2023-2024 New Member Form - Form - Congregation Beth Am

1370 Abbott Court
Buffalo Grove IL, 60089
Tel: 847-383-5017
www.bethambg.org

MEMBERSHIP PROFILE DIRECTORY INFORMATION

PRIMARY MEMBER PROFILE INFORMATION

Title

* First Name

* Last Name

* Email Address

* Mobile Phone Number

* Birthday

Hebrew Name (if known)

AREAS OF INTEREST AT CONGREGATION BETH AM

* Relationship Status

* Anniversary Date

* Do you have another adult to add on the account?

SECONDARY MEMBER INFORMATION

Title

* First Name

* Last Name

* Email Address

Mobile Phone Number

* Birthday

Hebrew Name (if known)

AREAS OF INTEREST AT CONGREGATION BETH AM

HOME ADDRESS

* Mailing Address

Suite/Apartment/Unit

* City

* State

* Zip Code

PERMISSIONS

* I give permission for Congregation Beth Am (CBA) to publish my name, email, address and phone number in the member’s only Membership Directory.
Please Select OneYesNo

* I give permission to CBA to use/publish photo(s) of me/members of my family taken at CBA functions.
Please Select OneYesNo

FORMER SYNAGOGUE MEMBERSHIP

* This is my first time joining a synagogue
Please Select OneYesNo

* I have previously been a member of the following Synagogue

FAMILY INFORMATION

* I have children I would like to add to my member profile
Please Select OneYesNo

Add Children Information
* First Name
* Last Name

* Birthday
Hebrew Name (if known)

* Religious School Grade Level
* Are you interested in enrolling this child in Religious School?

YAHRZEIT INFORMATION

Yahrzeit is a Yiddish word meaning the anniversary of a death. It is the yearly anniversary of a loved one’s death (traditionally the anniversary of the Hebrew date, not the Gregorian date). Please refer to our FAQ sheet for any additional explanation needed.

* Do you have Yahrzeit names to add to your member profile?
Please Select OneYesNo

Add Yahrzeit Information
* First Name
* Last Name

* Date of Death
* Approximate Time of Death (to determine the Hebrew date)

Hebrew Name (if known)
* Relationship

MEMBERSHIP PLEDGE

PLEDGE AMOUNT

Please consider a dues pledge in the suggested amount of 1.5% to 2.5% of your annual income. Only annual income up to a maximum of $300,000 for a one-adult family and $400,000 for a two-adult family should be considered when applying the 1.5% to 2.5% guidelines. Dividend and interest income should be included in annual income. The fiscal year begins July 1, 2023 and ends June 30, 2024.

Here are some examples of how to apply these guidelines:

Example one: A member family with $60,000 in annual income would select an amount of their choosing between $900 and $1500.

Example two: A member family with $120,000 in annual income would select an amount of their choosing between $1800 and $3000.

Example three: A member family with $180,000 in annual income would select an amount of their choosing between $2700 and $4500.

Please contact the office at 847-383-5017 for more information or help.

* Please Enter Your Annual Dues Pledge Amount Here

ADDITIONAL MEMBERSHIP OPPORTUNITIES

MEN'S CLUB MEMBERSHIP

* Interested in becoming a Men's Club Member?

Membership is $36.00/year

* Men's Club Member - Name

SISTERHOOD MEMBERSHIP

* Interested in becoming a Sisterhood Member?

Membership levels are based on your donation preference.
$36.00/year
$54.00/year
$72.00/year

* Sisterhood Member - Name

ARZA MEMBERSHIP

The Association of Reform Zionists of America is the Israel arm of the Reform Movement, representing our community to the Zionist National Institutions in Israel and around the world.

* Interested in becoming an ARZA Member?

Membership is $50.00/year per household. For more information about ARZA: https://arza.org/arza-membership/

PAYMENT OPTIONS

PLEASE SELECT YOUR PAYMENT SCHEDULE

Please Select OneSingle Annual Payment (1st payment due July 15, 2023)Ten Equal Monthly Payments (Billed on 15th of each month: July 2023 - April 2024)Other (Please contact the office at 847-383-5017 if you require a different option.)

PLEASE SELECT YOUR METHOD OF PAYMENT

Please Select OnePayment by Personal Check.Payment by ACH Bank Withdrawal from Checking AccountPayment by Credit Card

ACH withdrawals will have an automatic withdrawal on the 15th day of each month according to the payment schedule selected above. IF PAYING BY ACH, a micro deposit may be used to set up your account. The CBA office may reach out to you to obtain those test amounts for security verification.

Credit Cards will automatically be charged on the 15th day of each month according to the payment schedule selected above. CREDIT CARD PAYMENTS FOR ANNUAL DUES AND SCHOOL TUITION ARE SUBJECT TO A 3% SURCHARGE. THIS SURCHARGE IS CAPPED AT A MAXIMUM OF $20 PER YEAR FOR ANNUAL DUES AND $20 PER YEAR FOR TUITION.

WOULD YOU LIKE TO RECEIVE MONTHLY BILLING STATEMENTS?

Please Select OneYes, please send my billing statement by email.Yes, please send my billing statement by mail.No billing statement is needed.

OPTIONAL ACKNOWLEDGMENT TO THE CONGREGATION

At the end of the membership year, Beth Am will publicly acknowledge our member families whose fulfilled dues pledges meet one of the following criteria:

Two-adult member families whose fulfilled dues pledge is at least $4990

One-adult member families whose fulfilled dues pledge is at least $3150

Any member family whose fulfilled dues pledge is at least $2525 if that amount exceeds 2% of its annual income.

* Will your fulfilled pledge satisfy any one of the three criteria above?
Please Select OneYesNo

* Do you want your fulfilled pledge to be recognized by name or be listed as anonymous?
Please Select OneAcknowledgement by NameAnonymous Acknowledgement

* Name for Acknowledgement

MEMBERSHIP & PLEDGE AGREEMENT

I hereby make my annual membership pledge to Congregation Beth Am. Beth Am financial commitments must be current to receive High Holy Day tickets and other temple services. I understand that due to budgetary and planning needs, dues are for the entire year and are not refundable even if I choose to resign mid-year. I will provide written notice to the Beth Am office if I wish to discontinue membership. Verbal notice or voice mail does not constitute an official resignation. If I fail to complete an annual pledge form in future years, but my membership has not been officially discontinued, dues may be continued to be charged in the manner listed above for future years at a rate increased by no more than 10% over the previous year. Permission is granted to send announcements, news, and updates to my email address(s). My signature confirms my agreement to abide by the terms and conditions of Congregation Beth Am membership.

* Signature

* Today's Date
Please use mm/dd/yyyy format