Temple Beth Am NEW Member Application 2025-2026 - Form

2025-2026 NEW MEMBER APPLICATION

MEMBERSHIP PROFILE

Adult Applicant A (Primary)

Title

Last Name

First Name

Marital Status

Anniversary

Hebrew Name

Date of Birth

Birth Place

Are you a Veteran?

YESNO

Email Address

Cell Phone

Occupation

Business Name

Business Phone

Business Address

Address, City, State, Zip

Languages Spoken

Religious Background

Adult Applicant B (Secondary)

Title

Last Name

First Name

Hebrew Name

Date of Birth

Birth Place

Are you a Veteran?

YESNO

Email Address

Cell Phone

Occupation

Business Name

Business Phone

Business Address

Address, City, State, Zip

Languages Spoken

Religious Background

Child 1

Child 1 Full Name

Child 1 Hebrew Name

Child 1 Date of Birth

Child 1 Email

Child 1 School

Child 1 Grade (2024-2025 school year)

Child 2

Child 2 Full Name

Child 2 Hebrew Name

Child 2 Date of Birth

Child 2 Email

Child 2 School

Child 2 Grade (2024-2025 school year)

Child 3

Child 3 Full Name

Child 3 Hebrew Name

Child 3 Date of Birth

Child 3 Email

Child 3 School

Child 3 Grade (2024-2025 school year)

Child 4

Child 4 Full Name

Child 4 Hebrew Name

Child 4 Date of Birth

Child 4 Email

Child 4 School

Child 4 Grade (2024-2025 school year)

CONTACT INFORMATION

How would you like your name(s) to appear on Temple mailings?

Home Phone Number

Address

Apt., Suite, Etc..

City

State

Zip Code

MEMBERSHIP LEVELS

Thank you for being a part of our Temple Beth Am community. Over the years, we have been proud to provide our members with an unparalleled variety and depth of programs and services. This congregation has a tradition since 1955 of keeping our doors open to all those who seek membership, regardless of ability to pay. As our operating costs continue to increase, we hope that this year, all members who are able, will give as generously as possible to ensure our commitment to excellence.

For families who are blessed with over $150,000 annual income,
we invite you to join one of the Committee of 100 Levels.
The Committee of 100 was created many years ago. Its purpose is to make Temple Beth Am membership possible for those unable to pay full dues, and to enhance our programming. The Committee has grown to over 350 families.

Your leadership support is much appreciated and as a small token for your generosity we offer these rewards:

The Committee of 100: will be recognized in the Commentator and on the wall in our Sanctuary Lobby.
President’s Honor Circle: all of the above plus a Judaica book.
Rabbi’s Honor Circle: all of the above plus complimentary attendance to special events.
Circle of Blessing: all of the above plus a gift of Judaica chosen by our Clergy plus reserved seating in our sanctuary for the High Holy Days for immediate family members and a reserved parking spot for High Holy Days.
Circle of Life: all of the above plus a gift of Judaica chosen by our Clergy plus reserved seating in our sanctuary for the High Holy Days for immediate family members and a reserved parking spot for High Holy Days.

If you have a challenge in meeting the minimum membership contribution, you are encouraged to contact Rita Diaz, Membership Director at 786-364-9434 for a confidential conversation.

Please enter Membership amount from Rita here

SECURITY FEE

SECURITY FEE $975 (required)

Young Adult/Family ages 21–29 = Complimentary Membership (donation appreciated)

Add Donation Amount Here

Members who have completed their 2024–2025 financial obligation are invited to renew. Fulfillment of your total membership obligation must be completed in either one, two, quarterly or monthly payments. Congregants who have a challenge in meeting the minimum contribution are encouraged to contact Rita Diaz, Membership Director, at 786.364.9434.
Rita will help each member with confidentiality and care.

We require 3% convenience fee to help Temple Beth Am offset a portion of the credit card processing fees that are incurred on all credit card transactions.

Building Maintenance Fund

We ask that all new and returning members make a Building Maintenance Fund contribution, in addition to their annual membership commitment. The contribution is fixed at $2,500, payable over a 5-year period (i.e., $500 per year). Payment is not required during the first year of membership but is certainly encouraged if you have the ability to do so. The full amount of your Building Maintenance Fund will be billed in your first year of membership. Payment will be spread out over the subsequent five years of membership. Please enter the amount of your payment in the box below. (If you already have completed your Building Maintenance Fund pledge, please choose option "My Building Maintenance pledge is complete.)

* Building Maintenance Fund ($2500 over 5 years)

Building Maintenance Fund, year 1 $0Building Maintenance Fund, Pay $2500 IN FULL NOWBuilding Maintenance Fund, year 2 $500Building Maintenance Fund, year 3 $500Building Maintenance Fund, year 4 $500Building Maintenance Fund, year 5 $500Building Maintenance Fund, year 6 $500My Building Maintenance pledge is completePlease Select 1

Payment Options

Pay Membership in Full Now. A 3% credit card fee will be added to all credit card charges.Monthly Payment Plan ($200 Fee). A 3% credit card fee will be added to all credit card charges.

Total Due

Payment Authorization

* Authorization for Temple Beth Am to charge my Credit Card or debit my checking/savings account for my membership options above.

I authorize Temple Beth Am to charge my Credit Card for my account balance based on the Payment Plan selected above. A 3% credit card fee will be added to all credit card charges.I authorize Temple Beth Am to debit my Checking/Savings Account for my account balance based on the Payment Plan selected above.

* Signature

Date

Please take this opportunity to tell us "Who You Are"
What are your passions and interests?

Adult Applicant A- Other Interests?

Please list

Adult Applicant B- Other Interests?

Please list