CBI Membership Form

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Pesach 5784
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Congregation B'nai Israel
Pesach 5784
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events
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Whether you have been connected to CBI for years or are new, we are delighted to have you join us as a member.

As a member of CBI, you will be an integral part of our progressive Jewish community campus. CBI’s campus includes a synagogue associated with the Conservative movement, Abundance Farm, Gan Keshet Preschool, ALMA religious school, teen programming, adult education, havurah micro-communities, Tikkun Olam social justice work, and many more ways to live Jewishly and to be in community with others. Your dues helps make all of this possible.

IMPORTANT: PLEASE READ

Please log into your account by adding your name to the top of the form above where it says "Enter a Name". If you have been receiving CBI emails, then you already have an account. If you do not have an account, you can send an email to amy@cbinorthampton.org to set one up. Logging in will allow you to pay by bank transfer which will avoid credit card fees. You can also pay by credit card, but we ask you to pay the convenience fees, as well.

If you would like to set up monthly payments, please make sure the number of payments equals the number of months remaining in the fiscal year. Our fiscal year ends on June 30.

If you prefer to pay by check, please make sure you are logged in, then choose "bill to account" in the payment section after submitting this form. Please send the check to CBI 253 Prospect St. Northampton, MA 01060, attention Amy Stein.

STANDARD DUES STRUCTURE:

MEMBERSHIP TYPE	STANDARD MEMBERSHIP DUES	BUILDING FEE (first 5 years)	TOTAL DUES
Two-Adult Family	$2,246	$170	$2,416 per year ($201.33 per month)
One-Adult Family	$1,830	$170	$2,000 per year ($166.66 per month)
Individual	$1,492	$170	$1,662 per year ($138.50 per month)
Limited Membership*	$670 one adult $1,337 two adults	$0	$670 $1,337
Undergraduate students enrolled in area colleges	No cost	No fee	$0

PRORATED DUES SCHEDULE:

DUES TYPE	July 1—Sept. 30	Oct. 1—Dec. 31	Jan. 1—March 31	April 1—June 30
Two-Adult Family	$2,246.00	$1,684.50	$1,123.00	$561.50
One-Adult Family	$1,830.00	$1,372.50	$915.00	$457.50
Individual	$1,492.00	$1,119.00	$746.00	$373.00
One-adult dual member	$670.00	$502.50	$335.00	$167.50
Two-adult dual member	$1,337.00	$1,002.75	$668.50	$334.25

*LIMITED MEMBERSHIPS:

Dual members (for those who have already have a “home” synagogue, those on Sabbatical, and those who live more than a few hours drive. $670 for one adult, $1,337 for two adults.

NON-STANDARD DUES:

Many of our members pay less and some pay more than standard dues amounts.
Here are some guidelines to help you determine the amount that works for you. If you choose to pay non-standard dues, please write in the amount at the bottom of the membership form.

Annual Household Income Suggested Percentage of Full Cost
Less than $20,000 25% (or whatever you feel you can afford)
$20,000 to $45,000 50%
$45,000 to $70,000 75%
$70,000 and up 100% (or more--see below**)

**For those who can afford more, we hope you will consider becoming a sustaining member by paying an additional $500 or more on top of the standard dues amount--thank you!

You can split your dues into multiple installments in the payment section. You will be directed to the payment section after you submit the membership form information.

If you would like to have a conversation about membership before submitting an application, please reach out to Amy Stein, amy@cbinorthampton.org.

* Number of Adults Joining as Members

1 Adult2 Adults

* Primary Applicant First Name

* Primary Applicant Last Name

Preferred Name or Nickname

* Date of Birth

Pronouns

Hebrew Name

Ben/Bat/M'Beit

Parent 1 Hebrew Name

Parent 2 Hebrew Name

* Address Line 1

Address Line 2

* City

* State

* Zip Code

Home Phone

Mobile Phone

Work Phone

* Email

Occupation

Company/Work Name

If married, anniversary date.

Previous Synagogue Affiliation (if any)

Concurrent Synagogue Affiliation (if any)

I understand my name and contact information will be added to the online member directory. I also understand I can update or remove that information by signing into my online account.

Partner or Spouse First Name (if applicable)

Partner or Spouse Last Name (if applicable)

Preferred Name or Nickname

Date of Birth

Pronouns (optional)

Hebrew Name

Ben/Bat/M'Beit

Parent 1 Hebrew Name

Parent 2 Hebrew Name

Address Line 1

Address Line 2

City

State

Zip Code

Partner or Spouse Mobile Phone

Partner or Spouse Email

Occupation

Company/Work Name

Spouse or Partner Work Phone

Previous Synagogue Affiliation (if any)

Concurrent Synagogue Affiliation (if any)

I understand my partner/spouse's name and contact information will be added to the online member directory. I also understand I can update or remove that information by signing into my online account.

Please feel free to share more about yourself and what has drawn you to CBI.

How many children will be included in your family membership?

01234More than 4 children

Child 1 First Name

Child 1 Last Name

Preferred Name/Nickname

Birthday

Hebrew Name

Pronouns

Child 1 Email

Is child living at the main address?

yesno

If no, indicate the address where the child lives.

Name of School

Current Grade

Are you interested in enrolling your child in ALMA (religious school)?

yesno

Child 2 First Name

Child 2 Last Name

Preferred Name/Nickname-Child 2

Birthday-Child 2

Hebrew Name-Child 2

Pronouns-Child 2

Child 2 Email (if applicable)

Is child living at the main address?

yesno

If no, indicate the address where the child lives.

Name of School

Current Grade

Are you interested in enrolling your child in ALMA (religious school)?

yesno

Child 3 First Name

Child 3 Last Name

Preferred Name/Nickname-Child 3

Birthday-Child 3

Hebrew Name-Child 3

Pronouns-Child 3

Child 3 Email (if applicable)

Is child living at the main address?

yesno

If no, indicate the address where the child lives.

Name of School

Current Grade

Are you interested in enrolling your child in ALMA (religious school)?

yesno

Child 4 First Name

Child 4 Last Name

Preferred Name/Nickname-Child 4

Birthday-Child 4

Hebrew Name-Child 4

Pronouns-Child 4

Child 4 Email (if applicable)

Is child living at the main address?

yesno

If no, indicate the address where the child lives.

Name of School

Current Grade

Are you interested in enrolling your child in ALMA (religious school)?

yesno

If you have additional children, please list their information here.

Yahrzeit Information

It is custom of the congregation to read the names of loved ones who are no longer with us on the anniversary of their passing. You will be notified via mail from the CBI Office of the Hebrew date of your loved one’s death unless you specify the English/Gregorian date.

Do you wish to submit yahrzeit names and receive notices of the anniversary of their passing?

NoYes

Yahrzeit 1 First Name

Yahrzeit 1 Last Name

Yahrzeit 1 Relationship to Applicant

Yahrzeit 1 Date of Passing

Time of Passing

Before sundownAfter sundown

Yahrzeit 2 First Name

Yahrzeit 2 Last Name

Yahrzeit 2 Relationship to Applicant

Yahrzeit 2 Date of Passing

Time of Passing

Before sundownAfter sundown

Yahrzeit 3 First Name

Yahrzeit 3 Last Name

Yahrzeit 3 Relationship to Applicant

Yahrzeit 3 Date of Passing

Time of Passing

Before sundownAfter sundown

If you wish to submit additional yahrzeit names and dates, please type in the details here. Please include the secular (English) date of death.

I (we) am (are) interested in receiving information about the following programs:

Abundance FarmAdult EducationFamily Programs (Celebratory gatherings during Jewish holiday seasons)Gan Keshet PreschoolShabbat Shabloom (Shabbat musical program for families with children ages 5 and under)ALMA (religious school)Teen ProgramsTikkun Olam (social justice)Programming for people ages 65+Spirituality GroupMeditation GroupOhel Minyan, daily minyan

I (we) am (are) interested in learning more about getting involved with the following committees:

Bikkur Holim (visiting the sick in the hospital)Chesed (Caring community)Cemetery CommitteeChevra Kadisha (Ritual Cleansing for Burial)FundraisingMembership CommitteeRitual CommitteeTikkun Olam CommitteeIsrael Committee

I (we) am (are) interested in volunteering at CBI on an occasional basis.

I would like to prepare kiddush lunch with a group of volunteersI would like to be a greeter for Shabbat servicesI am available to help set up and clean up for events and programsI would like to make dinners for community members who are sick or mourningI would like to volunteer to visit the sick in the hospitalI can provide rides for community membersI would like to read Torah/Haftorah at servicesI would like to help with office tasks

“Havurah: An Experiment in Jewish Gathering” is an initiative hosted by Congregation B’nai Israel that supports the development of homegrown, peer-led, Jewish gatherings. The goal of this initiative is to provide a platform for people to fill in gaps they experience in current Jewish programming and offerings by providing the structure and support for gathering and forming mini-communities that foster deep, caring, supportive relationships.

Viist the CBI website havurah page to learn more about the current groups: www.cbinorthampton.org/havurah.

Please indicate which groups you would like to learn more about:

Havurot that are open to new members

Creative Writing HavurahDocumentary Films HavurahHealing Circle Havurah, for people living with chronic illnessHelping Children Harmed by Antisemitic Conduct HavurahHiking HavurahJewish History and Life HavurahKnowing Our Voices, Hearing Our Stories (women in Jewish texts)Mah Jongg HavurahSurvivors of Childhood Sexual Abuse HavurahUkulele HavurahVisual Artists HavurahStorytelling HavurahWounds into Wisdom: Jewish Intergenerational TraumaJews of Color HavurahI would like to discuss ideas for starting a new havurah

Notes or comments about volunteering, committees, or havurot interest and availability.

Please write any special talents, interests or ideas you wish to share with us to better serve the congregation:

Please select a membership level from the options below if you are paying standard dues. If you prefer to write in a non-standard dues amount, do not choose a membership level and write in the amount in the following box instead.

I (We), would like to join at the standard membership level selected below

I (we) would like to pay the following non-standard dues amount from now until June 30, 2024:

If you are paying non-standard dues for this year, please let us know what you would like to be charged for your second year (full year) of dues starting on July 1, 2024.

Please check here to select Building Fee of $170. This fee is required for all standard memberships. If you do not check this, you will be billed for it.

Please select this box if you will make your membership dues contribution by sending us a check.

Please select this box if you will make your membership dues contribution by sending us a check.Checks can be made out to Congregation B'nai Israel with "Membership contribution" in the memo line.

Please submit your application after signing below and complete the payment section of this application.

Type Signature

Date

Tue, April 23 2024 15 Nisan 5784