Beth Israel Congregation Dues Pledge Form

For 2012 - 2013

Name_____________________________________Spouse_________________________________

      (Last)           (First)                 (Last)           (First)

Address____________________________________________________________________

City__________Zip______Phone__________________E-mail ________________________

[] Do not publish my e-mail address in the Synagogue Directory.

PLEDGE:

I agree that my dues for the coming fiscal year shall be: $_____________.

I will also pay the required United Synagogue Dues as follows: None if pledge is up to $190; $34.75 if pledge is $191-$499; $69.50 if pledge is $500 or more
My USCJ dues will therefore be: $______________
My total Beth Israel Congregation dues and USCJ pledge for 2012-13 are: $______________

PAYMENT PLAN AND OTHER PAYMENTS

[] I am enclosing my first dues payment of: $_______________ or

You will be billed on a monthly basis.

BUILDING FUND ASSESSMENT

After one year of membership, all congregants are assessed a Building Fund contribution to maintain and develop our site. The amount is $2,000, or $200/year for 10 years. If you have not yet paid it off, your building fund assessment of $200 per year, is automatically due on a quarterly basis (at least $50 per quarter). You may pay all or part of it at this time. Please indicate on your check or credit card form how much of your current payment is for the building fund. (Please call the office if you have any questions about your current obligation.)

[] I am enclosing my Building Fund payment of: $_______________

Total amount enclosed: $_______________

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