Membership Form

2016-17 Membership Application

Name:
Date of Birth
Name2:
Date of Birth 2
Children Names & Dates of Birth
Address:
Phone:
-
E-mail:

Family Membership- Includes 2 High Holiday seats

Enter

Single Membership Includes 1 High Holiday seat

Enter2

Associate Membership ( a family or individual who has an existing membership at another shul may purchase holiday tickets at $86)

Enter3

Please specify your requirements for High Holiday Seats for this year:

Number of Men Seats Required
Number of Women's seats required:
Please call me at the following number to discuss my seating needs


Additional High Holiday seats may be purchased at the following rate:

Members $86

Non-Members $136

You can go to the donation payment page today online or Email this form and mail a check or call the office 

Enter Dues
 $ 
Total for Member Seats at $86
 $ 
Non Member Seats @$136 ea
 $ 
Building Maintenance Fund
 $ 
Total:

Congregation Ansel Sholom

2016-2017 Membership 

Application/Dues

Yahrzeit(Please list name,relationships and dates)

Your info is submitted to the office when you hit submit.  You can call the office at 914-632-9220 to pay by phone or you can go to the payment page to pay online with Visa/Mastercard of Paypal.  We are happy to receive you check in the mail as well

THANK YOU