Dues Adjustment Form

Ohef Sholom Temple Dues Adjustment 2022-2023

Any information you provide will be kept confidential.
ADULT APPLICANT 1 - CONTACT INFORMATION
Adult Applicant 1 Name: *

First Name Last Name
Adult Applicant 1 Date of Birth: *

Month Day Year
Date
Adult Applicant 1 Preferred Phone Number: *

Area Code Phone Number
Adult Applicant 1 Email: *
example@example.com
Employed? *

Yes No
Employer: *
Military? *

Yes No

To skip this section if it does not apply, click "Next" at the bottom of this page.

To skip this section if it does not apply, click "Next" at the bottom of this page.

Reason(s) for Requesting a Dues Adjustment

Please check ALL THAT APPLY and use the spaces provided to explain any reasons for requesting a dues adjustment.
If additional explanation is required outside of this form, please email nina@ohefsholom.org.
Please select all that apply:

Change in Marital Status Paying Full Dues at Another Temple Full-Time Student Young Professional Change of Family Income (please explain):
Enter explanation for CHANGE OF FAMILY INCOME here:
Significant hardship (please explain):
Enter explanation of SIGNIFICANT HARDSHIP here:
Other (please specify):
Enter explanation of "Other" circumstances here:
Please let us know if we can be of assistance with any of these circumstances.

We have many resources to help!
2022-2023 Membership Dues

Single - $1,500

Family - $2,200
Amount of dues you are requesting to pay MONTHLY:
Enter amount
If you have any questions about this form or dues adjustments in general, please contact the Temple office at 757-625-4295 or email Director of Engagement, Nina Kruger at nina@ohefsholom.org.
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Ohef Sholom Temple Dues Adjustment 2022-2023