Membership - Cong. Adas Yeshurun

* First Name

Spouse Name

* Last Name

Street Address

City

State

Zip

* Email

Cell

Spouse's Email

Spouse Cell

Security Fee

$36 Security FeeThis security fee helps to defray the costs of the Shabbos Morning Security guard.

* Membership Choices

Please Select OnePremium Membership ($1800) -includes up to 4 seats + $36 Security FeeFamily Membership ($1150) - includes 2 seatsFirst Time Family Membership ($600) includes 2 seatsSingle Membership ($600) - includes one seatPlease contact me regarding my membership level

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.

TOTAL - Additional Donations/earmarks can be made below

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, even if you select same seats as last year, 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.

Who needs seats?

	* Name	Location	When	Early Minyan	Location-	Seating request notes

* 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 $18 fee per child. This fee covers all of yomim noraim even if you only send to one session.

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.

Yomim Noraim/ Yizkor Donation

A donation in this field will be applied to Yom Kippur Yizkor and for our Yomim Noraim Campaign.

Notes for Yizkor Donation

Donation to the Youth Fund

The Youth Fund helps support youth programming in Yeshurun.

Donation to the Security Fund

The Security Fund helps support the Armed Security Gaurd in Shul each week and other security costs.

Donation to Rabbi's Charity Fund

This fund helps those members of our kehillah who may be unemployed, underemployed, facing health or other challenges.

Other Donation

Please add a note to the right.

Notes for your donation

TOTAL

Notes to our Membership Committee here

Questions? Contact Sammy Joseph at membership@adasyeshurun.com.