Renewal - Young Israel Congregation

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Home > Membership & Donations > YICBH 5785 Membership Renewal Form

Membership Renewal

Please type your name and email address. All other requested information is optional.

You can scroll directly to the bottom of this form to select the appropriate dues, fees, and number of High Holiday seats.

If you have the time, you may answer the other questions on this form to keep our database accurate with your current address, names of immediate family members, and gabbai / yahrzeit information.

Thank you for renewing your membership.

For technical help with form issues, email Jared Plitt

Membership Type

INFORMATION: ADULT 1

ENGLISH NAME

* First

* Last

Gender

OTHER DETAILS

* Email

Mobile Phone

Birthdate

INFORMATION: ADULT 2

ENGLISH NAME

First

Last

Gender

OTHER DETAILS

Mobile Phone

Birthdate

Anniversary

ADDRESS INFORMATION

PRIMARY ADDRESS

Would you like to update your primary address we have on file?

Address Line 1

Address Line 2

City

State/Province

Postal Code

Home Phone

SECONDARY ADDRESS

Would you like to provide or update a secondary address?

Secondary Address Line 1

Secondary Address Line 2

Secondary Address City

State/Province

2nd Address Postal Code

CHILDREN'S INFORMATION

Would you like to provide or update your children's information we have on file?

How many children do you have?

Children's Information

English Name

Hebrew Name

Date of Birth

GABBAI INFORMATION

Are any bar-mitzvah age men in your family comfortable with:

laining their Bar-Mitzvah Parsha?laining any parsha, with enough advance notice?leading any part of davening?

Bar-Mitzvah Parsha

YAHRZEITS

Would you like to provide, or update any yahrzeit information we have on file?

How many yahrzeits would you like us to keep track of?

English Name & Relationship

Hebrew Name (transliterated)

English Yahrzeit Date

Hebrew Yahrzeit Date

MEMBERSHIP DUES AND FEES

Required- 5785 Dues

Family Membership	$1,550
Single Membership	$1,150
New Members 40 and Below	$500 first year, Plus security $300

Required- 5785 Fees

Security Assessment	$300
Eruv Council Dues	Included
Building Repair and Reserve Fund	$3,600 (Payment arrangement to be made with the office).

Optional- High Holiday Seats

Permanent Seats	Included
Member High Holiday Seats	$125 per
Non-Member High Holiday Seats	$360 per

TOTAL OF REQUIRED AND OPTIONAL DUES AND FEES:

To renew your membership choose one option below:Option 1. Family Membership - $1,550 + $300 SecurityOption 2. Single Membership - $1,150 + $300 SecurityOption 3. Membership 40 and Below - First year only - $500 + $300 Security

Are you a Permanent Seat holder?

How many of your Permanent Seats do you want to reserve for the High Holidays?

Permanent seats needed, Men - (No additional charge)

Permanent seats needed, Women - (No additional charge)NOTE- This selection is for Permanent Seat holders only, please.

How many High Holiday seats do you want to reserve for MEN?

Member High Holiday seats, Men - $125

Non-Member High Holiday seats, Men - $360

How many High Holiday seats do you want to reserve for WOMEN?

Member High Holiday seats, Women - $125

Non-Member High Holiday seats, Women - $360

Total of Dues, Fees, & High Holiday Seats

Thu, November 21 2024 20 Cheshvan 5785

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