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Membership


Welcome to Kehillat Beth Israel. Your privacy is important to us. The information you provide will enrich your experience as a member of Kehillat Beth Israel and is for office use only. Please complete this application form by July 31st along with your annual dues payment information. Thank you for becoming a part of our community. We look forward to growing and learning with you and your family.


ADULT 1

e.g. Yaakov ben Yitzhak v'Rikva
Please check all that apply.


PARENTS OF ADULT 1


ADULT 2

e.g. Dinah bat Yaakov v'Leah
Please check all that apply.


PARENTS OF ADULT 2


YAHRZEIT REMINDERS

Yahrzeit Reminders for Member 1

i.e. English Name, Hebrew Name, Date of Death, Time of Death (if known), Relationship.


Yahrzeit Reminders for Member 2

i.e. English Name, Hebrew Name, Date of Death, Time of Death (if known), Relationship.


ADDRESS & HOME PHONE


EMERGENCY CONTACT INFORMATION


MARITAL STATUS

If applicable.


CHILD 1

optional
optional


CHILD 2

optional
optional


CHILD 3

optional
optional


CHILD 4

optional
optional


CHILD 5

optional
optional


OTHER INFORMATION (IF APPLICABLE)

OPTIONAL DONATION

In you are able, please consider making a contribution in excess of your dues to help underwrite our inevitably increased need for dues subsidies this year.


MEMBERSHIP AGREEMENT

 
I/we promise to abide by all the rules and regulations of the Congregation as stated in the By-Laws.
I/we understand that the Fiscal Year for payment of all Kehillat Beth Israel accounts is July 1, 2020 to June 30, 2021.
I/we understand that all requests for Dues reductions can only be considered after consultation with the Executive Director.


YOUR TOTAL AMOUNT DUE

Thu, 22 October 2020 4 Cheshvan 5781