Membership Application

* * Email

of person filling out the form ↑

* * Today's Date

ADULT - 1

ADULT - 2

* * First Name

First Name

* * Last Name

Last Name

Hebrew Name

Gender

⠀MaleFemaleUnspecified

* * Date of Birth

Date of Birth

* * Marital Status

Married/PartneredSingleWidowedDivorced

Marital Status

Married/PartneredSingleWidowedDivorced

* * Religious Traditions in which you were raised

Religious Traditions in which you were raised

* * Home Address

Home Address

* * City

City

* * State

State

* * ZIP

ZIP

Home Phone

* * Cell Phone

Cell Phone

* * Email Address

Email Address

Children's Information (under the age of 26)

* * First Name

* * Last Name

* * Date of Birth

* * Gender

Please Select OneMaleFemaleUnspecified

Hebrew Name

* * Current Grade

Child's Email Address

Child's Cell Phone

EMERGENCY CONTACT

Name

Phone

Relationship

* MEMBERSHIP CONTRIBUTION

We ask that you consider the importance of your role in ensuring a strong and vibrant Beth Hillel Temple congregation. To fully fund the operating budget (salaries, utilities, supplies, insurance, etc.) equally across our membership each household’s share or sustaining amount is $3,000. We recognize that some in our membership are able to give more and others less than this amount. Please consider making at least a 4% increase over your commitment of last year. The amount of your commitment is up to you. The willingness of our members to make these pledges and then to fulfill them has made the Member Community Commitment process a success.

SPECIAL NOTE: In an effort to make BHT even more inclusive, tuition for the BHT Religious School is considered part of the MCC pledge. While tuition is included, we know the cost is approximately $850. We hope every member will consider supporting the Religious School with a little extra in your MCC pledge this year.

* Choose one from the following 2 options and enter your ($) amount:

1. Commit to the sustaining amount ($3,000) or larger amount

Enter Amount ↑

2. Commit to a different amount ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀

Enter Amount ↑

* PHOTO RELEASE FORM
With this form, your permission is requested for photos of you and your family members to be published in Beth Hillel Temple’s newsletters, website, and other publicity materials so that we may celebrate and publicize our congregation and its activities. Temple policy dictates that when children are the primary subject of the photo, even if prior parental permission has been obtained on registration forms, an extra step of notifying parents to let them know that we are considering using their child’s photo will be undertaken. When adults are featured and easily identified (i.e., they are the main or only subject of the picture), we will have their permission prior to publication of their photo and name in the caption of materials publicly accessible. Names will not be associated with any pictures posted on Facebook and pictures will not be tagged. Group shots, silhouettes, long-distance views, and other photos in which individual children are not identifiable do not require permission for publishing on the web. Personal addresses, e-mails, and phone numbers of members will not be posted on the public portion of the website.

Please check one of the following choices:

I/We GRANT to Beth Hillel Temple its representatives and employees the right to take photographs of me and my property in connection with activities of the Temple. I authorize Beth Hillel use and publish the same in print and/or electronically.

I agree that Beth Hillel Temple may use such photographs of me with my name, if I am easily identified and I am over 22 years of age, on the website, and without my name, if I am younger than 22, for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I/We DO NOT GRANT to Beth Hillel Temple its representatives and employees the right to take photographs of me and my property in connection with activities of the Temple.

* SIGNATURES
Please complete this application by typing in your full name below, which will act as your signature.

* ADULT - 1

ADULT - 2

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