Membership Application - Form - Congregation Har Shalom

Adult 1

* First Name

* Last Name

* Email

Phone

* Date of Birth

Hebrew Name

Pronouns

Occupation (Adult 1)

Preferred Method of Contact (check all that apply)

EmailRegular Mail (Post Office)Phone

Adult 2

First Name

Last Name

Date of Birth

Hebrew Name

Pronouns

Email Address

Phone

Occupation

Preferred Method of Contact (check all that apply)

EmailRegular Mail (Post Office)Phone

* Address

Apt/Unit (if applicable)

* City

* State

* Zip

Number of Children in your Household

Name

Hebrew Name

Birthdate

Gender

School

Previous Synagogue (Name and Location):

Any other affiliations you would like to share:

* Tell us about yourself/family

* Tell us about why you’re interested in joining Har Shalom

What committees would you be interested in joining?

Are there loved ones' Yahrzeit dates you wish to recognize:

English Name

Hebrew Name (if known)

Relationship

Date of Death (English)

Notification Preference

English Name

Hebrew Name (if known)

Relationship

Date of Death (English)

Notification Preference

Membership Pledge

Congregation Har Shalom depends entirely on the financial support of our members. Each member is a very important part of the Har Shalom community and has a sacred responsibility to support the congregation’s educational, spiritual, and life cycle needs. Your membership pledge allows us to pay the annual operating costs of Congregation Har Shalom, and some of the needs of the Jewish community, however, these dues do not cover the costs of programs and events such as Religious School tuition, Bnai Mitzvah, and other event expenses.

* Choose a Membership Category:

Please Select OneRegular MembershipPathway to Judaism MembershipOut of Town Membership

Regular Membership: Includes all member benefits, including weekly e-newsletter, voting privileges, inclusion in the membership directory, and member discounts to programs and High Holidays.
Pathway to Judaism Membership: For those who are in the process of converting to Judaism. Non-voting members but receive all other member benefits.
Out of Town Membership: For those individuals/families who want to support Har Shalom and belong to other congregations, live out of town, have children at local colleges/universities, or are non-Jewish. Non-voting members, but receive all other member benefits.

Please choose a membership dues level:

Mile Chai $5280 per year ($440/month)Chai $3600 per year ($300/month)Ruach $2400 per year ($200/month)Kadimah $1500 per year ($125/month)Mitzvah $1200 per year ($100/month)Aliyah $ 900 per year ($75/month)Experiencing a financial hardship? Check this box if you would like the Executive Director to contact you for a confidential conversation about your membership pledge and to arrange a plan that works for you.

* Please check your preferred payment method of your pledge:

Please selectAuto-pay with ACH or Credit CardSelf-pay online via credit card or check

Please note, each member family is charged an $18 per month security and facility fee. We have security on-site for all services and events and this fee ensures Har Shalom’s ability to continue to provide a secure building and have highly trained security guards while members and guests are on Har Shalom’s campus.

* I understand that in addition to dues I am required to pay a monthly security fee of $18

I understand that in addition to dues I am required to pay a monthly security fee of $18

Signature Adult 1

Signature Adult 2