NEW MEMBER APPLICATION

Do you have a special code for Membership?

Enter your code here and then complete the rest of your application.

Our membership year begins July 1, 2025 and ends June 30, 2026. All memberships are on this schedule, regardless of when you join. Dues are pro-rated if you join 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. You can skip the payment option at the end of the form.
We also offer ASSOCIATE MEMBERSHIPS 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. Please email shul@asbi.org to learn how to join as an associate.

ADDRESS

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

Home Phone (if applicable):

MEMBER INFORMATION

ADULT 1

* Adult 1 First & Last Name:

Adult 1 Hebrew Name

* Adult 1 Cell Phone:

* Adult 1 Email:

Adult 1 Profession:

Adult 1 Work Phone:

* Adult 1 Date of Birth:

Adult 1 Emergency Contact:

Adult 1 Tribe:

CohenLeviIsrael

(Adult 1) Are you interested in reading Torah?

YesNo

(Adult 1) Are you interested in leading services?

YesNo

ADULT 2

Adult 2 First & Last Name:

Adult 2 Hebrew Name

Adult 2 Cell Phone:

Adult 2 Email:

Adult 2 Profession:

Adult 2 Work Phone:

Adult 2 Date of Birth:

Adult 2 Emergency Contact:

Adult 2 Tribe:

CohenLeviIsrael

(Adult 2) Are you interested in reading Torah?

YesNo

(Adult 2) Are you interested in leading services?

YesNo

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

First & Last Name:

Date of Birth

Grade / School

DaughterSon

First & Last Name:

Date of Birth

Grade / School

DaughterSon

First & Last Name:

Date of Birth

Grade / School

DaughterSon

First & Last Name:

Date of Birth

Grade / School

DaughterSon

First & Last Name:

Date of Birth

Grade / School

DaughterSon

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

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

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.)

What brings you to ASBI? How did you hear about us?

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 via a Dues Adjustment Form.

* 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 the rabbi with any questions.

* Adult 1:

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

Adult 2:

* Please select your membership type:

Please Select OneStudentStudent Family - for married couples; at least one spouse must be a student24 & Under IndividualIndividualFamily - for married couples, including children who are living at home or full-time students

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

Thank you for being a part of our ASBI Community! Please click "Continue" below to submit your application and stay tuned for a follow-up email with more information based on the code you submit with your form!

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.

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, please DO NOT make a selection--skip the payment option below and click "Continue" to send in your membership application.

Select your membership amount below to pay your 2025-2026 membership dues now.

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

Total: