Beth Israel New Member Application - Form

Personal Information

Please select what best describes you and your household.

Please Select OneHouseholdIndividual

Do any of the following apply to you?

Full Time StudentPart Time ResidentActive Military or Law Enforcement

If student, name of school and field of study

* Address

City

State

Zip

* Marital Status

Anniversary

if applicable

ADULT 1

* First Name

Last Name

* Email Address

* Preferred Phone

Preferred Pronouns

* Birthdate

* Occupation

* Hebrew Name

Father's Hebrew Name

if applicable

* Mother's Hebrew Name

if applicable

* Please select one:

Mother's Religious Status?

* Previous Synagogue Affiliation

* Name of Previous Synagogue and city/state

Are you a Jew by Choice or Birth?

What type of service are you most familiar with?

I'm interested in leading services and/or chanting Torah/HafTarah

* Describe your Jewish Journey up until now

Volunteering Interests | We are a Shul that runs on volunteer energy and enthusiasm for our CBI family. Please let us know how you might like to get involved.

ADULT 2

* First Name

Last Name

* Email Address

* Preferred Phone

Preferred Pronouns

Birthdate

Occupation

* Hebrew Name

Father's Hebrew Name

if applicable

* Mother's Hebrew Name

if applicable

Please select one:

Mother's Religious Status?

* Previous Synagogue Affiliation

* Name of Previous Synagogue & City/State

Are you a Jew by Choice or Birth?

What type of service are you most familiar with?

I'm interested in leading services and/or chanting Torah/HafTarah

* Describe your Jewish Journey up until now

Volunteering Interests | We are a Shul that runs on volunteer energy and enthusiasm for our CBI family. Please let us know how you might like to get involved.

Children Information

How many children are still living in your home?

CHILD 1

* First Name

* Last Name

Date of Birth

Gender

CHILD 2

* First Name

* Last Name

Date of Birth

Gender

CHILD 3

* First Name

* Last Name

Date of Birth

Gender

CHILD 4

* First Name

* Last Name

Date of Birth

Gender

Yahrzeits
This information can be added later or at any time. Once we have this information, then we will be able to send you reminders of when these dates are coming up.

How many yahrzeits would you like to observe?

YAHRZEIT 1

* Name of Deceased

Hebrew Name of Deceased

if known

Name of Observer

Relationship to Observer

* Date of Passing

Hebrew Date of Passing

if known

Occurred:

Before SunsetAfter Sunset

YAHRZEIT 2

* Name of Deceased

Hebrew Name of Deceased

if known

* Name of Observer

* Relationship to Observer

Date of Passing

Hebrew Date of Passing

if known

Occurred:

Before SunsetAfter Sunset

YAHRZEIT 3

* Name of Deceased

Hebrew Name of Deceased

if known

Name of Observer

Relationship to Observer

Date of Passing

Hebrew Date of Passing

if known

Occurred:

Before SunsetAfter Sunset

YAHRZEIT 4

* Name of Deceased

Hebrew Name of Deceased

if known

* Name of Observer

* Relationship to Observer

Date of Passing

Hebrew Date of Passing

if known

Occurred:

Before SunsetAfter Sunset

Annual Dues
Our annual dues structure is based on a "Fair Share" system. We ask that you consider your annual contribution amount based on your household's ability to support the Shul. Your pledge helps to cover weekly security costs, weekly Kiddush luncheon, the physical building upkeep, salaries for the Rabbi and other staff members, holiday and educational programming, and our High Holiday Cantor (to list a few).

The following "Suggested Fair Share" chart is designed to be helpful:

Annual Income	Suggested Percentage	Annual Fair Share Contribution
$25,000	2-3%	$500-$750
$50,000	3-4%	$1500-$2000
$75,000	3-4%	$2250-$3375
$100,000	3.5-5%	$3500-$5,000
$150,000	3.5%-5%	$5250-$7500
$200,000	4-5.5%	$8,000-$11,000

Please put your pledge in the field below. We will be in touch to set up a billing structure and help you set up your account in this system.

* Amount I wish to Pledge for my CBI dues

Building Fund
All new members are assessed a one time building fund charge of $950.00. This amount is charged to your account in equal installments over a 6 year period. If you wish to pay this off sooner, then please contact the office to make that arrangement.

Our fiscal year runs July 1 - June 30th. Please indicate your pledge amount for the current fiscal year with these dates in mind. You will be asked to renew your membership in the spring.

E-Signature

* First/Last Name(s) for application signature

I am/We are interested in membership at Beth Israel Congregation and hereby submit this application. I/We agree to abide by the rules, regulations and by-laws of Beth Israel Congregation.