MEMBERSHIP INFORMATION | Dues Pledge

Instructions

Please submit your annual dues pledge form below. Then visit the Payment Center to make a dues payment.

Note: You may also print this form and mail to Hevrat Shalom Congregation, P.O. Box 3606, Gaithersburg, MD 20878.

Annual Dues Pledge Form

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Dues Pledge Schedule

Please select your family circumstances to establish your minimum dues. Then enter any additional dues amount that you are able to pay. Thankfully most members generously pledge considerably more than the minimum according to their financial ability. However Hevrat Shalom Congregation will never turn away a member because of inability to pay. Individuals with a special situation or financial hardship should request a confidential meeting.

Minimum Dues *

Family ($825)
Single ($600)
Ingleside Family ($745)
Ingleside Single ($540)

The above are the minimum dues requested. Please pledge more if you can. Dues include High Holiday tickets. Dues for new members are half price for the first year of membership.

Additional Dues

Please indicate any additional amount you can pay over-and-above the minimum dues. This is greatly appreciated!

High Holidays

Included with membership. Non-members may purchase tickets separately from the Payment Center.

Oneg and Special Events

Please indicate below a special event or memory for which you wish your sponsored Oneg to be acknowledged.

Amount Pledged - Oneg and Special Events

Event

Date

Additional Gifts and Contributions

This is for special occasions such as birthdays and Yahrzeits to be acknowledged from the Bema and in our Newsletter.

Amount Pledged - Additional Gifts and Contributions

Purpose

Special Assessment

In addition to the membership pledge there is mandatory a special assessment of $100 per membership.

Amount - Special Assessment *

Price: $ 100.00

Special Assessment

TOTAL AMOUNT PLEDGED

Hevrat Shalom Congregation will never turn away a member because of inability to pay. Individuals with a special situation or financial hardship should request a confidential meeting.

Amount Pledged - TOTAL *

$ 0.00

Payment and Directory Listing

I/we pledge the above total amount for membership dues and assessment for this fiscal year which begins on July 3rd. Payments will be made as follows:

Payment Schedule *

Annually
Semi-Annually
Quarterly

Include in Annual Membership Directory? *

Indicate if you grant permission to Hevrat Shalom Congregation to list your name(s) in the annual membership directory.

Signature

Electronic Signature *

Type your full name here

Today's Date *

mm/dd/yyyy

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