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Temple Beth Sholom Membership Application
Please verify reCaptcha before submitting the form.
*
Membership type
Single
Couple
Adult 1
*
Adult 1: First Name
*
Adult 1: Last Name
Hebrew name
*
Phone
*
Email
Birthday
*
Mailing Address
Address 2
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
Are billing/mailing address the same?
Yes
No
Billing Address
Address 2
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Marital status
Select One
Single
Married
Partnered
Widowed
Separated
Divorced
Anniversary
Have you participated in any of the following TBS programs?
The Tribe
Shalom Baby
Parent Child Classes
Religious Tradition in which you were raised
Reform
Reconstructionist
Conservative
Modern Orthodox
Orthodox
Non-practicing Jew
No religion
Religion other than Judaism
Adult 2
*
Adult 2: First Name
*
Adult 2: Last Name
Adult 2: Hebrew First Name
Phone
Email
Birthday
Is the address the same as Adult 1?
Yes
No
Address
Address line 2
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Have you participated in any of the following TBS programs?
The Tribe
Shalom Baby
Parent Child Classes
Religious tradition in which you were raised
Reform
Reconstructionist
Conservative
Modern Orthodox
Orthodox
Non-practicing Jew
No religion
Religion other than Judaism
How did you find out about Temple Beth Sholom?
Do you have children?
No
Yes
Child
Child Info
First Name
Last name
Hebrew name
Date of birth
Gender
B'nei Mitzvah date
Is/Are your child/children attending:
TBSIS
SLJ/jLAB
After-School Enrichment
Parent Child Programs
What grade level?
Name of school/university
School type
Public
Private
If college student, expected date of graduation
If adult, occupation
Address if not living with you
Marital status
Name of spouse if married
Email
Do you have any special needs?
Would you like to schedule a personal meeting with one of our rabbis?
Yes
No
Please specify the type of Yarhzeit date you would like to observe for your loved one(s).
Hebrew Calendar
Gregorian Calendar
Please list the names and dates of those for whom you wish Yarhzeit (anniversary or death) notices sent.
Please list name, Yarhzeit date (before or after sundown) and relationship to which member.
Emergency contact name
Emergency contact relationship
Emergency contact number
Annual Commitment
Circle of Giving
Please Select One
Pillar - $18,000 - $36,000
Benefactor - $10,000 - $17,999
Guardian - $5,500 - $9,999
Sustainer - $4,000 - $5,499
tbsmb.org/circle-of-giving
Please enter your Circle of Giving amount
Remain anonymous
Remain anonymous
Standard Annual Commitment
*
Select Age Bracket for 1 Adult Household
Please Select One
Age 35+* $2,800
Age 35+* Winter/Dual Membership $1,400
Age 31-34* - $1,200
Age 26-30* - $360
Age 25 and under - Complimentary
*
Select Age Bracket for 2 Adult Household
Please Select One
Age 35+* $3,750
Age 35+* Winter/Dual Membership $1,875
Age 31-34* - $1,800
Age 26-30* - $360
Age 25 and under - Complimentary
Increase my contribution by $250
Increase my contribution by $250
Makes all full time, full dues-paying members part of the Circle of Giving Sustainer Level
Temple Beth Sholom has a mandatory Security Assessment of $425 due annually.
*Age of the eldest adult in the household
**The 12 monthly payment option must be paid in full by May 31, 2023. Payments are prorated over the number of remaining months until May 2023.
*
TBS Legacy Endowment Campaign
Please Select One
Yes
No
Are you interested in learning more about our TBS Legacy Endowment Campaign?
*
TBS Publicity Release
Please Select One
Yes
No
I have read and agree to the TBS Publicity Release policy online at
tbsmb.org/publicityrelease
Join Sisterhood/Women of Reform Judaism (optional)
Not at this time
$54 - Leah
$118 - Rachel
$180 - Sarah
Join Brotherhood (Optional)
Not at this time
$54
ARZA (optional)
Not at this time
$54
Supporting the Reform Israel Fund
TOTAL:
*
Signature
As a member of Temple Beth Sholom, I understand that I am making a full-year financial commitment to support the Congregation. I further understand that the Temple depends on this commitment, and I pledge to fulfill my financial obligation on or before May 31, 2024. If I am unable to do so, I agree to contact the Temple Executive Director to make alternative payment arrangements.
*
Today's Date
Fri, May 17 2024 9 Iyar 5784
