Membership Application

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FULL FAMILY MEMBERSHIP

Annual Full Family Membership Dues are $1200.
Additional amounts are:

Security Fee: $250
National Council of Young Israel Dues: $25
Chazak Project Building Fund: $3,800 payable over 4 years
$950 per year for each of 4 years
$3,400 if paid all 'up front'

FULL SINGLE MEMBERSHIP
Annual Single Family Membership Dues are $600.
Additional amounts are:

Security Fee: $250
National Council of Young Israel Dues: $25
Chazak Project Building Fund: $1,900 payable over 4 years
$475 per year for each of 4 years
$1,700 if paid all 'up front'

ASSOCIATE FAMILY MEMBERSHIP
Annual Associate Family Membership Dues are $950.
Additional amounts are:

Security Fee: $250
National Council of Young Israel Dues: $25

ASSOCIATE SINGLE MEMBERSHIP
Annual Associate Single Membership Dues are $475.
Additional amounts are:

Security Fee: $250
National Council of Young Israel Dues: $25

* What kind of member?

* Last Name

* Primary First Name

Title

Gender

Marital Status

SingleMarriedDivorcedWidowed

Business Phone No.

Primary's Cell Phone

* Primary's Email Address

* Address

Address 2

* City

* State

* Zip

Primary's Hebrew Name

Tribe

Primary's Father's Hebrew Name

Primary's Mother's Hebrew Name

Occupation

Spouse Last Name

Spouse First Name

Title

Gender

Occupation

Business Phone No.

Secondary's Cell Phone

Secondary's Email Address

Secondary's Hebrew Name

Secondary's Father's Hebrew Name

Secondary's Mother's Hebrew Name

CHILDREN

Child 1

Name

Hebrew Name

Date of Birth

School

Email Address

Child 2

Name

Hebrew Name

Date of Birth

School

Email Address

Child 3

Name

Hebrew Name

Date of Birth

School

Email Address

Child 4

Name

Hebrew Name

Date of Birth

School

Email Address

Child 5

Name

Hebrew Name

Date of Birth

School

Email Address

Child 6

Name

Hebrew Name

Date of Birth

School

Email Address

YAHRZEITS

Family Member 1

Full English Name of the Deceased

Hebrew Name

Father's Hebrew Name

Hebrew Date of Death

Relationship to You

Other Relationship

Mourner's Name

Family Member 2

Full English Name of the Deceased

Hebrew Name

Father's Hebrew Name

Hebrew Date of Death

Relationship to You

Other Relationship

Mourner's Name

Family Member 3

Full English Name of the Deceased

Hebrew Name

Father's Hebrew Name

Hebrew Date of Death

Relationship to You

Other Relationship

Mourners Name

Family Member 4

Full English Name of the Deceased

Hebrew Name

Father's Hebrew Name

Hebrew Date of Death

Relationship to You

Other Relationship

Mourners Name

Tue, September 28 2021
22 Tishrei 5782

CONTACT

859 Peninsula Blvd
Woodmere, NY 11598
Phone: (516) 295-0950
Fax: (516) 295-4212
E-mail: office@yiwoodmere.org

Tue, September 28 2021 22 Tishrei 5782