Membership and Renewal | Temple Beth Sholom

Name*

First Last

Date of Birth*

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DD

YYYY

Hebrew Name*

Son of/Daughter of*

Please check one:

Kohen
levi
Yisrael

Jewish by:

Birth (Mother Jewish)
Conversion
Conservative
Orthodox
Reform
Not Jewish

Spouse

Spouse's Name

First Last

Spouse's Date of Birth

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DD

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Spouse's Hebrew Name

Son of/Daughter of

Please check one:

Kohen
levi
Yisrael

Jewish by:

Birth (Mother Jewish)
Conversion
Conservative
Orthodox
Reform
Not Jewish

Personal Information

Address*

Street Address Address Line 2 City State ZIP Code

Wedding Anniversary

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DD

YYYY

Cell

Spouse's Cell

Email*

Spouse's Email

Business Information

Business Name

Type of Business

Occupation

Address

Street Address Address Line 2 City State ZIP Code

Phone

Spouse's Business Name

Type of Business

Spouse's Occupation

Address

Street Address Address Line 2 City State ZIP Code

Phone

Childrens' Names & Birth Dates

Name (Child 1)

First Last

Hebrew Name

Gender

Male
Female

Date of Birth

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DD

YYYY

Name (Child 2)

First Last

Hebrew Name

Gender

Male
Female

Date of Birth

MM

DD

YYYY

Name (Child 3)

First Last

Hebrew Name

Gender

Male
Female

Date of Birth

MM

DD

YYYY

Name (Child 4)

First Last

Hebrew Name

Gender

Male
Female

Date of Birth

MM

DD

YYYY

Deceased Loved Ones for Yahrzeit Listing

Yahrzeit

Please indicate Name, Relationship, To Which Member and Date of Death

Previous Synagogue Affiliation

Conservative
Orthodox
Reform
Reconstructionist

Any synagogue office previously held?

Please select any that apply:

I can chant the Haftarah
I can read Torah
I can lead the Daily Services
I am interested in a learner’s minyan
I can lead the Shabbat Services

I/We would like to receive more information about:

Sisterhood
Men's Club
PTA
Adult Learning
Youth Activities
Tikkun/Social Action
Chesed/Caring Committee
Other

Personal Interests, Talents & Hobbies

We would like to see Temple Beth Sholom sponsor the following additional services and activities

Fair Share Statement

In place of a dues requirement, Temple Beth Sholom operates on the basis of Fair Share – the philosophy that makes each of us responsible for the other. It allows those of us who can assume a larger share of the financial burden, based on our own assessment of ability, to do so. The voluntary Fair Share commitment of each member, each year, contributes the major portion of Temple income to cover operating expenses. Our Building Fund charge, payable over 5 years, also helps maintain our House of Worship and Religious Schools. High Holiday tickets are allotted based on family composition.

Membership Renewal*

IT IS UNDERSTOOD AND AGREED THAT YOUR MEMBERSHIP WILL AUTOMATICALLY BE RENEWED EACH YEAR UNLESS A NOTICE OF TERMINATION IS RECEIVED IN WRITING AT LEAST THIRTY (30) DAYS PRIOR TO THE RENEWAL YEAR ON JULY 1.

I understand

Membership Dues

Choose Your Membership*

Building Fund*

The building fund is payable over 5 years. Choose to pay it all once or a single payment.

Full Payment - $2500
One-Year Payment - $500
Pay at a Later Date

Security Fee*

All Members

Price: $200.00

Total

$0.00

Renew or Join!

Spouse

Personal Information

Business Information

Childrens' Names & Birth Dates

Deceased Loved Ones for Yahrzeit Listing

Fair Share Statement

Membership Dues

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