Dues Adjustment Form - Anshe Sholom B'nai Israel Congregation

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DUES ADJUSTMENT FORM

ASBI is committed to making accommodations that respect the financial capacity of our individuals and families. No one will be denied membership due to financial circumstances.

Dues Adjustments happen on an annual basis; even if you have been granted an adjustment in previous years, you must submit a new request for the current year (beginning July 1, 2025 and ending June 30, 2026).

All forms will be reviewed confidentially. A response to your request will be sent via email. Once your dues amount is finalized, please plan to pay your balance or set up a payment plan to be in good standing for the year.

* First Name:

* Last Name:

* Email Address:

* Please enter in the adjusted total amount you would like to pay in membership dues for the 2025-2026 year:

To be paid by:

To be paid in the following number of payments

Payment Date / Payment Plan Start Date (all payments must be completed prior to June 30, 2026)

Payment frequency:

* Please explain why you need this adjustment:

* I understand that I will not be in good standing until I have made a payment or set up a payment plan upon approval of my Dues Adjustment Request. I understand that these arrangements are for the 2025-2026 membership year only.

I understand that I will not be in good standing until I have made a payment or set up a payment plan upon approval of my Dues Adjustment Request. I understand that these arrangements are for the 2025-2026 membership year only.

After you click "Submit" please check your email for a confirmation to ensure that your form has been received.

Thu, July 3 2025 7 Tammuz 5785

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