Leave this field empty

Membership Application
2017-2018

 

Adult 1

Title, First Name, Last Name

Yes
No
Converted
Orthodox
Conservative
Reform
Secular
Christian
Secular
Other
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

This image will be used for office purposes only.

Adult 2

Title, First Name, Last Name

Yes
No
Converted
Orthodox
Conservative
Reform
Secular
Christian
Secular
Other

MM/DD/YY

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

Child 1

First Name, Last Name

If not living with Parent(s)

Yes
No

Child 2

First Name, Last Name

If not living with Parent(s)

Yes
No

Child 3

First Name, Last Name

If not living with Parent(s)

Yes
No

**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.**

Couple (two adult household) $2,790.00
Senior Couple (one person 65 or older) $2,090.00
Single (one adult household) $1,420.00
Senior Single (65 or older) $1,080.00
Young single adult (under 30) $385.00
Associate (member of another temple or child enrolled in a Jewish Day School or Preschool) $845.00

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

Annually $275.00

*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 $72 and $204 per year.

Member 1 - 3 years $300.00
$

Please make check payable to TEMPLE SINAI OF GLENDALE totaling the amount in the parenthesis above.

Dues Adjustment

I would like to be contacted by the Financial Secretary

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Increase the amount by 2.5% to cover credit card fees. Please select YES to increase your payment.
Total: