The document is a membership application for Temple Beth Sholom that collects contact information, family details, religious background, and dues payment details for applicants. It requests names, addresses, birthdates, marital status, occupations, affiliations with other Jewish organizations, areas of interest, children's information, deceased family members for yahrzeit observance, and selection of the appropriate membership dues category.
The document is a membership application for Temple Beth Sholom that collects contact information, family details, religious background, and dues payment details for applicants. It requests names, addresses, birthdates, marital status, occupations, affiliations with other Jewish organizations, areas of interest, children's information, deceased family members for yahrzeit observance, and selection of the appropriate membership dues category.
The document is a membership application for Temple Beth Sholom that collects contact information, family details, religious background, and dues payment details for applicants. It requests names, addresses, birthdates, marital status, occupations, affiliations with other Jewish organizations, areas of interest, children's information, deceased family members for yahrzeit observance, and selection of the appropriate membership dues category.
The document is a membership application for Temple Beth Sholom that collects contact information, family details, religious background, and dues payment details for applicants. It requests names, addresses, birthdates, marital status, occupations, affiliations with other Jewish organizations, areas of interest, children's information, deceased family members for yahrzeit observance, and selection of the appropriate membership dues category.
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2009/2010
Membership Application THE TEMPLE BETH SHOLOM FAMILY RECORD (This information is treated confidentially in our Temple office.) Full Name ______________________________________________________________________________________ Title: __Mr. __Mrs. __Ms. __Dr. ___Other _________________ (Nickname)________________________ Hebrew Name ___________________________ ben/bat ________________ v ______________________________ Father’s Name Mother’s Name Residence Address _______________________________________________________________________________ Apt. # City and State ___________________________________________________ Zip Code _______________________ Occupation __________________________________ Name of Business ___________________________________ Business Address _________________________________________________________________________________ City State Zip Phone Numbers: Home _________________________________ Business ________________________________________ Cell _________________________ Email or Fax _________________________________________________ Date you moved to Las Vegas ________________________ from _________________________________________ City State Other Congregational affiliation _______________________ in ___________________________________________ City State Date of birth _________ _________ _________ Place of birth ___________________________________________ Month Day Year City State __Married __ Single ___ Separated ___ Widow ___Widower Anniversary________/ ______/_______ Month Day Year I was raised:___ Orthodox; ___ Conservative;___ Reconstructionist; ___Reform; ___Non Practicing; ___Not Jewish Did you convert to Judaism? ___ Yes; ____ No. Conversion Date ________________ Place __________________ City State
Rabbi who coordinated the conversion process: _________________________________________________________
Membership in Jewish Organizations _________________________________________________________________ Areas of interest in Temple activities: ___Men’s Club ___Women’s League ___Religious School ___Preschool ___Adult Education ___ Music Programming ___Committee, which Area(s) ______________________ List name and relationship to any member (s) of the Temple _______________________________________________ Spouse’s Name ___________________________________ Maiden Name ( if applicable) ______________________ Title: __Mr. __Mrs. __Ms. __Dr. ___Other _________________ (Nickname)________________________ Hebrew Name ___________________________ ben/bat ________________ v ______________________________ Father’s Name Mother’s Name Date of birth _________ _________ _________ Place of birth ___________________________________________ Month Day Year City State
Cell _________________________ Email or Fax _________________________________________________
Occupation __________________________________ Name of Business ___________________________________ Business Address _________________________________________________________________________________ City State Zip I was raised:___ Orthodox; ___ Conservative;___ Reconstructionist; ___Reform; ___Non Practicing; ___Not Jewish Did you convert to Judaism? ___ Yes; ____ No. Conversion Date ________________ Place __________________ City State Rabbi who coordinated the conversion process: _________________________________________________________ Membership in Jewish Organizations _________________________________________________________________ UNMARRIED CHILDREN IN HOUSEHOLD Grade # of Yrs. Year of English Name Last Name Hebrew Name Gender Birth Date In Attended Bar/Bat (if different) School Hebrew Mitzvah School
___ The child does not reside with me. The child’s address is _______________________________________________________ For school mailings to be sent to both parents, please list both parent’s name and address information _________________________________________________________________________________________________________
Is the child (children) Jewish by birth? _______ If not, please explain (We consider a child Jewish when the mother was Jewish At time of child’s birth or if the child converted to Judaism.) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________
MARRIED CHILDREN or CHILDREN LIVING AWAY FROM HOME
We would like to stay in touch with our extended Temple Beth Sholom family to remind them of Holy Days and Observances.
Name ___________________________________________ Educational Institute (if applicable) ________________________
Home or Institute Address ___________________________________________________________________________________ City State Zip Field (s) of Study (if applicable) ______________________________________________________________________________ Telephone ________________________________ Fax _____________________ Email ___________________________ Name ___________________________________________ Educational Institute (if applicable) ________________________ Home or Institute Address ___________________________________________________________________________________ City State Zip Field (s) of Study (if applicable) ______________________________________________________________________________ Telephone ________________________________ Fax _____________________ Email ___________________________
YAHRZEIT INFORMATION Name of Deceased ____________________________________ Relationship ___________________________________
Member to be notified _________________________________ Date of Passing ________________________________
Name of Deceased ____________________________________ Relationship ___________________________________
Member to be notified _________________________________ Date of Passing ________________________________
Name of Deceased ____________________________________ Relationship ___________________________________
Member to be notified _________________________________ Date of Passing ________________________________
TEMPLE TEMPLE BETH BETH SHOLOM SHOLOM 2008/2009 2009/2010 DUES DUES SCHEDULE SCHEDULE
United Synagogue of America affiliation dues and Ticket(s) for Seating in the Member’s Section for Rosh Hashanah and Yom Kippur are included.
Family Membership Dues Categories are determined
by the age of the older spouse at the time of application.
Please check the Membership Category Building Fund Assessment Number of HHD that applies to your family situation (Payable over 5 years) Tickets Included
Family (30+ years of age)………………...……$1,560
$1,660 per per year……………………….$2,500 year 2
$1,450 per Senior Family (65+ years of age)………… …$1,350 peryear………………………..$2,150 year 2
$ 730 Starting Family (25-29 years of age)……….…..$ 830 per peryear………………………..$1,175 year 2 $1,320per Single (30+ years of age)………………...……$1,220 peryear………………………...$2,025 year 1
$1,150 per Senior Single (65+ years of age)…………….…$1,050 per year………….……………..$1,750 year 1
$ 650 Single (25-29 years of age)……………….……$ 750per peryear……………..………..…$1,075 year 1
Under 25 years of age (single or married)…………..No Charge……… ….………Not applicable 1
Please note that members are required to pay at least 1/2 of the Annual Membership Dues to receive courtesy seating in the member section for the High Holy Days services. Information is available from the Temple office regarding the costs for additional High Holy Day tickets. The membership year runs from July 1 through June 30 of each year.
Security Fee Members of Temple Beth Sholom help to defray the cost of security through a Security Fee. The fees fees for for the 2009/2010 areyear 2008/2009 $125are $100 for members who do not have children in the preschool or Schechter schools and $150 for households who do have children in one of these schools.
METHOD OF PAYMENT:
Credit Card Payments: You may pay by Visa or MasterCard. If you pay in full there will be no additional charge. If you choose to pay by credit card in installments, a 3% fee will be charged.
____ Payment in full is enclosed.
____ Partial payment is enclosed in the amount of $_________________ (check or money order)
____ Please charge my credit card in the amount of $________________ Charge to my: ____Visa; ____ MasterCard
