For office use only. Temple Israel Membership Application. Family Name. Home Address Street City State Zip. Home Phone Fax

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1 For office use only Member # Effective Date Temple Israel Family Home Address Street City State Zip Home Phone Fax m Single m Married m Partnered m Separated m Divorced m Widowed If applicable: Wedding anniversary (or commitment ceremony date) Current or previous congregation affiliation Adult #1 Adult #2 Title m Dr. m Mr. m Ms. m Mrs. m Other m Dr. m Mr. m Ms. m Mrs. m Other Gender m Male m Female m Male m Female Maiden (If applicable) Hebrew Preferred (Nickname) Birthdate Address Cell Phone Profession Position/Title Employer Business Street Address Business (City, State, Zip) Work Phone

2 General Information Adult #1 Adult #2 Education m High School m College m High School m College m Post-Graduate m Post-Graduate Universities attended Degrees earned Religious background m Jewish m Other m Jewish m Other m Consecrated m Confirmed m Bat/Bar Mitzvah m Graduated m Consecrated m Confirmed m Bat/Bar Mitzvah m Graduated At which temple/ synagogue/other? Organizations/ special interests List the organizations to which you belong Offices held or holding Special interests Are you associated as a m Yes m No m Yes m No member and/or worker with any Jewish communal or civic organization? If yes, please specify Please specify if you have any talents/skills/creative abilities that would be helpful to temple May we call upon you to m Yes m No m Yes m No be a Hebrew Torah reader? Temple Relationships Relatives or close friends who are members of Temple Israel Relationship

3 Members of Immediate Family Children Living at Home Bar/Bat Mitzvah Date School Grade Children Away at School School Address School Adult Children Gender Spouse/Partner Address Other Adults Living in the Home Relationship Additional Information Please list any special considerations of which you would like us to be aware, or any other comments you would like to note.

4 Yahrzeit Record Observer 1: Observer 2: First Middle Last First Middle Last Address: Phone: Street City State Zip You will be notified of the Yahrzeit of your loved one via a postcard. s are NOT automatically read. You may either call Donna (248) in advance to have your loved one s name read at Shabbat services or give names to an usher upon your arrival. s are read at services on the preceding Friday/Saturday of the anniversary of death.* of deceased Relationship to you Observer Date of death Time of death *Observe in (This person is my:) (Circle one) (Include year) (Circle one) (Circle one) PM = after sundown FYI: To concur with the observance sent from the funeral home, please circle Hebrew. Otherwise, you will be notified in accordance with the English date of death. For more than four names, please use space below Walnut Lake Road, West Bloomfield, MI Phone: Fax: Website:

5 Financial Agreement Member : Date: Please check one of the following dues options: m Voluntary Dues (For first-time members only). My dues are a voluntary donation of any amount for my membership ending June 30, No Building Fund payments are required during this time. My total dues contribution for this period is $. I am enclosing a payment of $. I understand I will be billed if there is an unpaid balance. m Fair Share Dues (1% of your household income from all sources). My Fair Share dues contribution is $. I am submitting payment of $ with this application. I understand I will be billed if there is an unpaid balance. (Please see Building Fund information below) m Full Dues Membership Contribution of $2,850. I would like to pay this fee in the following way: Full amount is enclosed Please bill me (Please see Building Fund information below) m Gift Memberships q Bereavement ( of deceased Date of death ) q Wedding q Auf Ruf q Conversion (Date Clergy ) BUILDING FUND - $2,500 (For Fair Share and Full Dues only. This amount is in addition to dues and can be paid over a number of years.) m Please bill me $ per year for years for a total of $2,500. -ORm I am under 40. Please bill me $100 a year until I reach 40 at which time a new payment schedule will be decided upon. Signed: Signed: Additional Notes: WHAT IS THE FAIR SHARE PLAN? With fair share, every member s annual membership contribution is based on the member s individual situation. The level may increase, decrease, or remain the same, from year to year, depending on changing circumstances. WHY IS FAIR SHARE USED RATHER THAN A FLAT FEE? FAIR SHARE allows every member to pay in accordance with his/her financial ability. Those who are financially more able will underwrite the membership of those who are less financially secure. Therefore, the FAIR SHARE approach relies on the historical concept of tzedakah. FAIR SHARE is a Jewish story - that of a people who have survived through the centuries because they have cared for each other and have provided for the needs of the total community. RECOMMENDED ANNUAL FAIR SHARE contribution is 1% of your household income from all sources Walnut Lake Road, West Bloomfield, MI Phone: Fax: Website:

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