CEH Membership Registration Form

Congregation Etz Hayim Membership Application
Whom can we thank for referring you to CEH?
I am applying for the following membership option. (All memberships except for associate include High Holy Day tickets for all family members living full-time in residence.)

Benefactor (incl. 2 add'l High Holy Day tickets & special recognition) - $6,840Household Plus - (Includes Religious School tuition) - $6,380Household - (Age 35-74 with child(ren) under 26) - $3,650Household Senior - (Aged 75 or older with child(ren) under 26) - $2,740Household Single Parent - (Aged 35-74 adult and child(ren) under 26 - $2,740Household Young - (Eldest adult aged 34 or younger with child(ren) under 26) - $1,820Household Young Single Parent - (Eldest adult aged 34 or younger with child(ren) under 26) - $1,370Couple (Aged 35-74 and no child(ren)) - $3,420Couple - Senior (Aged 75 or older with no child(ren)) -$2,510Couple - Young (Eldest age 34 or younger with no child(ren)) - $1,600Single (Aged 35-74) - $2,280Single - Senior (Aged 75 and older) - $1,820Single - Young (Aged 34 or younger) - $910Associate (Households outside local area) - $180
A building fee of $400 per year will be added for the first 10 years of membership, except for Associate Members. If paid in full during the first year of membership, the building fee will be discounted 20%.
Financial means should never be a barrier to membership. For confidential financial assistance, please contact treasurer@etzhayim.net or president@etzhayim.net.
Please list full name of each adult in household.
Adult 1

First NameLast Name
Salutation
Relationship Status
E-mail
Home Phone Number:

Area CodePhone Number
Mobile Phone Number:

Area CodePhone Number
Work Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Occupation
Birth Date:

MonthDayYear
T-shirt Size
ADULT 1 - Select one option

Jewish*Non-JewishUncertainOther
*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.
Hebrew Name (optional)
Date of Bar/Bat Mitzvah and Torah Portion (optional)
Hobbies/Interests
Adult 2

First NameLast Name
Salutation
Relationship Status
E-mail
Home Phone Number:

Area CodePhone Number
Mobile Phone Number:

Area CodePhone Number
Work Phone Number:

Area CodePhone Number
Occupation
Birth Date:

MonthDayYear
T-shirt Size
ADULT 2 - Select one option

Jewish*Non-JewishUncertainOther
*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.
Hebrew Name (optional)
Date of Bar/Bat Mitzvah and Torah Portion (optional)
Hobbies/Interests
Please list full name of each child in household.
Child 1

First NameLast Name
Birth Date:

MonthDayYear
Child 1 - Select one option

Jewish*Non-JewishUncertainOther
*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.
T-shirt Size
Name of School & Grade
Hebrew Name (optional)
Date of Bar/Bat Mitzvah and Torah Portion (optional)
Hobbies/Interests
Child 2

First NameLast Name
Birth Date:

MonthDayYear
Child 2 - Select one option

Jewish*Non-JewishUncertainOther
*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.
T-shirt Size
Name of School & Grade
Hebrew Name (optional)
Date of Bar/Bat Mitzvah and Torah Portion (optional)
Hobbies/Interests
Child 3

First NameLast Name
Birth Date:

MonthDayYear
Child 3 - Select one option

Jewish*Non-JewishUncertainOther
*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.
T-shirt Size
Name of School & Grade
Hebrew Name (optional)
Date of Bar/Bat Mitzvah and Torah Portion (optional)
Hobbies/Interests
Child 4

First NameLast Name
Birth Date:

MonthDayYear
Child 4 - Select one option

Jewish*Non-JewishUncertainOther
T-shirt Size
Name of School & Grade
Hebrew Name (optional)
Date of Bar/Bat Mitzvah and Torah Portion (optional)
Hobbies/Interests
Member Directory Permissions

Please indicate which information is okay to publish in our Member Directory. This directory is shared only with members and staff of Congregation Etz Hayim.
Adult 1 - Directory preferences

Mailing addressEmail addressHome phoneCell phone
Adult 2 - Directory preferences

Mailing addressEmail addressHome phoneCell phone
Activities & Ways to Get Involved
Do you have a skill/talent that you would like to contribute to our congregation? If yes, please describe.
ADULT 1 - Would you like to contribute to/participate in any of the following activities? Please mark all that apply.

Leading ServicesReading Torah/HaftorahMinyan ParticipationAdult EducationPreschool & Activities for Young ChildrenReligious School & Youth Organization ActivitiesBook ClubsProgram PlanningLibraryChesed CommunitySocial Action CommitteeEvent SupportKiddush AssistanceSynagogue OperationsMarketing and CommuniicationsAdministrative AssistanceFundraisingGrant WritingLegal AssistanceSynagogue Board and Committee Chair
ADULT 2 - Would you like to contribute to/participate in any of the following activities? Please mark all that apply.

Leading ServicesReading Torah/HaftorahMinyan ParticipationAdult EducationPreschool & Activities for Young ChildrenReligious School & Youth Organization ActivitiesBook ClubsProgram PlanningLibraryChesed CommunitySocial Action CommitteeEvent SupportKiddush AssistanceSynagogue OperationsMarketing and CommunicationsAdministrative AssistanceFundraisingGrant WritingLegal AssistanceSynagogue Board and Committee Chair)
List activities you would like to organize at our synagogue that are not outlined above.
Anything else we should know about you/your family?
How would you like for us to contact you?

EmailPhone
Should be Empty:

Congregation Etz Hayim Membership Application

Activities & Ways to Get Involved