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Congregation Beth El Membership Commitment Form

Please update any of the following information with current data.

* Family Name:

* First Name (s):

Street Address

City, Sate, Zip

Home Phone:

Email (Adult 1):

Cell Phone (Adult 1):

Email (Adult 2):

Cell Phone (Adult 2):

Membership Information

Your Current Membership Category Is:

Dues:

Please select the voluntary contributions you would like applied to your account:

	Shomrim - If you would like to join this dues-inclusive program, see options below and details in the enclosed brochure
	JTS Donation (Jewish Theological Seminary) - $10.00
	Chai Donation (Family Support Fund) - $72.00

Other Contributuon Amount:

Please Contact me about the following

	Volunteering
	Life & Legacy - Estate planning for our future

Join Shomrim and Become a Guardian of Our Community

Shomrim Member

I/We wish to become part of the Shomrim benefactor program. Shomrim is a dues-inclusive giving program designed to allow benefactors to commit one time during the year to support the annual activities and operational needs of Beth El. Information about benefits of Shomrim are included in this packet of information.

Please write in the dollar value that you would like to contribute for the selected level of Shomrim. The ranges listed below are inclusive of annual synagogue membership dues.

Guardian - $5,000 - $7,499

Benefactor - $7,500 - $9,999

Builder - $10,000 - $14,999

Sustainer - $15,000 - $24,999

Visionary - $25,000 - $49,999

Pillar - $50,000+

Please list as:

Check this box if you would like to remain anonymous

Yes

Financial Policy

In order to satisfy your financial commitment to Congregation Beth El and be considered a member in good standing, we are asking our members to choose one of the payment options and methods listed on this form. A member in good standing is defined as: being current with all fees and donations including Dues, Capital Campaign, Religious School, Hebrew High and Early Childhood Center Tuition Payments and Fees, B’nai Mitzvah Fees and Fund Account Donations.

Financial arrangements may be made with our Financial Secretary. At the beginning of our new fiscal year (July 1), the Financial Committee will review all accounts with open prior balances that are not in good standing and will contact congregants to arrange for a payment plan to bring outstanding balances current.

All of the above requirements are necessary for Beth El to honor your High Holy Day Seating Request.

Choose Your Payment Option

Payment Plans (to be set up by the Beth El office)

	1 Payment Plan - Pay in full by July 1 with check, ACH or credit card. If paying by credit card, the surcharge will be waived.
	2 Payment Plan - 50% by July 1 / 50% by December 31, payable by check, ACH or credit card. If paying by check or ACH, there is no fee. If paying by credit card, there will be a 2.5% surcharge added to each payment.
	12 Month Payment - Plan: Equal monthly installments from July 1 to June 1. If paying by check or ACH, there is no fee. If paying by credit card, there will be a 2.5% surcharge added to each payment.
	Special Arrangement Plan - If your financial circumstances do not permit you to pay the required dues amount or make payments through the above options, please contact the Financial Secretary at the Beth El office. Request for special arrangements should be made no later than May 31.

Account Details

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

*E-mail

*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

Comments

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

Total: