Online Membership Form

Community* (Group, Congregation, Sangha, other)

Address

City

Zip

Phone

Point of Contact's eMail

Organization Leader's Name
(Rabbi, Pastor, Clergy, Director, etc.)

eMail

Phone

SECTION 2

Organization Size*
Please use your organizations method for determining size; either rolls, membership, average attendance, or other method.
001-125 Members - $75 - 1 Rep126-350 Members - $150 - 1 Rep351-500 Members - $250 - 2 Reps501-1000 Members - $500 - 2 Reps1001+ Members - $750 - 3 Reps

Attach File (optional)

Subscribe to Newsletter
YesNo

Enter Representatives' Name Phone and eMail
[group group-1cr clear_on_hide inline]Representative #1[/group]
Name*

Phone*

email*

[group group-2cr clear_on_hide inline]Representative #2
Name

Phone

email
[/group]
[group group-3cr clear_on_hide inline]Representative #3
Name

Phone

email
[/group]

SECTION 3

This section is used to provide information about payment information and who in your organization should be contacted to process payment of dues. Organizations use different job titles such as Financial Officer, Business Manager, Treasurer, Accounts Payable, etc. On the right, we use the term “Treasurer” however, please enter the information as applicable to your organization.

NOTE: Dues are annual on date of membership unless other arrangements are requested. Payment may be made by check, credit/debit card, or PayPal.

Treasurer*
(or Financial Officer, Business Manager, etc)

Treasurer eMail*

Treasurer Phone*