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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.

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:

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

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 Commitment

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

Would you be 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

* 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 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.

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 type:

Student - $250Student Family - $47524 & Under Individual - $510Individual - $445 for First YearFamily - $875 for First YearAssociate Individual - $330Associate Family - $400

Total:

Tue, October 16 2018 7 Cheshvan 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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