Valley Ruach at Adat Ari El Membership Application

Membership Application

2011-2012 Membership rates for Jews 21-39 years old
are $180 per person and are tax deductible*.

Please complete the following application, and use the
Paypal button on the next page to make your payment securely online.

Membership Benefits Include:

A free ticket to the Valley Ruach guitar-accompanied High Holyday Services
Discounts at almost every Valley Ruach event, including up to $5 off monthly Shabbat dinners
Numerous Adat Ari El synagogue benefits
The feeling of belonging to a community, and the knowledge that your financial support enables us to continue to provide excellent programming for everyone, regardless of financial situation.

Household Information

Name:*	(primary contact)
Address: *
City: *
State: *
Zip: *
Home Telephone:*

Member 1 - Information

Title:

Mr Mrs. Ms. Dr. Rabbi

Full Name: *
Date of Birth:*
Cell Phone:
Email: *

Member 2 - Information

Title:

Mr Mrs. Ms. Dr. Rabbi

Full Name:
Date of Birth:
Cell Phone:
Email:

Children under 5 (different rates apply to young professionals with children of school age. please call the synagogue office for more information)

Name	Gender (M/F)	Date of Birth	Grade	School

Religious Background

When I was growing up, my family was affiliated with a congregation that was:

Member 1:	Reform Conservative Orthodox Not Affiliated Not Jewish
Member 2:	Reform Conservative Orthodox Not Affiliated Not Jewish

Current/previous congregational affiliation:

Name of Congregation

Date of Membership

Please indicate how you would like to pay:
pay with a credit card or Paypal
pay by check
request financial aid or speak with someone about paying with installments

(you will be able to pay on the next page)

* Adat Ari El is incorporated as a 501(c)(3) entity and as such, membership and donations
are fully tax-deductible to the extent that only intrinsic religious benefits are received.

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