Renew Membership Form - 25/26

Renew Membership - CBI 2025/6 (5786)

Thank you for supporting CBI by renewing your membership. We are grateful to share in community with you and for your tzedakah (contribution), at whatever level you are able to offer.
If you prefer a paper form, please contact the CBI office at cbi18@cbi18.org.

Please login to your ShulCloud account before filling out the below form – click the grey "login" button on the top right of your screen. You will know you are logged in when you see your name in the grey box. If you have never logged in before please choose "forgot password" and follow reset instructions.

If you would like to use a DAF (Donor Advised Fund) or pay by check and did not use this form of payment last year, please call the office before filling out the form. If you would like to use an account credit, please choose that option on the payment screen. Members who have previously paid by check please use the bill to account option on the payment screen.

Click here to view all membership dues and religious school fees.

* Adult 1: First Name

Adult 1: Middle Name

* Adult 1: Last Name

Has your email, phone or mailing address changed?

Adult 1: Home Phone

Adult 1: Mobile Phone

Adult 1: Work Phone

Adult 1: Email

Adult 1: Date of Birth

Adult 1: Gender

Adult1: Tribe

Address

Address Line 2

Address City

Address State

Address Zip Code

Adult 2: First Name

Adult 2: Middle Name

Adult 2: Last Name

Adult 2: Mobile Phone

Adult 2: Work Phone

Adult 2: Email

Adult 2: Date of Birth

Adult 2: Gender

Adult 2: Tribe

Are there any new members in your household?

Please list any additional adults, together with their birthdates, in the household:

Please list any children, together with their birthdates, in the household:

Please list any adult children, together with their birthdates, who no longer live in your household:

ALL RENEWING MEMBERS PLEASE CONTINUE BY SELECTING AN OPTION BELOW:

* Are you requesting need-based scholarships for this year's membership dues & education fees?

A. Choose your Membership Giving Level - Either Standard or Benefactor

A. Choose your Membership Giving Level

A1. Standard Membership Category

If selecting Benefactor status, please click "Unselect" for A1 and then skip ahead to Section A2. Only use "unselect" if choosing a Benefactor Level in A2.

Please note that "Friend of CBI" Associate Membership status does not include High Holy Days or the ability to sign up for Religious School.

A1. Standard Membership Category

Dues amounts below reflect what we ask our members to contribute in order to support all our community's programs and services. We know not all members are currently able to contribute at this level. Please select the dues category that correctly matches your household below (children under 18 are included in your adult membership level), and you will have the opportunity to provide us the scholarship amount you are requesting later in this form.

Please note that "Friend of CBI" Associate Membership status does not include High Holy Days or the ability to sign up for Religious School.

* Membership Category

Please Select One$3,750 - Couple (age 36-68)$2,050 - Individual (age 36-68)$2,350 - Senior Couple (69+)$1,350 - Senior Individual (69+)$650 Young Couple (35 and under)$350 Young Individual (35 and under)$575 "Sharon" Families (only Former Members of Temple Sharon)

A2. Benefactor Levels - Honors Circle

Includes High Holy Day tickets and Recognition Events

Platinum - Gold Benefits + 2 more Gala Tix (8 total), Free Tix to All CBI Community Events (excluding private events)

Gold - Silver Benefits + Private event with Rabbi Adam and Hazzan Amy, 2 more Gala Tix (6 total), Full Page Gala Advertisement (instead of ½ Page), 1 HH reserved parking spot, Adult Enrichment Patron Status

Silver - Bronze Benefits + 2 more Gala Tix (4 total), 2 HH Tix for potential prospects (never before members)

Bronze - Copper Benefits + Gala Sponsorship including 2 Tix and ½ Page Gala Advertisement, Free Dinners at Shabbat under the Stars

Copper - Recognition Dinner, Event w/ Clergy, Purim Gift, Gala Journal Recognition, HH Group Aliyah

B. Mandatory Security & Maintenance Fee:

* Security & Maintenance Fee - Required

$225 Couple$110 Individual

* Security & Maintenance Fee - Required

$225 Couple$110 Individual

Friend of CBI: No Security Fee Required

C. Religious School

Do you want to register children for religious school?

C1. Religious School Registration

After completing this form, please complete the religious school registration form by clicking here, so our team will be prepared for your child(ren) to start school in September. Please note, we offer special pricing for Jewish Day School families. Please choose "Jewish Day School" under Grade option. For any questions please contact shoffman@cbi18.org.

Child 1 First Name

Child 1 Last Name

Child 1 Grade

Child 2 First Name

Child 2 Last Name

Child 2 Grade

Child 3 First Name

Child 3 Last Name

Child 3 Grade

Child 4 First Name

Child 4 Last Name

Child 4 Grade

Subtotal and Scholarship Request

* Please share some background to let us know why you are requesting a scholarship and are not able to pay the full dues and/or education tuition amount.

Please note the amount due for membership dues, security & maintenance, and education tuition for this year, July 1, 2025-June 30, 2026. Then please write in the box below the amount you are requesting to pay in dues. If you were provided with a scholarship last year, we respectfully request that you increase your contribution by at least 10%. Your requested scholarship amount is subject to committee review.

* After scholarship is applied to my account, I will pay my dues:

Please Select OneIn full by checkIn full with card on file - I give permission for the card to be chargedMonthly by checkMonthly with card on file - I give permission for the card to be chargedPlease contact me for a credit card to charge in fullPlease contact me for a credit card to charge monthly

All donation options below this line cannot be part of your scholarship request.

D. Adult Social Groups

$36 Women's Club: in box below, enter the number of people for women's club membership

$36 Men's Club: in box below, enter the number of people for men's club membership

$36 PrimeTimers (65+) - Optional Donation: enter a quantity of people for PrimeTimers in the box below:

E. Youth Groups

For 25/26 year, we are no longer asking for a dues payment for Machar and Kadima youth groups. We will ask for payment during individual event registration.

Do you want to register children for USY?

$200 USY (7th-12th)

Download the CBI Youth Group Release & Authorization and Code of Conduct forms at the link below (they're in one file):

CLICK HERE

If you have any trouble accessing the form or questions, email youth@cbi18.org and a copy can be sent via email.

It is expected that you and your child (the "we" in the form) will go over the Release & Authorization and Code of Conduct together and your child will abide by this policy. As a parent, please initial as you go through the forms (the "I" in the form). There is space for the participant to sign at the bottom of each document. It is recommended both parents (if applicable) familiarize themselves with the rules, even though only one is required to initial and sign. The forms are geared toward our USY program, but please fill it out for younger children regardless.

View the CBI Youth Group Release & Authorization and Code of Conduct forms at the link below:

CLICK HERE

If you have any trouble accessing the form or questions, email youth@cbi18.org and a copy can be sent via email.

It is expected that you and your children (the "we" in the form) will go over the Release & Authorization and Code of Conduct together and your children will abide by this policy. It is recommended both parents (if applicable) familiarize themselves with the rules, even though only one is required to sign.

Please enter your name as a Digital Signature that you and you children have read and understand the CBI Youth Group Release & Authorization and Code of Conduct:

Youth First Name:

Youth Last Name:

Youth Phone (if they have one):

Youth Email (if they have one):

Youth First Name:

Youth Last Name:

Youth Email (if they have one):

Youth Phone (if they have one):

Youth Date Of Birth (MM/DD/YYYY):

Youth Gender:

Grade in Sept 2025:

Youth Date Of Birth (MM/DD/YYYY):

Youth Gender:

Grade in Sept 2025:

Youth 2 First Name:

Youth 2 Last Name:

Youth 2 Phone (if they have one):

Youth 2 Email (if they have one):

Youth 2 First Name:

Youth 2 Last Name:

Youth 2 Phone (if they have one):

Youth 2 Email (if they have one):

Youth 2 Date Of Birth (MM/DD/YYYY):

Youth 2 Gender:

Grade in Sept 2025:

Youth 2 Date Of Birth (MM/DD/YYYY):

Youth 2 Gender:

Grade in Sept 2025:

Youth 3 First Name:

Youth 3 Last Name:

Youth 3 Phone (if they have one):

Youth 3 Email (if they have one):

Youth 3 First Name:

Youth 3 Last Name:

Youth 3 Phone (if they have one):

Youth 3 Email (if they have one):

Youth 3 Date Of Birth (MM/DD/YYYY):

Youth 3 Gender:

Grade in Sept 2025:

Youth 3 Date Of Birth (MM/DD/YYYY):

Youth 3 Gender:

Grade in Sept 2025:

Youth 4 First Name:

Youth 4 Last Name:

Youth 4 Phone (if they have one):

Youth 4 Email (if they have one):

Youth 4 First Name:

Youth 4 Last Name:

Youth 4 Phone (if they have one):

Youth 4 Email (if they have one):

Youth 4 Date Of Birth (MM/DD/YYYY):

Youth 4 Gender:

Grade in Sept 2025:

Youth 4 Date Of Birth (MM/DD/YYYY):

Youth 4 Gender:

Grade in Sept 2025:

Youth Allergies

Please note name(s) of child(ren) and allergy/allergies in box above, and please indicate if life threatening allergy, mild allergy, sensitivity, or other.

Other Medical Conditions:

Please note name(s) of child(ren) and condition(s) in box above.

Youth Allergies

Please note name(s) of child(ren) and allergy/allergies in box above, and please indicate if life threatening allergy, mild allergy, sensitivity, or other.

Other Medical Conditions:

Please note name(s) of child(ren) and condition(s) in box above.

Medications:

Please note name(s) of child(ren) and medication(s) in box above.

Medications:

Please note name(s) of child(ren) and medication(s) in box above.

All Youth Medical/Health Insurance Company Name:

Please note name(s) of child(ren) and insurance company/companies in box above.

Medical/Health Insurance Policy #:

Please note name(s) of child(ren) and all insurance policies in box above.

Medical/Health Insurance Group #:

Please note name(s) of child(ren) and insurance group number(s) in box above.

All Youth Medical/Health Insurance Company Name:

Please note name(s) of child(ren) and insurance company/companies in box above.

Medical/Health Insurance Policy #:

Please note name(s) of child(ren) and insurance policies in box above.

Medical/Health Insurance Group #:

Please note name(s) of child(ren) and insurance group number(s) in box above.

Primary Physician Name:

Please note name(s) of child(ren) and primary physician name(s) in box above.

Primary Physician Phone Number:

Please note name(s) of child(ren) and primary physician number(s) in box above.

Primary Physician Name:

Please note name(s) of child(ren) and primary physician number(s) in box above.

Primary Physician Phone Number:

Please note name(s) of child(ren) and primary physician number(s) in box above.

Emergency Contact First Name:

Emergency Contact Last Name:

Emergency Contact Cell Number:

Emergency Contact Email:

Emergency Contact First Name:

Emergency Contact Last Name:

Emergency Contact Cell Number:

Emergency Contact Email:

Emergency Contact Relationship to Youth:

Emergency Contact Relationship to Youth(s):

F. Additional Support Opportunities

$360 University Park Minyan & Other Alternative Services

$500 Adult Enrichment Patron

$360 University Park Minyan & Other Alternative Services

$500 Adult Enrichment Patron

General Fund (enter discretionary amount for unrestricted funds that can be used to support all areas)

Membership Support Fund (enter discretionary amount for scholarships for members needing financial assistance)

General Fund (enter discretionary amount for unrestricted funds that can be used to support all areas)

Membership Support Fund (enter discretionary amount for scholarships for members needing financial assistance)

Capital Improvement Fund (enter discretionary amount)

Climate Action Fund (enter discretionary amount)

Capital Improvement Fund (enter discretionary amount)

Climate Action Fund (enter discretionary amount)

CDC Preschool Fund (enter discretionary amount)

Religious School Fund (enter discretionary amount)

CDC Preschool Fund (enter discretionary amount)

Religious School Fund (enter discretionary amount)

G. Act of Kindness

This year I pledge to give my time by:

Serving on a committeeVolunteering in the officeAttending shiva minyanimServing as a "buddy" for older or ill congregantsVolunteering on a social action projectReading Torah and/or haftarah

Other ways I'd like to share my skills, talents, and passions with my CBI community:

Comments (optional)

Total

Mon, June 9 2025 13 Sivan 5785

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