B'nai David-Judea

B'nai David-Judea Congregation Membership Form

Please submit form below.

If paying by credit card, please enter in credit card information in the form. If paying by check or cash, please deliver to:

B’nai David-Judea Congregation, 8906 W. Pico Blvd., Los Angeles, CA 90035

310.276.9269 · Fax 310.317.7211 · E-mail: amram@bnaidavid.com

First Name *

Last Name *

Mobile Phone Number *

Email *

Spouse First Name

Spouse Last Name

Spouse Mobile Phone Number

Spouse Email

Home Phone Number *

Fax

MEMBERSHIP TYPE * Full Family Membership + 2 Seats ($1606)
Full Single/Single Parent Family Membership + 1 Seat($1166)
Full College Student Membership + 1 Seat ($286)
Newlywed Membership + 0 Seats (FREE)
Associate Membership + 0 Seats ($676)

Full Membership- Incluided Seats

Handicap Accessible Seats? Yes

Full Membership- MALE Extra Seats ($125 Each)

Handicap Accessible Seats? Yes

Male Guest Name(s)

Full Membership- FEMALE Extra Seats ($125 Each)

Handicap Accessible Seats? Yes

Female Guest Name(s)

Full Membership- FEMALE Child Seats, 7th -12th Grades, ($75 Each)

Handicap Accessible Seats? Yes

Full Membership- MALE Child Seats, 7th-12th Grades. ($75 Each)

Handicap Accessible Seats? Yes

Student Member Included Seats

Handicap Accessible Seats? Yes

Newlywed Seats ($300/Couple)

Handicap Accessible Seats? Yes

Add-Ons Sisterhood Membership ($18)
Youth Programming ($100)
Security Assessment- Due in November ($250)

I would like to purchase an purchase an Aliyah for the High Holidays for the amount of: (Minimum $200)

Rehov Yeladim for the High Holidays- MEMBERS ($75 Each BOY 6 months-11 years)

Rehov Yeladim for the High Holidays- MEMBERS ($75 Each GIRL 6 months-11 years)

Rehov Yeladim for the High Holidays- NON-MEMBERS ($95 Each BOY 6 months-11 years)

Rehov Yeladim for the High Holidays- NON-MEMBERS ($95 Each GIRL 6 months-11 years)

Amount Due *

Amount Enclosed *

Payment Method * Cash (please drop off to the office, DO NOT MAIL)
Check (please drop off or mail to the office)
Credit Card (Enter Info Below)
Payment Plan (by post-dated check or credit card. Please contact Amram Hassan to set up your plan)

Credit Card Number

Credit Card Expiration Date

Additional Comments/Notes