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Membership

NEW MEMBER APPLICATION

Thank you for your interest in becoming a member at ASBI! If you have any questions about membership, or about the shul in general, you can contact membership@asbi.org.

IF YOU ARE ALREADY A MEMBER, LOG INTO YOUR ACCOUNT TO MAKE A PAYMENT OR UPDATE YOUR INFORMATION. EMAIL shul@asbi.org WITH QUESTIONS.

Our membership year begins July 1, 2018 and ends June 30, 2019. All memberships are on this schedule, regardless of when you join. Dues are pro-rated in the second half of the year.

No one is ever turned away from the congregation for financial reasons. If you are unable to afford the standard dues rates, please fill out a dues adjustment form at asbi.org/duesadjustment. If you are filling out a dues adjustment, BE SURE TO SUBMIT A COMPLETED MEMBERSHIP FORM IN ADDITION TO THE DUES ADJUSTMENT FORM.

ADDRESS

* Home Address (Please include Unit Number, City, State, and ZIP)

Home Phone (if applicable):

MEMBER INFORMATION

* Adult 1 First & Last Name:

Adult 2 First & Last Name:

Adult 1 Hebrew Name

Adult 2 Hebrew Name

Adult 1 Work Phone:

Adult 2 Work Phone:

* Adult 1 Cell Phone:

Adult 2 Cell Phone:

* Adult 1 Email:

Adult 2 Email:

* Adult 1 Date of Birth:

Adult 2 Date of Birth:

Adult 1 Profession:

Adult 2 Profession:

Adult 1 Emergency Contact:

Adult 2 Emergency Contact:

Adult 1 Tribe:

CohenLeviIsrael

Adult 2 Tribe:

CohenLeviIsrael

(Adult 1) Are you interested in reading Torah?

YesNo

(Adult 2) Are you interested in reading Torah?

YesNo

(Adult 1) Are you interested in leading services?

YesNo

(Adult 2) Are you interested in leading services?

YesNo

CHILD(REN)'S INFORMATION (if applicable):

First & Last Name:

Date of Birth

Grade in School (if applicable)

First & Last Name:

Date of Birth

Grade in School (if applicable)

First & Last Name:

Date of Birth

Grade in School (if applicable)

First & Last Name:

Date of Birth

Grade in School (if applicable)

First & Last Name:

Date of Birth

Grade in School (if applicable)

ALLERGIES

Does anyone in your family have an allergy? Please let us know the family member, their allergy, and its severity:

GETTING INVOLVED AT ASBI

Weekday Minyan Commitment:

Our daily Minyan is the cornerstone of ASBI's ritual life. Please do your part to ensure that the Minyan remains strong.

Your Pledge

Kiddush Fund Contribution

Donating to the ASBI Kiddush Campaign helps to ensure that there is a Kiddush at the synagogue every Shabbat.

Other Amount

Mikvah Contribution

Donating to the Adam R. Straus Memorial Mikvah ensures that this lovely space is well-maintained and that this important community resource is fully operational.

Other Amount

Are you interested in hosting visitors to the community for Shabbat meals or providing housing for visitors?

I am interested in hosting mealsI am interested in housing visitors to the community

Are you interested in becoming involved in any of the following committees?

Adult ProgrammingChesedEducationFamilyHospitalityIsraelKiddushMembershipMikvahRitualSecuritySocial ActionWomens Tefillah GroupYoung Professionals

What would you like to see ASBI offer? (i.e. types of classes, volunteer opportunities, accessibility enhancements, etc.)

What would you like to offer ASBI? (i.e. resources, professional skills, volunteer time, leining, Kiddush sponsorship, etc.)

MEMBERSHIP TERMS

I/We hereby apply for membership to Anshe Sholom B'nai Israel Congregation. I/We agree to abide by the Constitution and by all rules made by the Congregation. I/We agree to complete payment of my/our annual dues in accordance with the membership rates described below, or as agreed to by the Dues Adjustment Committee.

* Do you agree to the terms detailed above?

Please Select OneYesNo

The by-laws of ASBI Congregation restrict membership to those who are Jewish as determined by our rabbi. Check the box that applies to you below. Please contact Rabbi Wolkenfeld with any questions.

* Adult 1:

Please Select OneI am a convert to Judaism under Orthodox auspices (please forward documentation to the rabbi – rabbiw@asbi.org)My mother or her mother was a convert under Orthodox auspices before my birth (please forward documentation to the rabbi - rabbiw@asbi.org)My mother and her mother were both born Jewish

Adult 2:

Please Select OneI am a convert to Judaism under Orthodox auspices (please forward documentation to the rabbi – rabbiw@asbi.org)My mother or her mother was a convert under Orthodox auspices before my birth (please forward documentation to the rabbi - rabbiw@asbi.org)My mother and her mother were both born Jewish

* Please select your membership type:

Please Select OneStudent ($250)Student Family ($475; at least one adult is a student)24 & Under Individual ($510)Individual ($885 / $445 for first-time members)Family ($1750 / $875 for first-time members)Associate Individual* ($330)Associate Family* ($400)

*Please note that associate memberships are intended for those who are already a member of another shul or live outside of the community. High Holiday tickets and voting rights are not included with an associate membership. For further questions, email shul@asbi.org.

Students: please indicate your school and expected date of graduation:

IMMEDIATE PAYMENT (Optional)

To pay your membership dues now in full or via a payment plan, please select your membership type below and you will be directed to a payment page. Individual and Family discounts are for first-time members only - please do not select this option if you are a returning member.

PLEASE NOTE: These amounts are pro-rated and will cover your membership through June 30, 2019. Our membership year runs from July 1 - June 30 for all members, regardless of when you join.

If you are making a payment now, please note that your membership form will not be submitted until you complete and submit your payment information on the following page.

If you are filling out a Dues Adjustment Form or prefer to pay by check, please DO NOT make a selection--skip the payment option below and click "Continue" to send in your membership application.

You will receive a confirmation email when your application has been successfully submitted to ASBI.

Select your membership amount below to pay your 2018-2019 membership dues now:

Student - $250 ($104 pro-rated)Student Family - $475 ($198 pro-rated)24 & Under Individual - $510 ($213 pro-rated)Individual - $445 for First Year ($369 pro-rated)Family - $875 for First Year ($729 pro-rated)Associate Individual - $330 ($138 pro-rated)Associate Family - $400 ($167 pro-rated)

Total:

Thu, February 21 2019 16 Adar I 5779

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ANSHE SHOLOM B'NAI ISRAEL CONGREGATION | 540 W MELROSE ST | CHICAGO, ILLINOIS 60657 | 773-248-9200

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