Dues Adjustment Form

Ohef Sholom Temple Dues Adjustment Form 2018-2019

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
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 membership@ohefsholom.org.
Please select all that apply:

Change in marital status Pay 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!
2018-2019 Membership Dues

Single - $1,345

Family - $2,000
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 membership@ohefsholom.org.
Enter the message as it's shown *
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Ohef Sholom Temple Dues Adjustment Form 2018-2019