NEW MEMBER Dues Covenant/Membership Pledge 2023-2024
The financial contributions of our members at Beth Shalom ensure the continued operations of our religious programming, educational and cultural programs, and religious school for the Bloomington Jewish community.  Thank you for your continued support.

PLEASE COMPLETE THIS FORM AND RETURN BY AUGUST 15, 2023
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Mission Statement:  Congregation Beth Shalom is a participatory and inclusive community dedicated to learning, prayer, friendship, and Jewish life in Southern Indiana.  We strive to be a “Big tent” Jewish home where everyone is welcome.
Last Name - Member #1
First Name - Member #1
Last Name - Member #2
First Name - Member #2
Contact Emails - please list name and email of all adults in household:
Contact Phones- please list name and phone number of all adults in household:
Address:  Please provide complete address with zip code
Emergency Contact - please list best name, phone number and email
Hebrew Names - please list English and Hebrew name of all adults in household
Date of Birth - please list name and date of birth (M/D/Y) of all adults and children in household and let us know if we can publish birth dates (we will publish month and day only:
Interested in information about our Religious School?
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Please provide wedding anniversary date if appropriate and let us know if we can publish the date
Please provide a list of Yahrzeits with name of deceased, relationship, and date of death
Get involved!  Let us know if you would like to be on any of the following committees
Do you have any skills you would like to volunteer?
Do you have any training that might be helpful to volunteer?
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Is there anything else we should know about you or special needs that we can help you with?
MEMBERSHIP DUES/BUILDING ASSESSMENT.  Note: If requesting Dues Reduction, please use the next section.

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DUES REDUCTION:
The Board recognizes that some members may require a dues reduction.  To request a dues reduction, choose membership type (2 adult, 1 adult, etc) and put the amount of reduction in the 'Other' location. (ex: -$300).

VOLUNTARY ASSESSMENT. If your membership dues are less than 1.5-2% of your income, please consider an additional contribution.
TOTAL PLEDGE. (Please add all previous responses.)
Please type your name(s) and the date to acknowledge that you hereby agree to abide by the Constitution, By-laws, and Policies of Congregation Beth Shalom and pay your pledge in full before April 30, 2024.
DUES PAYMENT INFORMATION.  

Please note that all members are expected to make some dues payment before the start of the High Holidays. All payments should be completed no later than April 30, 2024.

Payments may be made by check or credit card.   Payments by check may be mailed or dropped off at the office (3750 E. Third St, Bloomington IN 47401) and will incur NO convenience fee.  Please make your check payable to 'Congregation Beth Shalom'.

Credit card payments may be made online.  Note: credit card payments will incur a 3.49% convenience fee at checkout (This fee is charged by our credit card processor).

To see your current balance or to make a payment, you can log into RakefetOnline.  If you do not have a login please contact Treasurer@bethshalom-bjc.org and an invitation will be sent by return email.  You can also call Sarah in the office to give her credit card information.

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Please print a copy of this page for your records, then click SUBMIT.
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