Congregation B'nai Israel

Membership Form

July 2023 – June 2024

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

Additional Adult in Household

First Last

Additional Adult Email

Additional Adult Phone

Additional Members of your household – Name (age)

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

A1. Standard Membership Category

All but “Friend of CBI” include High Holy Day tickets. If selecting benefactor status, skip to section A2. If requesting scholarship, please choose your standard membership category and request the scholarship application below.

$3,550 Couple (age 36-67)

$1,950 Individual (age 36-67)

$2,100 Senior Couple (68+)

$1,250 Senior Individual (68+)

$600 Young Couple (35 and under)

$330 Young Individual (35 and under)

$525 “Sharon” Families (Only for Former Members of Temple Sharon)

$360 Friend of CBI (member of other synagogue)

Unselect (use ONLY if selecting a Benefactor Level in A2)

A2. Benefactor Levels – Honors Circle

Includes High Holy Day tickets and Recognition Events

$18,000 Platinum Chai

$11,000 Golden Chai

$8,000 Silver Chai

$6,000 Bronze Chai

$4,500 Copper Chai

Unselect

Copper – Recognition Dinner, Event w/ Clergy, Purim Gift, Gala Journal Recognition. HH Group Aliyah, Recognition in Monthly Tribute E-mails
Bronze – Copper Benefits + Gala Sponsorship including 2 Tix and ½ Page Gala Advertisement, Free Dinners at Shabbat under the Stars
Silver – Bronze Benefits + 2 more Gala Tix (4 total), 2 HH Tix for potential prospects (never before members)
Gold – Silver Benefits + Private event with Rabbi Greenwald and Hazan Amy, 2 more Gala Tix (6 total), Full Page Gala Advertisement (instead of ½ Page), 1 HH reserved parking spot, Adult Enrichment Patron Status
Platinum – Gold Benefits + 2 more Gala Tix (8 total), Free Tix to All CBI Community Events (excluding private events)

B. Mandatory Security and Maintenance Fee:

Category*

$200 Couple

$100 Individual

Scholarship

We want everyone interested in being part of our community to join CBI. We do not want membership or tuition to be a barrier to your participation. Please indicate here if you would like our Executive Director to send you our confidential scholarship application. Please choose “pay by check”

Yes

C. Adult Social Groups

Women's Club

Price: $36.00

Men's Club

Price: $36.00

ChaiLife (20s and 30s) – optional contribution

Price: $36.00

PrimeTimers (65+) – optional contribution

Price: $36.00

D. Education

How many children would you like to register for religious school?

Are you interested in learning about our preschool or religious school?

Preschool

Religious School

After completing this form, please complete the Religious School Information Form, so our team will be prepared for your child(ren) to start school in September. For any questions please contact shoffman@cbi18.org.

Child 1 Name
First Last

Child 1 Grade*

$700 Kindergarten

$700 1st Grade

$1,150 2nd Grade

$1,150 3rd Grade

$1,150 4th Grade

$1,150 5th Grade

$1,200 6th Grade

$1,200 7th Grade

$725 Hebrew High (8-12th Grades)

Child 2 Name
First Last

Child 2 Grade*

$700 Kindergarten

$700 1st Grade

$1,150 2nd Grade

$1,150 3rd Grade

$1,150 4th Grade

$1,150 5th Grade

$1,200 6th Grade

$1,200 7th Grade

$725 Hebrew High (8-12th Grades)

Child 3 Name
First Last

Child 3 Grade*

$700 Kindergarten

$700 1st Grade

$1,150 2nd Grade

$1,150 3rd Grade

$1,150 4th Grade

$1,150 5th Grade

$1,200 6th Grade

$1,200 7th Grade

$725 Hebrew High (8-12th Grades)

Child 4 Name
First Last

Child 4 Grade*

$700 Kindergarten

$700 1st Grade

$1,150 2nd Grade

$1,150 3rd Grade

$1,150 4th Grade

$1,150 5th Grade

$1,200 6th Grade

$1,200 7th Grade

$725 Hebrew High (8-12th Grades)

E. Synagogue Youth Groups

After completing this form, please complete the Youth Group Information Form to provide us with more information about your child

Machar (K-3rd) Quantity

Price: $50.00

Kadima (4th-6th) Quantity

Price: $75.00

USY (7th-12th) Quantity

Price: $180.00

F. Additional Support

Dedicated Support Opportunities

$360 University Park Minyan and other Musical Services

$500 Adult Enrichment Patron

CBI Goes Solar (enter discretionary amount for solar carport and EV chargers)

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)

Security Fund (enter discretionary amount for CBI security needs)

Youth Shabbat Programming & Junior Congregation (enter discretionary amount)

CDC Preschool (enter discretionary amount)

G. Act of Kindness

This year I pledge to give my time by:
Serving on a committee
Volunteering in the office
Attending shiva minyan
Bringing food to older or ill congregants
Volunteering on a social action project

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

Credit Card Processing Fee*

Price: $0.00

Total

H. Payment Information

Payments towards 2023-2024 ANNUAL GIVING, DONATIONS, AND TUITION must begin by August 25, 2023 to guarantee High Holy Day tickets and religious school enrollment.

Payment Method*

I will pay in full online now with my Visa or MasterCard (3.5% Fee will be added)

I will pay by credit card in installments (3.5% Fee will be added)

I will send a check(s) to the CBI office

Number of months (not to exceed 10)*

Credit Card Number*

Expiration Date*

CVC (Security Code)*

Cardholder's Name*

Credit Card*

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number
Expiration Date Month Year
Security Code Cardholder Name

Comments (optional)