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This website is dedicated in memory of Helen & Ben Kershenbaum and Ceil & Nat Nathanson

Membership Application

Thank you for your interest in joining our shul. After submitting the application below, a member of our Membership Committee will be in contact with you.
Membership Application:
Last Name:
Street Address:
City/State/Zip:
Phone:
Emails Email 1: Email 2:
Date Moving In
Full (Family) Membership:
  • Current annual dues: $850 + $50 Chevra Kadisha fee.
  • If signing up after July, dues are pro-rated the first year.
  • First year membership dues is 50% off ($425); Second year is 25% off."
Single Membership:
  • Current annual dues: $425 + $50 Chevra Kadisha fee.
In addition, our Building Fund is $2,500 for Homeowners Only, payable over years 2 and 3.

Youth Department:
  • Presently $35.00 per family with any children ages 2 ½ to 18.
Special arrangements can be made by contacting the Special Arrangements Committee.

For further details, contact our executive director Abraham Borenstein.
Member Type
Kohen/Levi/Yisrael
Name Spouse
First Name:
Occupation:
Office Phone:
Hebrew Name:
Father's Hebrew Name:
Mother's Hebrew Name:

Information about your children for our Youth Programs
Children's Names Hebrew Name Age School
1.
2.
3.
4.
5.
6.

Yahrzeits
Name Date Hebrew Date Relationship
1.
2.
2.
2.

Check off committees of interest to you:
Please enter any additional information you would like to provide: