Membership Dues

Name

First Name Last Name

Phone Number*

Area Code Phone Number

Email

example@example.com

Amount Paying?

How will you be paying?

CheckCredit Card

fee

amount being paid

Please consider paying an additional $3.00 to cover the bank fees incurred when using a credit card

Yes, I will be happy to pay an additional $3.00 to cover the bank feesNo thank you, charge my credit card the original amount

The amount of ${amountPaying} will be applied to your membership. Please write "Membership Dues" in the memo part of your check and mail it to:

Temple Beth El

5150 Peridia Blvd. East

Bradenton, FL 3420

metadata "TBE Membership"

Amount

USDMembership Dues - 4010