Membership-2 - Congregation Beth HaMidbar

Membership packet

Name
Prefix First Middle Last
Phone (Home)
Phone (Cell)
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
The Congregation’s membership list will be sent to all members and will include the above information. The membership list is NOT to be used for any solicitation purposes. Please note if you wish any information to be excluded from the membership list sent to all members.
Special instructions:

Membership Category*
- Family - $475
- Single - $350
- Winter Visitor - $150
Hidden
StartDate
MM
DD
YYYY
Memorial Book Donation - $
We wish to contribute to the Congregation in memory of our beloved departed, whose names are to be printed in the Memorial Book.
High Holidays - $
Total
$0.00
Please skip the Credit Card section and mail a check. Thank you.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Please skip the Credit Card section and mail a check. Thank you.

Name	Relationship

First Name	Last Name	Birthdate (day and month)

Name	Phone #

Name	Phone #	Address