New Member Form - Form - Congregation Shaarei Shamayim

Household Information

* First Name

* Last Name

* Adult 1 Email

* Adult 1 Cell

Birthdate

Adult 2 First Name

Adult 2 Last Name

Adult 2 Email

Adult 2 cell

Birthdate

* Home Address

* City

* State

* Zip code

Home Phone

Child 1

Birthdate

Grade

Child 2

Birthdate

Grade

Child 3

Birthdate

Grade

Child 4

Birthdate

Grade

I would like to observe the following yahrzeits:

Provide name of deceased, relationship to you, date of death (mm/dd/yyyy).

I would like to observe my yahrzeit on:

Hebrew dateEnglish dateThe Hebrew date is not always the same each year because the Jewish calendar differs from our secular calendar.

Sharing Contact Information

Do not share in our newsletterDo not share in our directoryDo not share with Jewish Federation of MadisonDo not share with our Reconstructionist and Renewal affiliates

How would you like to receive the monthly newsletter?

Electronic copy (via email)Hardcopy (via mail)

Join a Havurah Mailing List

Social Action List - General (periodic email with social justice activities)Acts of Caring List (an email list of volunteers who help provide meals, rides, and visits to those in need)Social Action Organizing Group (a discussion group for people doing social action at CSS)Kibitz (unmoderated discussion forum)Please check any mailing list you would like to be on.

Photo Waiver Release

Do not use my photograph (for adult members).Do not use my child(ren)'s photograph.I authorize Shaarei Shamayim to use photographs of my household members in online and printed materials.Shaarei Shamayim periodically uses members' photographs in printed materials and on our website.

Member Interests

Other skills you have to offer:

Other ways you would like to contribute your time:

Membership Pledge

Annual financial commitments are Shaarei Shamayim's main source of revenue. They fund our staff salaries, adult and youth education, social action projects, ritual services, and holiday celebrations. Your financial commitment is based on your individual gross income. Please see our dues guidelines below. Membership runs from September 1 to August 31 each year.

Dues Guidelines

At Shaarei Shamayim no one is turned away because of an inability to pay the published membership commitment levels. In case of need, please contact the office at 608-257-2944 or email office@shamayim.org to discuss your situation with us.

* Pledge