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 Address

* How did you hear about us?

Please list any friends or relatives who are members of Neveh Shalom and their relationship to you

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 Pronouns

Adult 1 Employer

* Adult 1 Occupation

If retired, please list former occupation and tick the following box

Adult 1 is retired

Adult 1 Business Phone Number

* Marital Status

Adult 1 Anniversary (if applicable)

ADULT 1 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 OneYesNoPlease fill out this section even if your partner is not Jewish.

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 Pronouns

Adult 2 Employer

Adult 2 Occupation

If retired, please list former occupation and tick the following box

Adult 2 is retired

Adult 2 Business Phone Number

ADULT 2 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.I am not Jewish. We are an interfaith family.

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 (up to and including age 26) to add to your account?

Please Select OneYesNo

CHILD 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

FAMILY INFORMATION

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.

YAHRZEIT OBSERVANCES

Please click the + below, if you would like to add any yahrzeit observances to your Neveh Shalom account:

Deceased First Name

Deceased Last Name

English Date of Death

We will use this date to calculate the Hebrew date of death.

After sunset?

Mourner First Name

Mourner Last Name

Relationship to Deceased

ex. I am observing the yahrzeit of my grandfather

MEMBERSHIP FEES

You will not make any payments today! Monthly payment plans are also available.

PART 1 of 3: MEMBERSHIP COMMITMENT

Standard annual commitment levels for July 1, 2023 - June 30, 2024.
Note: New memberships are only prorated after the High Holy Days.

* Family Types:

Please Select OneSustaining Members (ages 35+): 2 adults (one or both 35+), plus any children under 18: $3,072Sustaining Member (age 35+): 1 adult; or interfaith family; or single-parent family: $2,599Senior Members (ages 65+): 2 senior adults (one or both 65+): $2,599Senior Member (age 65+): 1 senior adult: $1,925Young Adult Family (ages <35): 2 adults (both under 35), plus any children under 18: $1,536Young Adult Single (age 18-34): $180

Financial Accommodations:

PART 2 of 3: SAFETY & SECURITY ASSESSMENT

Neveh Shalom places a high priority on the security and safety of those visiting our campus. To support this obligation, we seek the involvement of the congregation through this security commitment.

Full Security Assessment: $180Reduced Security Assessment: $120Reduced Security Assessment: $60

PART 3 of 3: BUILDING FUND CONTRACT

The Board of Directors has resolved that each new member shall agree to pay a Building Fund assessment of $3,072 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 $3,072 to be paid, in full, within the next 6 years:

Signature:

Payment Schedule:

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

AnnuallyQuarterlyMonthly