Membership Form - Congregation Agudas Achim

Please use this form to apply for membership at Agudas Achim. Please enter all information completely to the best of your ability.

Member Category	Suggested Contribution	Category Explanation
Sustaining	$3960	This is the cost of shul operations if the costs were shared equally across all account types
Full Community	$2556	For a Family or a Couple
Pathways	$1800	Couples under 35, Seniors
Solo	$1350	For an individual member
Affiliate	$1080	For individuals or families who hold primary membership at another synagogue
Inclusive	$360	For those seeing to participate in synagogue life at a meaningful yet accessible level
Open Door	$180	Individuals or families seeking a way in

Check this box if you have a gift certificate

* Primary Adult First Name

Primary Adult Middle Name

* Primary Adult Last Name

Hebrew Name

Hebrew Father's Name

Hebrew Mother's Name

Tribe

* Hebrew Name in English

* Primary Adult Birthdate

* Primary Adult Email

* Primary Phone Number

please enter the number that you would like us to use.

Address Line 1

Address line 2

City

State

Zip

* Marital Status

Anniversary

Secondary Adult First Name

Secondary Adult Middle Name

Secondary Adult Last Name

Hebrew Name

Hebrew Father Name

Hebrew Mother Name

Tribe

Hebrew Name in English

Secondary Adult Birthdate

Secondary Adult Email

Secondary Adult Phone number

Any Children?

yesno

Please enter information about any children, or skip on to the next section.

Child 1 First Name

Child 1 Middle name

Child 1 Last Name

Child 1- Hebrew Name

Hebrew Name in English

Child 1 Birthday

Child 2- First Name

Child 2 - Middle Name

Child 2- Last Name

Child 2 - Hebrew Name

Hebrew Name in English

Child 2- Birthday

Child 3- First Name

Child 3 -Middle Name

Child 3 - Last Name

Child 3- Hebrew Name

Hebrew Name in English

Child 3 - Birthday

Additional Children

If you have more than 3 children, please enter the full name, Hebrew name, and birthdate

Please use the following section to enter any Yahrzeit observances.

Please enter all observances for Adult 1

Please enter the Name of Deceased, English Date of Death, Before or After sunset, and relationship to mourner.

Please enter all observances for Adult 2

Please enter the Name of Deceased, English Date of Death, Before or After sunset, and relationship to mourner.