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New Full Member Application
Please verify reCaptcha before submitting the form.
Primary Account Holder Information
*
Primary Person Title
*
Primary Person First Name
*
Primary Person Last Name
Home Telephone
*
Best Email Address
*
Cell Phone Number
*
Date of Birth
*
Hebrew First Name
*
Father's Hebrew Name
*
Mother's Hebrew Name
*
Were You Born Jewish?
Please Select One
Yes
No (Please provide details of conversion)
*
Please provide details of conversion
*
Occupation
Business Name
*
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Date of Marriage
Secondary Account Holder Information
Spouse's Title
Spouse's First Name
Spouse's Last Name
Cell Phone Number:
Email Address:
Date of Birth:
Hebrew Name:
Father's Hebrew Name
Mother's Hebrew Name
Were You Born Jewish?
Please Select One
Yes
No (Please provide details of conversion)
*
Please provide details of conversion
Occupation
Business Name
Account Information
*
Home Street Address
*
City
*
State
--Select State--
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Alaska
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California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Kentucky
Louisiana
Maine
Maryland
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Michigan
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Nevada
New Hampshire
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New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
Please list the English & Hebrew Names of Any Unmarried Children, Dates of Birth, & Gender
Please list the English & Hebrew Names of Any Married Children & their Spouses Names
Please List All Yahrzeits:
Please include for each deceased individual:
English Name
Hebrew Name (ex. Yitzchak ben Avraham)
Secular & Hebrew Date & Year of Death
Your Relationship to the deceased
Membership is effective upon approval by the Board of Directors and receipt of first dues payment or establishment of payment plan.
Membership Dues (Fiscal year June 1st to May 31st)
$1,395.00 per family $697.50 singles
Building Fund payable over 5 years
$6,000.00 per family $3,000.00 singles
Young Members Discount
If you (and/or your spouse, where applicable) are below the age of 33 you may apply for the Young Members Discount.
This entitles you to pay half membership for the first two years of membership and to defer the building fund for the first two years of membership.
After the first two years, membership will increase to the then-current full amount and you will be responsible to begin paying the then-current building fund.
Under 30 Discount
If you (and/or your spouse, where applicable) are below the age of 30, you may apply for the Under 30 Discount.
This entitles you to pay $150 for membership/year until the age of 30 and to defer building fund for the first two years of membership.
After the first two years, you will be responsible to begin paying the then-current building fund. At age 30 membership rates will increase to the then-current rate.
All Full Members, regardless of age, are required to pay the following fees and assessments each fiscal year:
$250 Security Assessment
$36 Mikvah Fee
$18 Eruv Fee
Are you interested in the Young Members Discount (under 33)?
Please Select One
Yes
No
Are you interested in the Under 30 Discount?
Please Select One
Yes
No
*
We/I apply for full membership in Congregation Bnai Yeshurun and accept the financial obligations as set by the synagogue and agree to abide by the Constitution and By-laws.
We/I apply for full membership in Congregation Bnai Yeshurun and accept the financial obligations as set by the synagogue and agree to abide by the Constitution and By-laws.
Wed, February 12 2025 14 Shevat 5785