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Membership Application

Beth Sholom Membership Application

Opening hearts and minds to the blessings of Jewish life
Uplifting and inspiring one another on our Jewish journeys

Thank you for your interest in joining Beth Sholom Synagogue. We are an inclusive, egalitarian Conservative congregation, established in 1955. Beth Sholom is a 501C-3 not-for-profit institution that is supported partially by the dues of its members and the building fund, as well as by donations and fundraisers. Dues are billed in July. We look forward to your involvement in synagogue life, as well as your financial support.

Membership Levels

General Membership	$2,100
• Two Jewish adults with or without dependent children
• One Jewish adult & one non-Jewish spouse/domestic partner, with or without dependent children (Jewish partner may opt for an Individual Membership)
Individual Parent Membership	$1,575
• (Individual Jewish adult with dependent children)

Individual Membership	$1,050
• (Individual Jewish adult)

Young Adult Membership	Starts at $18/month
• (Individual Jewish adult under age 30)

Associate Membership	$450
• (Primary member at another dues-dependent synagogue)

Building Fund Assessment,
(5 year pledge divided over first 5 years of membership)

General Membership	$3,600
Individual Parent Membership	$2,700
Individual Membership	$1,800
Young Adult Membership	$600
Associate Membership	N/A

Building Maintenance Supplement
(After first 5 years of membership)

General Membership	$200
Individual Parent Membership	$150
Individual Membership	$100
Young Adult Membership	N/A
Associate Membership	N/A

Security Supplement
(Annual)

Full Dues	$50
Reduced Dues	$5

* Membership Level:

Please Select OneGeneral MembershipIndividual Parent MembershipIndividual MembershipYoung Adult MembershipAssociate Membership

Associate membership only, Name of synagogue at which you maintain a full membership:

First Member

* First Name

Middle Name

* Last Name

Gender:

Pronouns

* E-Mail Address

Full Hebrew Name, Transliterated

(Type for English letters)

Full Hebrew Name, in Hebrew (optional)

(Use pop-up keyboard for Hebrew letters)

Tribe

Birthday

Mobile Phone Number:

Title

Work Phone:

Occupation:

Bar/Bat Mitzvah Portion

(If applicable)

Conversion Date:

(If applicable)

Conversion Synagogue:

(If applicable)

Conversion Rabbi:

(If applicable)

Second Member or Non-Jewish Spouse

First Name:

Middle Name

Last Name

Gender:

Pronouns

E-Mail Address

Full Hebrew Name, Transliterated

(Type for English letters)

Full Hebrew Name, in Hebrew (optional)

(Use pop-up keyboard for Hebrew letters)

Tribe

Birthday

Mobile Phone Number:

Title

Work Phone:

Occupation:

Bar/Bat Mitzvah Portion

(If applicable)

Conversion Date:

(If applicable)

Conversion Synagogue:

(If applicable)

Conversion Rabbi:

(If applicable)

* Street Address Line 1

Street Address Line 2

* City

* State

* Zip

Home Phone

Anniversary Date

(If applicable)

CHILDREN (Transliterate all Hebrew names)

Child 1 English Name

Child 1 Hebrew Name

Tribe:

Gender:

Pronouns:

Birthdate:

Email Address:

Mobile Phone Number:

Conversion Date:

(If applicable)

Conversion Rabbi:

(If applicable)

Child 2 English Name

Child 2 Hebrew Name

Tribe:

Gender:

Pronouns:

Birthdate:

Email Address:

Mobile Phone Number:

Conversion Date:

(If applicable)

Conversion Rabbi:

(If applicable)

Child 3 English Name

Child 3 Hebrew Name

Tribe:

Gender:

Pronouns:

Birthdate:

Email Address:

Mobile Phone Number:

Conversion Date:

(If applicable)

Conversion Rabbi:

(If applicable)

Child 4 English Name

Child 4 Hebrew Name

Tribe:

Gender:

Pronouns:

Birthdate:

Email Address:

Mobile Phone Number:

Conversion Date:

(If applicable)

Conversion Rabbi:

(If applicable)

YAHRZEITS (Transliterate all Hebrew names)

English Name of Deceased

Hebrew Name of Deceased

Date of Passing (English or Hebrew)

Check if after sundown

Check if after sundown

Relationship to Mourner

Name of Mourner

English Name of Deceased

Hebrew Name of Deceased

Date of Passing (English or Hebrew)

Check if after sundown

Check if after sundown

Relationship to Mourner

Name of Mourner

English Name of Deceased

Hebrew Name of Deceased

Date of Passing (English or Hebrew)

Check if after sundown

Check if after sundown

Relationship to Mourner

Name of Mourner

English Name of Deceased

Hebrew Name of Deceased

Date of Passing (English or Hebrew)

Check if after sundown

Check if after sundown

Relationship to Mourner

Name of Mourner

Fill in any other yahrzeits here.

I am/We are interested in participating in the following areas of synagogue life:

Adult Education

Adult Education

Interested Member(s)

Torah/Haftarah Chanting

Torah/Haftarah Chanting

Interested Member(s)

Minyan/Service Participation

Minyan/Service Participation

Interested Member(s)

Tikkun Olam (Repairing the World)

Tikkun Olam (Repairing the World)

Interested Member(s)

Chevra Kadisha (Cemetery)

Chevra Kadisha (Cemetery)

Interested Member(s)

Chesed Committee

Chesed Committee

Interested Member(s)

Fundraising

Fundraising

Interested Member(s)

Programming Development

Programming Development

Interested Member(s)

Youth Groups

Youth Groups

Interested Member(s)

Sisterhood

Sisterhood

Interested Member(s)

Center for Jewish Spirituality

Center for Jewish Spirituality

Interested Member(s)

What talents, skills, interests, and hobbies do you have that you would like us to know about?

Wed, November 30 2022 6 Kislev 5783

Beth Sholom Synagogue ♦ 6675 Humphreys Blvd ♦ 901-683-3591 ♦ Email Us

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