Membership Application

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

Lifecycle Groups (check all that apply)

Interest Groups (check all that apply)

What committees would you be interested in joining?

Welcoming CommitteeSpiritual Practices CommitteeYouth Education CommitteeLifelong Learning Committee

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

* Choose a Membership Category:

Regular Membership: Includes all member benefits, including weekly email newsletter, voting privileges, membership directory, children’s programs, adult education classes, and high holiday services. Also includes rabbinic counsel and reduced fee life cycle events.
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.

Membership Pledge

As a member, you are encouraged to contribute according to your financial ability. That is the essence of tzedakah––justice and righteousness––as our tradition teaches. Based on the number of member families and the total operational budget of Har Shalom, we estimate the cost to run the synagogue to be approximately $1,800 per member family per year. Membership dues are the primary way that we keep the lights on, care for our building, pay our Rabbi and professional staff and support our youth and adult education programs.

**Please note: The Aliyah membership category is reserved for Seniors (67+), Young Professionals (<30), and Har Shalom Preschool Families

* Please choose a membership dues level:

Please Select OneMile Chai $5280 per year ($440/month)Chai $3600 per year ($300/month)Ruach $2400 per year ($200/month)Kadimah $1800 per year ($150/month) - sustaining memberMitzvah $1200+ per year ($100+/month)Aliyah** $900 per year ($75/month)Don’t see a level that works for you? Just reach out to our Executive Director for a confidential conversation to discuss a plan that works for you.

If you are in need of financial assistance and unable to meet the dues levels listed, we instead request a modest contribution of 1% of gross household income. By selecting this option, you will be contracted for confidential conversation regarding your dues.

Minimum Dues 1% of Gross Household Income
HH Income	Annual Dues	Monthly Cost
$ 35,360	$ 354	$ 29
$ 40,000	$ 400	$ 33
$ 50,000	$ 500	$ 42
$ 60,000	$ 600	$ 50
$ 70,000	$ 700	$ 58

**Note that Aliyah membership category is reserved for Seniors on a fixed income (67+); Young Professionals (<30), and registered Har Shalom Preschool Families

* Please check your preferred payment method of your pledge:

Signature Adult 1

* Signature Adult 2

The Har Shalom office is closed for Winter Break from Dec. 21 to Jan. 3

Adult 1

Adult 2

Membership Pledge