Kehilat Pardes - RCS Membership Form

Kehilat Pardes - RCS Membership Form
If you prefer a hard copy - print the form by pressing Ctrl-P and send via mail
Membership Type*

New MemberRenewal
Membership Type*

Triple Chai ($5,520)Double Chai ($3,720)Chai Family ($2120)Chai Single (All Ages) or Under 30 (Family/Couple) $1,060Chai Senior Family/Couple (65+) $1,360Family ($1420)Senior (Family/Couple) 65+ ($870)Under 30 (Family/Couple and Single - All Ages) ($710)Friend of KP-RCS (Does Not Include Full Membership Rights) ($180)
*Chai Family, Single, or Senior:

- One standard Kiddush sponsorship
- B'nei Mitzvah sponsorship
- Free admission to Women's Sukkot event
- Free admission to Chinese and Trivia Night
- Free admission to Women's Open Mic Night
- Simchat Torah meal sponsorship (this does not include meal costs)
- Shavuot meal sponsorship (this does not include meal costs)
- 10 names in the Yizkor Companion

Double Chai membership includes:

Chai Family benefits plus:
- Pesach meal sponsorship (this does not include meal costs)
- Shavuot guest speaker sponsorship
- One Seudah Shlishit sponsorship
- ½ page in the Yizkor Companion

Triple Chai:

Double Chai benefits plus:
- An additional standard Kiddush sponsorship
- Free admission to all communal meals
- Unlimited Yizkor and Yahrzeit book listings
- High Holiday babysitting
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Personal Information (Member #1)
Name*

PrefixFirst NameLast Name
Hebrew Name
Occupation
Date of Birth

MonthDayYear
E-mail*
example@example.com
Cell Phone*

Area CodePhone Number
Personal Information (Member #2)
Name

PrefixFirst NameLast Name
Hebrew Name
Occupation
Date of Birth

MonthDayYear
E-mail
example@example.com
Cell Phone

Area CodePhone Number
Family Information
Would you like to add any additional family information? (wedding anniversary , children's name, etc.)

YesNo
Family Information (details)
Wedding Date

MonthDayYear
How many children are in the family?
**Please include your children's information, even if you opt-out. This information is used by our Youth Program coordinators to include your children in their programming.
Child #1 English Name
Child #1 Hebrew Name
Child #1 Date of Birth

MonthDayYear
Child #1 Grade
Child #2 English Name
Child #2 Hebrew Name
Child #2 Date of Birth

MonthDayYear
Child #2 Grade
Child #3 English Name
Child #3 Hebrew Name
Child #3 Date of Birth

MonthDayYear
Child #3 Grade
Child #4 English Name
Child #4 Hebrew Name
Child #4 Date of Birth

MonthDayYear
Child #4 Grade
Child #5 English Name
Child #5 Hebrew Name
Child #5 Date of Birth

MonthDayYear
Child #5 Grade
Yahrtzeit Information
Would you like to add any Yahrtzeit information?

YesNo
Yahrtzeit Information (Member #1)
Name of person you are remembering

First NameLast Name
Hebrew Name
Relationship
English Date of Passing

MonthDayYear
Hebrew Date of Passing (if English date is unavailable)
Father's Hebrew Name
Mother's Hebrew Name
Name of person you are remembering

First NameLast Name
Hebrew Name
Relationship
English Date of Passing

MonthDayYear
Hebrew Date of Passing (if English date is unavailable)
Father's Hebrew Name
Mother's Hebrew Name
Yahrtzeit Information (Member #2)
Name of person you are remembering

First NameLast Name
Hebrew Name
Relationship
English Date of Passing

MonthDayYear
Hebrew Date of Passing (if English date is unavailable)
Father's Hebrew Name
Mother's Hebrew Name
Name of person you are remembering

First NameLast Name
Hebrew Name
Relationship
English Date of Passing

MonthDayYear
Hebrew Date of Passing (if English date is unavailable)
Father's Hebrew Name
Mother's Hebrew Name
Committees
Check off any committees you might be interested in participating in
Committee Names

YouthHospitalityChesedReligious AffairsKiddushFundraisingMarketingProgrammingEducationMembershipInclusion Committee
Directory
You may print my contact info in the Shul Directory*
In 2023 we will be including children's names and ages in the directory, which is distributed only to members. If you'd like to opt out from having your children's names and ages included, please check here. Please include your children's information, even if you opt-out. This information is used by our Youth Program coordinators to include your children in their programming.

Opt out
Payment
How would you like to pay?*
Pay with Paypal by entering Membership Fee on the PayPal page.

Please note - if you do not pay on the next page - your membership will not be completed. You must disable pop-up blocker.
Pay via check made out to "Kehilat Pardes" and mail to:

Kehilat Pardes - Rock Creek Synagogue

13300 Arctic Avenue

Rockville, MD 20853
Pay via Zelle to treasurer@kehilatpardes.org
Additional names and information can be submitted by email here.

Alternate payment arrangements can be negotiated by contacting the treasurer
Should be Empty:

Kehilat Pardes - RCS Membership Form

Personal Information (Member #1)

Personal Information (Member #2)

Family Information

Family Information (details)

Yahrtzeit Information

Yahrtzeit Information (Member #1)

Yahrtzeit Information (Member #2)

Committees

Directory

Payment