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2023-24 Beth El New Membership Application & Dues
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4900 BRIARHAVEN ROAD, FORT WORTH, TEXAS 76109
(817) 332- 7141 | FAX (817) 332-7157
2023-24 MEMBERSHIP APPLICATION & DUES FORM
BUILDING THE JEWlSH FUTURE
IS THERE MORE THAN ONE ADULT MEMBER ON THE ACCOUNT?
Yes
No
CONTACT INFORMATION - PRIMARY MEMBER
*
Primary Member - First Name
*
Primary Member - Last Name
*
Primary Member - Birthday
Primary Member - Hebrew Name
*
Primary Member - Email
*
Primary Member - Mobile Phone
Primary Member - Place of Business
Primary Member - Business Phone
Primary Member - Religious Experience
INTERESTS - PRIMARY MEMBER
Interests & Skills
Committees & Special Interests
CONTACT INFORMATION - SECONDARY MEMBER
*
Secondary Member - First Name
*
Secondary Member - Last Name
*
Secondary Member - Birthday
Secondary Member - Hebrew Name
*
Secondary Member - Email
*
Secondary Member - Mobile Phone
Secondary Member - Place of Business
Secondary Member - Business Phone
Secondary Member - Religious Experience
INTERESTS - SECONDARY MEMBER
Interests & Skills
Committees & Special Interests
ADDITIONAL ACCOUNT INFORMATION
*
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
*
Anniversary Date
(if applicable?)
HOME RESIDENCE INFORMATION
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
Home Phone
(if applicable)
CHILDREN INFORMATION
*
Do you have Children to add to your member account?
Please Select One
Yes
No
Please select the "+" to add your Children
*
Child's Full Name
Child's Hebrew Name
*
Child's Date of Birth
Please select the "+" to add more Children
YAHRZEIT INFORMATION
*
Do you have Yahrzeits to add to your member account?
Please Select One
Yes
No
Please select the "+" to add your Yahrzeits
*
Full Name
*
Mourner's Name
*
Relationship
*
English Date of Death
*
Permanant Memorial
Please Select One
Yes
No
Location of Memorial
Please select the "+" to add more Yahrzeits
MEMBERSHIP DUES LEVEL
Please select a Membership Level below
Age 28 and Under
| $0.00
Age 29 to 35
| $1,330
Associate
| $1,330
Standard
| $2,660
Sanctuary Window
| $3,220
Bimah
| $4,600
Menorah
| $5,900
Eternal Light
| $7,700
Ark
| $11,000
10 Commandments
| $20,600
Torah
| $29,500
FINANCIAL ASSISTANCE
No one will be denied Membership at Congregation Beth El due to financial circumstances. If membership costs are a genuine hardship for you, please select the checkbox below and Amy Robbins, the Executive Director, will be in touch with you to make other financial arrangements.
I(we) will require Financial Assistance for the 2023-24 Membership year
Mon, December 4 2023 21 Kislev 5784
