New Customer Registration Form

Temple Kehillat Chaim2024-2025 Membership Dues Commitment Form
Member Details:
Adult #1*

First NameLast Name
Adult #2

First NameLast Name
Adult #1 Phone Number *
Adult #2 Phone Number
Adult #1 E-mail*
example@example.com
Adult #2 E-mail
example@example.com
Home Phone Number (if applicable)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment Preference

MonthlyQuarterlySemi-Annually (August and February)Annually
Round Up Option

Please round up all my payments ot the nearest $10
Method of Payment. Please indicate a method of payment below.

Please bill me. Statements will be sent for open balances due either monthly, quarterly, semi-annually, or annually.Charge my credit card (please contact the office with your updated credit card information). Balances due will be charged either monthly, quarterly, semi-annually, or annually. A 3% credit card processing fee is addded. See second commitment total box.
No one is denied membership due to financial hardship. If you do not fee you can make a commitment based on the above dues structure, contact our Finance Committee at bookkeeper@kehillatchaim.org.

I will be contacting the Finance Committee to make special arrangements.
Special arrangements are not automatically carried over from year to year, so you must call if your situation requires another year of special arrangements.

If you have any questions about completing this form, please call the TKC Office at 770-641-8630 or email bookkeeper@kehillatchaim.org.

All dues, M&M, and voluntary donations are tax deductible up to the limit allowed by law. Contact your tax advisor for more information.

PLEASE COMPLETE THIS FORM BY JUNE 30, 2024.
Please type your name here to sign this form. The parties agree that electronic signatures and/or executed pdf copies of this agreement will serveas effective originals as though signed in person.
Please verify that you are human*
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Temple Kehillat Chaim2024-2025 Membership Dues Commitment Form