Dues Agreement Form - Form - Congregation Rodeph Sholom

DUES AGREEMENT
FISCAL YEAR

(June 1, - May 31)

Adult (partner one, P1)

Adult (partner two, P2)

Name

Birth Date

Home Address

City

State

Zip Code

Home Phone

Work/Cell Phone

Best time and phone to call

Personal E-mail address

Single Membership (one individual)

Family Membership (two individuals or more)

Chai Membership (family or individual)

Associate Membership**

I would also like to be involved with Men's Club

I would also like to be involved with Sisterhood

Total Amount of Dues

Congregant Name (printed)

*Maintenance Fee ($200.00) is an annual fee paid at the beginning of the fiscal year. It is inclusive in the dues amount shown above. The first $200 from payments towards Membership Dues are allocated to the "Building Fund Fee." This will appear on your statement.

**For members who maintain a full membership by a synagogue affiliated with Tampa Rabbinical Association or USCJ affiliated congregation.

COMMITTEE OPPORTUNITIES

The following is a list of committees you can join.

DUES PAYMENTS

Once this form is submitted, go to My Billing under the My Account tab to verify your dues have been billed. Choose Submit A Payment if paying dues in full. If not paying dues in full, choose View My Recurring Payments to set up payment frequency.

DUES REDUCTION

I am requesting a dues reduction. I will submit an application by June 15th.

To complete the dues reduction form, click here.