Membership

* First Name

* Last Name

* Email

* Preferred contact method

Enter the best way to reach you (e.g. your cell phone or home phone number or email address)

* Your membership level

Early Bird

Your membership is eligible for the $50 Early Bird Discount available on all full memberships submitted before Aug 31.

Click the Early Bird box to activate the discount.

* Do you need seating for Rosh Hashana/Yom Kippur?

Please Select OneYesNo

If you are in need of financial assistance, your situation must be reviewed by the Membership Committee before a discount can be granted. Please contact either the Arnets at membership@adasyeshurun.com or Rabbi Millunchick at director@adasyeshurun.com.

Regardless of the discount you received in previous years, all situations are being reassessed this year.

Membership Choices

Premium Membership ($1800) -includes up to 4 seatsFamily Membership ($1150) - includes 2 seatsSingle Membership ($600) includes 1 seatsFirst Time Family Membership ($600) includes 2 seats

Seats

In the box above please enter the name of each person who will need a seat on a separate line. Please include any seating requests and if you will be attending the early minyan.

Alternate Payments

Credit Card and eCheck (ach) payments can be made by submitting this form with payment using the appropriate line on the Your Membership Level field.Check (sent to 3050 W. Touhy)Head Checks (Please send 1 check additional payments will be set up as ACH payments)I need to make alternate payment arrangements or need financial assistance

Payment Notes

No one will be turned away due to financial difficulties.
HOWEVER SEATS WILL NOT BE RESERVED UNTIL A PAYMENT PLAN IS IN PLACE.
All requests for discounts will be dealt in a private manner by the membership committee.

* Your membership includes 1 seat. How many of these seats will you be using this year?

If you need additional seats please enter them below.

* Your membership includes 2 seats. How many of these seats will you be using this year?

If you need additional seats please enter them below.

* Your membership includes 4 seats. How many of these seats will you be using this year?

* Do you need additional seats?

* Guest Seats ($200)

* Student Seats ($118)

Thank you for being an active part of our kehilah and community.
May we all merit an upcoming year of good health and happiness for our kehillah, community and all of K'lal Yisroel.

* Child Seats (6-17) ($60)

Choose Your Seats

Please complete the section below to ensure seating accommodations are made for everyone in your family/group.

Name - Enter each person in your group on a separate line. For additional lines, increase the number of additional seats specified above.
Location - For women's seats you can request balcony seats and seats in the overflow room downstairs in the notes section.
When - Please let us know if you will be here for both Rosh Hashana and Yom Kippur.
Early Minyan - Please select yes by each person who will be attending the Early Minyan.
Notes - Please use this field to specify location of Women’s Seats (either “Balcony” or “Overflow Room”) along with any other seating requests we should keep in mind

With the exception of Permanent seats, we cannot guarantee that you will get the same seats as last year. Permanent seats can be reserved with a building fund donation of $4,500. To make a building fund donation, please contact the shul office.
To see last years seats click here.

Who needs seats?

	Name	Location	When	Early Minyan	Notes and Seating Requests

* Would you like to sign up for babysitting for Rosh Hashana and Yom Kippur?

Please Select OneNoYes

How many children would you like to sign up for babysitting?

There is a $12 fee per child.

My child will be attending:

Rosh Hashana Day 1 10am-130pmRosh Hashana Day 2 10am-130pmYom Kippur Night 615pm-845pmYom Kippur Day 10am – 3pmYom Kippur Neilah 530pm - 745pm

In order that we can properly staff the groups, please let us know when your child will be attending.

Children younger than 3

Please tell us your child's name and age.
NOTE: Parents will be called out from shul if a diaper needs to be changed.

Children aged 3-6

Children aged 7-10

You can make additional donations now to be bundled with your membership payments.
Click to see various donation options. If you would like to donate to multiple items please select "General Donation" and let us know how you would like your donation allocated.

Additional donation

Amount

Total

OPTIONAL: You may enter notes to our Membership Committee here

Questions? Contact Allan and Rosanne Arnet at membership@adasyeshurun.com or call 773.850-0613.