Temple Beth Shira Membership Dues
Membership Dues (Check all that apply)
*
Millenial Annual Membeship (under 45) - $18
Millenial Household (under 45) - $36
New Member - Year 1 (Single) - $180
New Member - Year 1 (Household) - $360
New Member - Year 2 (Single) - $280
New Member - Year 2 (Household) - $560
Renewing Member (Single) - $380
Renewing member (Household) - $760
Men's Club - $50
Sisterhood - $40
Singles Group - $25
Invoice Number
Total Amount Being Paid (Donation):
Adult 1 Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Birthday (MM/DD) for Adult 1
Adult 2 Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Birthday (MM/DD) for Adult 2
Anniversary (if married)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Yahrzeit Information
Name 1
First Name
Last Name
Date of Passing (Gregorian)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relationship To Member (e.g. Mother of Nancy Smith)
Name 2
First Name
Last Name
Date of Passing (Gregorian)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relationship To Member (e.g. Mother of Nancy Smith)
Name 3
First Name
Last Name
Date of Passing (Gregorian)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relationship To Member (e.g. Mother of Nancy Smith)
Name 4
First Name
Last Name
Date of Passing (Gregorian)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relationship To Member (e.g. Mother of Nancy Smith)
Name 5
First Name
Last Name
Date of Passing (Gregorian)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relationship To Member (e.g. Mother of Nancy Smith)
Notes:
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USD
Membership
Calculated Donation
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Additional Donation
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Payment Methods
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