Membership Application | Temple Beth Sholom

Personal Information

Name *

First Name

Last *

Last Name

Address *

Address

City

State/Province

Zip/Postal

Phone *

Email

Hebrew Name *

(Enter 'unknown' if you do not know or don't have one)

Birthdate *

Preferred Pronouns *

She/her/hers

He/him/his

They/them

OtherOther

Occupation *

Company

Add Partner

Check here to add a spouse or partner

Partner Information

Name *

First Name

Last *

Last Name

Phone *

Email

Hebrew Name *

(Enter 'unknown' if you do not know or don't have one)

Birthdate *

Preferred Pronouns *

She/her/hers

He/him/his

They/them

OtherOther

Occupation *

Company

Anniversary Date

Child(ren)

Tell us about any children living at home with you. You may add first child and then click the 'Add another child' button for each additional child.

Name

First Name

Last

Last Name

Hebrew Name

(Enter 'unknown' if you do not know or child doesn't have one)

Birthdate

Preferred Pronouns

She/her/hers

He/him/his

They/them

OtherOther

Add another child Remove

Yahrzeits

Tell us about any Yahrzeits you would like us to honor.

Name

Relationship

Date of passing

Hebrew date of passing

We can calculate for you if you do not know.

Add another Yahrzeit Remove

What is the primary reason you are interested in joining TBS? *

Type of Membership *

Parnas (Sustainer): $3600.00 ($300.00 per month)

Mechayeh (Life Giver): $1800.00 ($150.00 per month)

Mashpiah (Benefactor): $1332.00 ($111.00 per month)

Nediv Lev (Generous): $936.00 ($78.00 per month)

Lev Patuach (Open Heart): $18.00 per month, per person

Shekalim (other amount)Shekalim (other amount)

Your dues commitment will be pro-rated from the time you submit this application.
Members are considered in good standing when they are current with that year's commitment by September 1st of the fiscal year, whether that commitment is payment in full or a payment plan on which payments are being made.
Members receive a 5 percent discount if dues are paid in full by July 31st.
Please contact the office if you need to adjust your dues commitment at any time.
Complete confidentiality will be maintained at all times.

Payment Schedule Preference *

Payment in Full

Monthly or Quarterly Payments

Payment Method Preference *

Mitzvah Matic (automatic bank withdrawal / preferred method)

Credit Card

Personal check (mailed or delivered to office)

Bank Information

Bank Name

Bank Routing Number

Account Number

Credit Card Information

Card Number

Expiration Date

MM/YY

CVV

3 or 4 digit card verification number

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