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Membership Application

In order to fill out this form completely, please scroll down and click on all the sections in blue type to open them (Adult Information, Yahrzeits, Children Information, Membership Classification).

Adult Information

Adult 1

* Full Name

Title, First Name, Last Name

* Birth date

* Gender

* Marital Status

* Street Address

* City, State, Zip

* Home Phone

Cell Phone

* Email Address

Fax

Occupation

Business Address

Born Jewish?

Yes

Converted

Tradition Raised?

Orthodox

Conservative

Reform

Secular

Hebrew Name

Bar/Bat Mizvah Date

Can you read and/or chant Hebrew?

If not born Jewish, raised

Christian

Secular

Other

If other:

Interest/Volunteer/Skill Areas:

Adult Education

Board of Directors

Brotherhood

Sisterhood

Social Action

Transportation Assistance

Landscaping/Gardening

Choir

Library

Fund Raising

Senior Adults

Mah Jongg

20's and 30's Group

Caring Community

Legal

Mailings

Computer

Community Relations

Clerical Help

Sound Systems

Photography

Handy-Person

Other

If other:

Family Photo

This image will be used for office purposes only.

Adult 2

Full Name

Title, First Name, Last Name

Birth date

Gender

Marital Status

Street Address

City, State Zip

Home Phone

Cell Phone

Email Address

Fax

Occupation

Business Address

Born Jewish?

Yes

Converted

Tradition Raised

Orthodox

Conservative

Reform

Secular

Hebrew Name

Bar/Bat Mitzvah Date

Can you read and/or chant Hebrew?

If not born Jewish, raised

Christian

Secular

Other

Wedding Anniversary

MM/DD/YY

Interest/Volunteer/Skill Areas:

Adult Education

Board of Directors

Brotherhood

Sisterhood

Social Action

Transportation Assistance

Landscaping/Gardining

Choir

Library

Fund Raising

Senior Adults

Mah Jongg

20's and 30's Group

Caring Community

Legal

Mailings

Computer

Community Relations

Clerical Help

Sound Systems

Photography

Handy-Person

Other

Yahrzeits

Name of Deceased

Relationship

Date of Death

Name of Deceased

Relationship

Date of Death

Name of Deceased

Relationship

Date of Death

Name of Deceased

Relationship

Date of Death

Name of Deceased

Relationship

Date of Death

Children Information

Child 1

Full Name

First Name, Last Name

Gender

Mailing Address

If not living with Parent(s)

Birth date

Hebrew Name

Bar/Bat Mitzvah Date

Read and/or chant Hebrew?

Confirmation Date

Name of School

Grade

Hebrew School Grade

Religious School Grade

Attend Jewish Camp? Name of Camp?

Physician Name

Phone

Allergies?

Other pertinent medical information

Interested in Junior or Senior Youth Group?

Yes

Child 2

Full Name

First Name, Last Name

Gender

Mailing Address

If not living with Parent(s)

Birth date

Hebrew Name

Bar/Bat Mitzvah Date

Read and/or chant Hebrew?

Confirmation Date

Name of School

Grade

Hebrew School Grade

Religious School Grade

Attend Jewish Camp? Name of Camp?

Physician Name

Phone

Allergies?

Other pertinent medical information

Interested in Junior or Senior Youth Group?

Yes

Child 3

Full Name

First Name, Last Name

Gender

Mailing Address

If not living with Parent(s)

Birth Date

Hebrew Name

Bar/Bat Mitzvah Date

Read and/or chant Hebrew?

Confirmation Date

Name of School

Grade

Hebrew School Grade

Religious School Grade

Attend Jewish Camp? Name of Camp?

Physician Name

Phone

Allergies?

Other pertinent medical information

Interested in Youth Group?

Yes

Membership Levels and Fees

**If you are need of dues relief, please still select the membership classification that applies to your household and check the Dues Adjustment box below.**

Please note that the amounts for the dues and security fees are for the 6 months ending June 2025.

Classification (Dues 2024-2025)

Couple/Family (two adult household) $1,570.00

Senior Couple (one person 65 or older) $1,175.00

Single/Family (one adult household) $800.00

Senior Single (65 or older) $610.00

Young single adult (under 30) $210.00

Associate (member of another temple or child enrolled in a Jewish Day School or Preschool) $475.00

Our Annual Security Assessment is for the safety and well-being of our community and its members.

* Security Assessment

Annually $200.00

*New members also pay a Building Maintenance Assessment of $300 annually for 3 years; all other members pay an Annual Maintenance Repair Fund charge of between $75 and $205 per year.

* Building Maintenance Assessment

Member 1 - 3 years $300.00

Additional Donation

About Financial Assistance

Temple Sinai does not deny membership to anyone due to financial hardship. A financial hardship does not have to be a catastrophic event. If for any reason you feel you require an adjustment, please check here and our Financial Secretary will contact you for a confidential conversation.

I would like to be contacted by the Financial Secretary

Will you pay by check (or if Financial Assistance is needed):

Please make check payable to TEMPLE SINAI OF GLENDALE

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Comments

For added Security please check the box below.

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