Beth Shalom of Whittier
14564 Hawes Street, Whittier, CA 90604
Office: 562-941-8744 ∙ FAX: 562-941-0449
MEMBERSHIP APPLICATION/RENEWAL
2017-2018 - 5777-5778
PLEASE PRINT
1. Last Name ________________________First ______________ Hebrew Name_________________________ 2. Last Name ________________________First ______________ Hebrew Name_________________________ Address ____________________________________ City ____________________ Zip _________________ Phone: Home (___) ______ - _________
Work (___) ______ - _________ Cell: (___) ______ - ________
1. E-mail Address: _______________ 2. E-mail Address: ________________ Cohen 1__ 2___ Levite 1___2___
Birth Date: 1.____/_____/_19____ Birth Date 2 ._____/_____/_19____ Anniversary Date ____/_____/_____ School-Age Children: Name: ______________________Hebrew Name ________________ DOB____
Public School Grade ______ Name: ______________________Hebrew Name ________________ DOB_____ Public School Grade ______ Name: ______________________Hebrew Name ________________ DOB_____ Public School Grade ______ Name: ______________________Hebrew Name ________________ DOB_____ Public School Grade ______
Please send me Yahrzeit Notices for: ______________________________________D.O.D._________________Relationship___________________ ______________________________________D.O.D._________________Relationship___________________ ______________________________________D.O.D._________________Relationship___________________ ______________________________________D.O.D._________________Relationship___________________ I/We request membership at Beth Shalom of Whittier in the following category:
Membership includes High Holidays and all Life Cycle Events Membership may be paid in 10 monthly billings.
_____ Family Membership $1,025.00 (School tuition included)
_____ Couple Membership $ 700.00
_____ Single Membership $ 525.00
_____ Student Membership $ 300.00
_____ Associate Membership $ 150.00 (Must be full member at another synagogue. No voting privileges)
Your membership is enriched when you participate directly in the various activities of the Congregation. Please list and/or select your special volunteer interests here.
Bingo ____ Fund Raising ____ Serving on the Board ____ House and Grounds ____ Band/Choir
Other (Specify) _________________________
Click here to view our fee schedule
Progressive Conservative Judaism
Beth Shalom of Whittier
Membership