Membership Application - Form - Congregation Neveh Shalom

Thank you for considering membership at Congregation Neveh Shalom. We are excited to be part of this membership journey with you and to help you find belonging and engagement in our kehilla (community)!

* Email

Please enter your contact email address.

ADULT 1 INFORMATION

Adult 1 Title

* Adult 1 First Name

* Adult 1 Last Name

* Adult 1 Date of Birth

* Home Street Address

* City

* State

* Zip Code

* Adult 1 Email Address

Home Phone Number

* Adult 1 Cell Phone Number

* Adult 1 Preferred Pronoun

Adult 1 Employer

* Adult 1 Occupation

Adult 1 Business Phone Number

* Marital Status

Adult 1 Anniversary (if applicable)

Religion

Hebrew Name (English or Hebrew)

Tribe

I consider myself Jewish or I identify as Jewish.My birth mother was Jewish at the time of my birth.

Conversion - Check here if applicable

Yes, I have converted

Conversion City and Name of Congregation

Conversion Date

Do you have a spouse/partner to add to your account?

Please Select OneYesNo

ADULT 2 INFORMATION

Adult 2 Title

Adult 2 First Name

Adult 2 Last Name

Adult 2 Date of Birth

Adult 2 Email Address

Adult 2 Cell Phone Number

Adult 2 Preferred Pronoun

Adult 2 Employer

Adult 2 Occupation

Adult 2 Business Phone Number

Religion

Hebrew Name (English or Hebrew)

Tribe

I consider myself Jewish or I identify as Jewish.My birth mother was Jewish at the time of my birth.

Conversion - Check here if applicable

Yes, I have converted

Conversion City and Name of Congregation (if applicable)

Conversion Date (if applicable)

Do you have children (age 23 or under) to add to your account?

Please Select OneYesNo

FAMILY INFORMATION

Child 1 First Name

Child 1 Preferred Name

Child 1 Last Name

Child 1 Gender

Child 1 Preferred Pronoun

Child 1 School Name

Child 1 Grade

Child 1 Date of Birth

Child 1 Hebrew Name

Do you have other children to add to your account?

Please Select OneYesNo

Child 2 First Name

Child 2 Preferred Name

Child 2 Last Name

Child 2 Gender

Child 2 Preferred Pronoun

Child 2 School Name

Child 2 Grade

Child 2 Date of Birth

Child 2 Hebrew Name

Do you have other children to add to your account?

Please Select OneYesNo

Child 3 First Name

Child 3 Preferred Name

Child 3 Last Name

Child 3 Gender

Child 3 Preferred Pronoun

Child 3 School Name

Child 3 Grade

Child 3 Date of Birth

Child 3 Hebrew Name

Do you have other children to add to your account?

Please Select OneYesNo

Child 4 First Name

Child 4 Preferred Name

Child 4 Last Name

Child 4 Gender

Child 4 Preferred Pronoun

Child 4 School Name

Child 4 Grade

Child 4 Date of Birth

Child 4 Hebrew Name

PRIOR SYNAGOGUE AFFILIATION

* Did you previously belong to a synagogue?

Please Select OneYesNo

If yes, enter the name and location:

If other, please indicate here:

COMMUNICATION PREFERENCES

PHOTO USAGE CONTENT

Throughout the year, we take photos of our congregants (children and adults) for use in our emails, website, and other outreach. If you would like to opt out from photos of you or your child appearing in our publications, please check here:

DO NOT use photos of our family for CNS materials.

BUILDING FUND CONTRACT

The Board of Directors has resolved that each new member shall agree to pay a Building Fund Assessment of $2,925 payable over a six-year time period. (This time period can be extended in extenuating circumstances.)
First building fund payment to coincide with first membership commitment payment.

By entering my name in the Signature box below, I agree to a Building Fund Assessment of $2,925 to be paid in full by:

Signature:

SAFETY & SECURITY ASSESSMENT

All member families are automatically billed an annual $150 security fee, which contributes to our building’s safety. This can be reduced or removed for this year by selecting an option below.
Please note that this amount can be paid over the course of 12 months.

Full Security Assessment: $150Reduced Security Assessment: $100Reduced Security Assessment: $50Remove Security Assessment: $0

MEMBERSHIP COMMITMENT

Please Select OneSustaining Member (35+), 2 adults, or family with children: $2,925Senior Members (65+), 2 senior adults: $2,475Senior Member (65+), single senior: $1,833CNS Member (35+), single adult, or interfaith family, or single-parent family: $2,475Young Family Members (<35), 2 adults, both parents under 35, plus children under 18: $1,463Young Adult Member, ages 18-35: $180Please contact me about our membership commitment level.

Payment Schedule:

Please indicate how you would like to pay your membership commitment:

AnnuallyQuarterlyMonthly