Membership & HHD Registration 5779

HOUSEHOLD INFORMATION

Attention current members! Log into your accounts before going any further so that your current data can populate this form.

Please update or fill in any missing or incorrect information. For questions, please email bdj@bnaidavid.com or call 310-276-9269.

* Adult 1 Title

Adult 2 Title

* Adult 1 First Name

Adult 2 First Name

* Adult 1 Last Name

Adult 2 Last Name

* Adult 1 Gender

Adult 2 Gender

Adult 1 Hebrew First Name

Adult 2 Hebrew First Name

Adult 1 Hebrew Father Name

Adult 2 Hebrew Father Name

Adult 1 Hebrew Mother Name

Adult 2 Hebrew Mother Name

* Adult 1 Email

Adult 2 Email

* Adult 1 Mobile Phone

Adult 2 Mobile Phone

Adult 1 Birthdate

Adult 2 Birthdate

* Address

* City

* State

* Zip Code

Home Phone

Tribe

Wedding Anniversary

CHILDREN

* Do you have a child or children aged 6 months - 5th grade?

Child 1

Child 1 First Name

Child 1 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Will your child be attending Rechov Yeladim for the High Holidays ($100 per child)?

(Choose one)YesNo

Are your child's vaccinations up to date?

YesNo - If you select this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

Child 2

Child 2 First Name

Child 2 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Will your child be attending Rechov Yeladim for the High Holidays ($100 per child)?

(Choose one)YesNo

Are your child's vaccinations up to date?

YesNo - If you selection this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

Child 3

Child 3 First Name

Child 3 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Will your child be attending Rechov Yeladim for the High Holidays ($100 per child)?

(Choose one)YesNo

Are your child's vaccinations up to date?

YesNo - If you selection this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

Child 4

Child 4 First Name

Child 4 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Will your child be attending Rechov Yeladim for the High Holidays ($100 per child)?

(Choose one)YesNo

Are your child's vaccinations up to date?

YesNo - If you selection this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

TWEENS / TEENS

* Do you have a child or children in 6th - 12th grades?

Tween / Teen 1

Tween / Teen 1 First Name

Tween / Teen 1 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

* Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Is your teen willing to do any of the following at Teen Minyan during the year? Check all that apply.

Lein TorahLead ServicesGive a Dvar Torah

Are your teen's vaccinations up to date?

YesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

Tween / Teen 2

Tween / Teen 2 First Name

Tween / Teen 2 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

* Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Is your teen willing to do any of the following at Teen Minyan during the year? Check all that apply.

Lein TorahLead ServicesGive a Dvar Torah

Are your teen's vaccinations up to date?

YesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

Tween / Teen 3

* Tween / Teen 3 First Name

Tween / Teen 3 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Is your teen willing to do any of the following at Teen Minyan during the year? Check all that apply.

Lein TorahLead ServicesGive a Dvar Torah

Are your teen's vaccinations up to date?

YesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

Tween / Teen 4

Tween / Teen 4 First Name

Tween / Teen 4 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Is your teen willing to do any of the following at Teen Minyan during the year? Check all that apply.

Lein TorahLead ServicesGive a Dvar Torah

Are your teen's vaccinations up to date?

YesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

(Choose one)YesNo

If yes, please elaborate.

MEMBERSHIP RENEWAL

I would like to pledge for the following membership level:

Please Select One1 or 2 Adult Household Membership Young Professionals or AssociateTrustee Circle (min. $6000 commitment)High Holiday Tickets Only

Please select a household membership level:

Please Select One2 Adult Household Membership - Includes 2 HHD Tickets - Includes 2 HHD Tickets - ($1950)1 Adult Household Membership - Includes 1 HHD Ticket ($1200)Young Professional - Includes 1 HHD Ticket Fees Below Already Included (Single Under 30 $300)Young Professional - Includes 2 HHD Tickets Fees Below Already Included (Couple Under 30 $500)Associate Membership ($700)Newlyweds (First Year of Marriage FREE)

Trustee Circle
Supporters at the Trustee Circle level are the cornerstone of B'nai David-Judea's mission and serve as role models to encourage other congregants to enhance their commitment to our congregation. One advantage of becoming a Trustee Circle member is the unique option to pledge funds just once a year via a streamlined process, rather than multiple times throughout the year. Your gift includes membership and fees, High Holiday fees, 2 tickets to the annual banquet, all four holiday appeals, mishloach manot, and tickets for the summer fundraiser.

Mandatory Fees - Security Fee

Security Fee ($350)I have already paid this fee or will make alternate arrangements with the office.

Mandatory Fees - Building Maintenance Fee

Building Maintenance Fee ($250)I have already paid this fee or will make alternate arrangements with the office.

HIGH HOLIDAY REGISTRATION

* Will you be joining us for the High Holidays this year?

High Holiday Seats - HHD seats are included with the following membership levels: Trustee Circle, Household Membership and Young Professionals. HHD seats are NOT included for Associate or Newlywed membership levels and must be purchased separately if needed. Seats for additional adults can be purchased for $180 per adult (free for Trustee Circle members).

Tweens and Teens - While there will be special programming for students in grades 6 - 12 during portions of our High Holiday services, our Teens and Tweens will require seats within the main sanctuary. These seats are not included in your membership package and must be purchased separately below. High Holiday seating for Tweens and Teens are offered for purchase at a discount rate of $100/seat.

Seating requests are honored on a first come, first served basis. Seating requests cannot be guaranteed.

Membership HHD Seats (Free)

Teen HHD Seats ($100)

Extra HHD Seats ($180)

Seat Requests

	Name	Location	When	Notes

YIZKOR MEMORIAL BOOK

* Would you like to commemorate your loved one(s) in our Yom Kippur 2018 Memorial book?

Please Select OneYesNo

Once again, as the Holidays approach, our thoughts turn to our loved ones who will not be with us, except in spirit. We honor their memory, and we cherish their dedication to the ideals of Judaism and their loyalty to the Jewish people, by inscribing their names in the Yizkor Memorial Book, which is presented during the Yizkor service on Yom Kippur. To commemorate your loved one(s) – parents, grandparents, aunts, uncles, friends – please fill out the information below.

Memorial Book Donation Amount

Remembered By:

Name

PAYMENT

Your total is below. On the next page, you will be able to set up a credit card payment plan or “bill to account” to pay by check. YOU MUST SELECT A PAYMENT OPTION on the next page for your form to be submitted. Any form without a payment selected WILL NOT BE RECEIVED by the office. If you need payment assistance, please fill out the form and select the “bill to account” option – you may then call the office at 310-276-9269 to discuss a reduced amount or any other arrangements.

We look forward to a meaningful and joyous year together.

Total

Alot Hashachar	4:48am
Earliest Tallit	5:20am
Netz (Sunrise)	6:09am
Latest Shema	9:30am
Zman Tefillah	10:37am
Chatzot (Midday)	12:51pm
Mincha Gedola	1:25pm
Mincha Ketana	4:46pm
Plag HaMincha	6:10pm
Candle Lighting	7:16pm
Shkiah (Sunset)	7:34pm
Tzeit Hakochavim	8:14pm
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