a great way to ensure continuous Tzedakah and help our fiscal responsibilities. The contribution you make will be charged to your card monthly.
Monthly contribution

$36 Chai X 2$54 Chai X 3$72 Chai X 4$90 Chai X 5$180 Chai X 10
Membership auto renewal

YesNo
PAYMENT
Your credit card will not be charged until the office has received and processed your membership form.
Total

$0.00

Payment*

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Credit Card Check

Postal / Zip Code

Country

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PERSONAL INFORMATION

FAMILY SECTION

MEMBERSHIP PLAN

BENEFACTOR MEMBERSHIP

Security Fund

CHAI FOR LIFE

PAYMENT