Membership Information Form 2012/2013

Welcome to Beth Emet! Please complete this form and click submit at the bottom of the page.

	Adult Applicant 1 Male Female		Adult Applicant 2 Male Female
Full Name (Please include middle name or initial)	Mr. Ms. Mrs. Dr. Other First Middle Last		Mr. Ms. Mrs. Dr. Other First Middle Last
Preferred Name (Steve for Steven)
Personal Status	Single Married (Date) / / Partnered Engaged Divorced Widowed Other
Hebrew Name (if known)
Birthplace and Date	City State Country Date / /		City State Country Date / /
Parents’ full names	1. 2.		1. 2.
How long have you lived in the area?
Education Highest Level Completed	High School	Some College	High School	Some College
	Bachelors	Masters	Bachelors	Masters
	Doctorate	Professional School	Doctorate	Professional School
	Other		Other
	Reform	Conservative	Reform	Conservative
	Orthodox	Secular	Orthodox	Secular
	Reconstructionist	Traditional	Reconstructionist	Traditional
	Jewish by Choice	Other	Jewish by Choice	Other
	Date of Conversion / /		Date of Conversion / /
Did your education include	Bar/Bat Mitzvah Confirmation N/A		Bar/Bat Mitzvah Confirmation N/A
Current or most recent congregation?

Contact Information

How would you like your name(s) to appear on synagogue mailings?

Name(s):
Home address:
City:		State:		ZIP Code:
Phone:	( )	Adult 1 Cell:	( )	Adult 1 Email:
Fax:	( )	Adult 2 Cell:	( )	Adult 2 Email:

Business Information

	Adult Applicant 1	Adult Applicant 2
Occupation/Profession/Type of work
Position/Title
Employer
Address
City, State, ZIP Code
Business Phone
Business Fax
Business Email

Children’s Information

Children 26-years-old and younger are included in your membership

	Child 1 Male Female	Child 2 Male Female	Child 3 Male Female	Child 4 Male Female
First and Middle Name
Last Name
Preferred Name
Hebrew Name (if known)
Current grade in school
Name of School
Birth date (mm/dd/yy)

If you have more than four children, please copy this page and attach additional sheet.

Referral Information

How did you hear about us?		Reason for joining (check all that apply)
	Referred by		Children in (check all that apply)
	Website		Beit Sefer (religious school) Early Childhood
	Jewish Publication		B’nai Mitzvah Teen Program Camps
	Live in neighborhood		Worship Service Adult Learning New to Area
	Other		Community Other

Friends and Relative Information

Please list any close friends or relatives who are members of the Beth Emet community and their relationship to you (i.e. Sarah Cohen/Steven’s Cousin)

Name	Relationship

Yahrzeit Information

Please list those immediate family members whose Yahrzeit (anniversary of death) you would like us to remember

Name	Date of Death (Secular Date)	Relationship
	/ /
	/ /
	/ /
	/ /
	/ /

We would like to observe the Secular Date Hebrew date (please check one)

What are you interested in gaining from your membership at Beth Emet Synagogue?

Would you like us to arrange a personal meeting with our Rabbi? yes no

May we publish your name, address, telephone number and email address in the Beth Emet membership directory and/or on our secure “members only” online directory?

yes no

If yes,

Printed Directory

Online Directory

Both

Finding Your Place at Beth Emet The Free Synagogue

So you’ve made the decision to join Beth Emet The Free Synagogue! Now what? Although we are a large congregation, we have a multitude of programs and committees that will allow you to find a deep and personal connection within our community. Whether you are interested in meeting new people, continuing your Jewish education, volunteering your time at our soup kitchen, or discussing Jewish text in an informal setting, Beth Emet has a way in which you can become engaged and make a meaningful difference not only in the life of the community but for yours as well.
To help us better understand how you wish to get involved, please tell us a little bit about yourself, your interests and your skills. Please review the list below, and check the boxes of programs about which you would like more information. Please note (1) for Adult 1 and (2) for Adult 2.

(1)	(2)		(1)	(2)
		Building/facility management expertise			Social justice issues
		Cook/baking			Soup Kitchen – Helping those in need
		Environment			Teaching
		Event planning			Technology
		Finance			Ushering/greeting
		Fundraising			Writer
		Graphic design			Tell us more about yourself and ways in which you want to get involved:
		Health care issues – getting involved	Adult #1
		Israel
		LBGTQ issues (Lesbian Gay Bisexual Transgender Questioning)
		Library	Adult #2
		Marketing
		Singing

Once we learn about your interests, we will place your name on our mailing list and someone will contact you regarding future projects, events and meetings. Watch for our bi-weekly e-newsletter and quarterly Temple bulletin to find out about upcoming programs.

Ambassador Program:

After you join, your name will be given to one of our current congregants who will call to welcome you to Beth Emet The Free Synagogue. Your ambassador will introduce you to other congregants and help to make you feel part of the Beth Emet family.

Please do not give me an Ambassador

Membership Commitment 2011/2012

Please check the box next to the membership commitment of your choice

Membership Commitment	Yearly Total	Payment Schedule Amounts:
		Semi-Annual	Quarterly	Monthly
		Due by: Aug. 31 & Dec. 31	Due by: Aug. 31, Oct. 31, Jan.31 & Apr. 30	10 Payments due at the end of month from July 31—Apr. 30
First Year Membership	$750.00	$375.00	$187.50	$75.00
Self Determined Membership for households under 40 or those with child(ren) enrolled in the Early Childhood program	We understand that everyone’s circumstances are different, regardless of age. Your commitment allows Beth Emet to keep its doors open and to fulfill our mission of being a vibrant place for learning, spiritual growth and doing acts of loving kindness. For those who are under 40 and/or for those who have a child enrolled in our Early Childhood program, Beth Emet has a membership program that allows one to self determine their annual membership commitment if they are unable to pay the standard rate. Please consider a minimum contribution equivalent to the first year introductory rate of $750.00.

Payment Information

A check made payable to Beth Emet The Free Synagogue is in the mail or

Please call for credit card information at

At least 1/12 of your dues are expected with this application. You can also make payment arrangements by contacting our Executive Director, Bekki Harris Kaplan at 847-869-4230, ext. 304 or via email at Kaplan@bethemet.org.

Please note that our membership year is July 1 through June 30. If you join after the High Holidays (Rosh HaShanah or Yom Kippur) we do pro-rate the membership rate through June 30. To determine the amount due, please contact Bekki Kaplan at kaplan@bethemet.org or call 847-869-4230, ext. 304.
Please note that all payments are to be made in full by April 30.

BETH EMET THE FREE SYNAGOGUE
Rabbi Peter Knobel Way • 1224 Dempster Street •Evanston, IL 60202 •847-869-4230

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Beth Emet The Free Synagogue 1224 Dempster Evanston, IL 60202 847.869.4230 info@bethemet.org