Membership 5785 (2024-2025) - Form

* First Name

Spouse Name

* Last Name

* Email

Cell

Security Fee

$100 Security FeeThe security fee helps to
defray the cost of the
Shabbos Morning Security
guard and other
security needs.

If you are in need of financial assistance, please email membership@adasyeshurun.com or contact Rabbi Millunchick at director@adasyeshurun.com.

No one will ever be refused membership for financial reasons.

* Membership Choices

Please Select OnePremium Membership $2100 -includes up to 4 seats + $100 Security FeeFamily Membership $1400 -includes 2 seats + $100 Security FeeFirst Time Family Membership $600-includes 2 seats + $100 Security FeeSingle Membership $700 -includes one seat + $100 Security FeePlease contact me regarding my membership.

Seats

In the box above please enter the name of each person who will need a seat on a separate line. Please include any seating requests and if you will be attending the early minyan.

Alternate Payments

Credit Card and eCheck (ach) payments can be made by submitting this form with payment using the appropriate line on the Your Membership Level field.Donors Fund or Check (sent to 3050 W. Touhy)Head Checks (Please send 1 check additional payments will be set up as ACH payments)I need to make alternate payment arrangements or need financial assistance

Payment Notes

No one will be turned away due to financial difficulties.
HOWEVER SEATS WILL NOT BE RESERVED UNTIL A PAYMENT PLAN IS IN PLACE.
All requests for discounts will be dealt in a private manner by the membership committee.

Your membership includes 1 seat. How many of these seats will you be using this year?

If you need additional seats please enter them below.

Your membership includes 2 seats. How many of these seats will you be using this year?

If you need additional seats please enter them below.

Your membership includes 4 seats. How many of these seats will you be using this year?

* Do you need additional seats?

Guest Seats ($250)

Children ($150)

Thank you for being an active part of our kehilah and community.
May we all merit an upcoming year of good health and happiness for our kehillah, community and all of K'lal Yisroel.

TOTAL - Additional Donations/earmarks can be made below

Choose Your Seats

Please complete the section below to ensure seating accommodations are made for everyone in your family/group.

Name - Enter each person in your group on a separate line. For additional lines, increase the number of additional seats specified above.
Location- Men's or Women's Seats
Women: Please note that the seating will be adjusted for the Yamim Noarim. Please let us know approximately where you would like to sit. If you say ‘same as last year’ we may not fully understand your request.

When - Please let us know if you will be here for both Rosh Hashanah and Yom Kippur.
Morning Minyan - Please let us know what morning minyan you will be attending.
Notes - Please use this field to tell us where you would like to sit.

Please note members with an official Makom Kavuah have preference regarding seating locations. A Makom Kavuah can be reserved with a building fund pledge of $4,500. If you have yet to select a makom please email membership@adasyeshurun.com.

Who needs seats?

	* Name	Location	When	* Morning Minyan	* Seat location	Notes

Are you interested in childcare for Rosh Hashana and Yom Kippur?

Please Select OneNoYesDetails regarding childcare will be sent to all those interested.

How many children would you like to sign up for babysitting?

There is a $65 fee per child. This fee covers all of Yomim Noraim even if you only send to one session.

My child will be attending:

Rosh Hashana Day 1 10am-130pmRosh Hashana Day 2 10am-130pmYom-Kippur-Night-610pm-815pmYom Kippur Day 10am – 3pmYom-Kippur-Neilah-525pm---716pm

In order that we can properly staff the groups, please let us know when your child will be attending.

Names and Ages

Please tell us your children's names and ages.

Please note:

Please add any notes or comments to our Membership Committee here

TOTAL

Questions? Contact the shul office at office@adayeshurun.com or Rabbi Aharon Gaffen at membership@adasyeshurun.com.