Dues Consideration Form

A REQUEST FOR SPECIAL DUES WILL NOT BE CONSIDERED UNLESS ALL INFORMATION AS REQUESTED IS COMPLETED.

APPLICANT, PLEASE NOTE: The information requested will be treated with the utmost confidence. Only fully completed applications will be reviewed; therefore, we kindly request you provide all requested information.

SPECIAL DUES GRANTED FOR ONE YEAR ONLY: The objectives of Temple Beth Am are to provide and conduct Jewish religious services and education and to provide for and promote the spiritual, cultural and social welfare of its members, its youth, and the community. These objectives can be attained only through the financial support and volunteer activities of all its members, such as the payment of dues, and the financial, religious, educational and social support of synagogue-related programs.

Your Name(Required)

First Last

Date of Birth(Required)

Phone(Required)

Email(Required)

Spouse's Name (if applicable)

First Last

Spouse's Date of Birth

Number of Children

Ages of Children

Number of children to attend TBA JLC (religious school)

Number of children to attend Pressman Academy ECC

Number of children to attend Pressman Academy

Occupation of Applicant(Required)

Employer

Occupation of Spouse

Spouse's Employer

Applicant's Annual Income(Required)

Spouse's Annual Income

Applicant's and spouse's retirement income

Additional income from any source

Previous Synagogue Affiliation(s)

Please include names and dates.

Rent/Mortgage

Membership includes dues plus a facility fee of $200 and a security fee of $950. What is the total amount you can pledge to support your synagogue?(Required)

Describe in detail the reason for your request for special dues consideration

We appreciate that our members may support more than one synagogue. Decisions are based solely on financial need.

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