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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 AND WANT TO UPDATE YOUR ACCOUNT, PLEASE CONTACT SHUL@ASBI.ORG.

Our membership year begins July 1, 2016 and ends June 30, 2017.

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.

MEMBER INFORMATION

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

Home Phone Number (if applicable):

* Adult 1 First & Last Name:

Adult 2 First & Last Name:

Hebrew Name

Hebrew Name

Work Phone:

Work Phone:

* Cell Phone:

Cell Phone:

* Email:

Email:

* Date of Birth:

Date of Birth:

Profession:

Profession:

Emergency Contact:

Emergency Contact:

I am a:

CohenLeviIsrael

I am a:

CohenLeviIsrael

Would you be interested in reading Torah?

YesNo

Would you be interested in reading Torah?

YesNo

Would you be interested in leading services?

YesNo

Would you be interested in leading services?

YesNo

Children (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)

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 Commitment

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

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

Would you be interested in becoming involved in any of the following committees?

Adult ProgrammingChesedEducationFamilyHospitalityIsraelKiddushMembershipMikvahRitualSecuritySocial ActionWomens Tefillah GroupYoung Professionals

What types of classes or programs would you like the synagogue to offer?

In what other ways would you like to contribute to the ASBI community? What skills would you like to offer?

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

* Please select your membership type:

Please Select OneStudent ($250)Student Family ($450; at least one adult is a student)24 & Under Individual ($500)Individual ($813)Family ($1625)Associate Individual* ($330)Associate Family* ($350)

*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 are not included with an associate membership. For further questions, email shul@asbi.org.

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

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.

PLEASE NOTE THAT THESE AMOUNTS ARE PRO-RATED, AS OUR MEMBERSHIP YEAR RUNS JULY 1 - JUNE 30.

If you are filling out a Dues Adjustment Form, please DO NOT make a selection.

Select your membership type:

Student $250 ($42 Pro-rated)Student Family $450 ($75 Pro-rated)24 & Under Individual $500 ($83 Pro-rated)Individual $813 ($136 Pro-rated)Family $1625 ($271 Pro-rated)Associate Individual $330 ($55 Pro-rated)Associate Family $350 ($58 Pro-rated)

Total:

Thu, June 22 2017 28 Sivan 5777

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

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