Membership Application

Membership Application to Congregation Shalom of San Antonio, a Reform Jewish community inspiring dynamic engagement in Jewish worship, values, texts, culture, and social action, encouraging participation by all who seek connection to Jewish life.

SECTION 1: APPLICATION INFORMATION

If a couple, please indicate information for “Adult A” and “Adult B.” If an individual, just use “Adult A.”

Name (Adult A)

First Last

Date of Birth (Adult A)

Email (Adult A)

Mobile Phone # (Adult A)

Name (Adult B)

First Last

Date of Birth (Adult B)

Email (Adult B)

Mobile Phone # (Adult B)

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone # (if applicable)

Mailing Address

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Marital Status

Married

Partnered

Single

Widowed

If married, date of marriage

How would you prefer your name(s) to appear on Congregation Shalom mailings? (e.g. Mr. & Mrs. Alan Cohen, Alan & Shirley Cohen, Alan Cohen & Shirley Fine, etc.)

SECTION 2:

Please help us get to know a little bit about you. We understand that not every question will apply to you, or you may not be able to answer every question. That’s okay. We appreciate your completing as much of this section as you can.

ADULT A:

Name

First Last

Profession / Title

Employer

Religious Background (Optional)

Reform

Conservative

Orthodox

Reconstructionist

Jewish Non-Practicing

Other Faith Tradition

Other Faith Tradition: (please describe)

Previous / Other Synagogue and City

Dates of Affiliation:

Hebrew Name (if applicable):

Father's Name

First Last

Father's Hebrew Name (if applicable):

Is your father living, or deceased?

Living

Deceased

If father is deceased, date of death:

Mother's Name

First Last

Mother's Hebrew Name (if applicable):

Is your mother living, or deceased?

Living

Deceased

If mother is deceased, date of death:

ADULT B:

Name

First Last

Other Faith Tradition: (please describe)

Profession / Title

Employer

Religious Background (Optional)

Reform

Conservative

Orthodox

Reconstructionist

Jewish Non-Practicing

Other Faith Tradition

Other Faith Tradition: (please describe)

Previous / Other Synagogue and City

Dates of Affiliation:

Hebrew Name (if applicable):

Father's Name

First Last

Father's Hebrew Name (if applicable):

Is your father living, or deceased?

Living

Deceased

If father is deceased, date of death:

Mother's Name

First Last

Mother's Hebrew Name (if applicable):

Is your mother living, or deceased?

Living

Deceased

If mother is deceased, date of death:

SECTION 3:

Please tell us who else is in your household so we can be sure to include them in our Congregational activities!

CHILDREN –

Please compete all applicable information for each child. Add additional children on back.

Name – Child A

First Last

Date of Birth

Hebrew Name

Current School

Current Grade Level

Name – Child B

First Last

Date of Birth

Hebrew Name

Current School

Current Grade Level

Name – Child C

First Last

Date of Birth

Hebrew Name

Current School

Current Grade Level

Name – Child D

First Last

Date of Birth

Hebrew Name

Current School

Current Grade Level

OTHER HOUSEHOLD MEMBERS

Do you have other household members who may participate in Congregation activities, such as adult children, grandchildren, or a companion that lives with you? If so, please tell us who they are so we can welcome them too.

Name

First Last

Relationship to you

Name

First Last

Relationship to you

Name

First Last

Relationship to you

SECTION 4: PROGRAM AND COMMITTEE INTERESTS

It is our sincere hope and desire to offer a variety of opportunities for involvement in the life of Congregation Shalom. Please let us know which, if any, of the following activities you might like to participate in. Please note, in some cases, we are gauging interest before forming groups and committees.

Check All That Apply:

Holiday Celebrations

Service Participation

Music/Choir

Youth Education

Check All That Apply:

Adult Education

Social Action

Shabbat Dinners

Fundraising

Check All That Apply:

Special Events

Budget & Finance

Membership/Outreach

Inclusion

Tell us more!

What interests and/or talents do you have (so that we may connect you with other Congregation Shalom members that share your interests and talents)?

SECTION 5: YAHRZEITS

Please complete the information below to the best of your ability for each person for whom you’d like to receive annual reminders. Please add additional Yahrzeits on a separate sheet and attach.

Name of Deceased

First Last

Relationship to Member (which member?)

Date of Death

Before or After Sundown?

(to determine Hebrew date)

Before sundown

After sundown

When would you like to be reminded?

Hebrew anniversary date

English anniversary date

Name of Deceased

First Last

Relationship to Member (which member?)

Date of Death

Before or After Sundown?

(to determine Hebrew date)

Before sundown

After sundown

When would you like to be reminded?

Hebrew anniversary date

English anniversary date

Name of Deceased

First Last

Relationship to Member (which member?)

Date of Death

Before or After Sundown?

(to determine Hebrew date)

Before sundown

After sundown

When would you like to be reminded?

Hebrew anniversary date

English anniversary date

Name of Deceased

First Last

Relationship to Member (which member?)

Date of Death

Before or After Sundown?

(to determine Hebrew date)

Before sundown

After sundown

When would you like to be reminded?

Hebrew anniversary date

English anniversary date

Name of Deceased

First Last

Relationship to Member (which member?)

Date of Death

Before or After Sundown?

(to determine Hebrew date)

Before sundown

After sundown

When would you like to be reminded?

Hebrew anniversary date

English anniversary date

Name of Deceased

First Last

Relationship to Member (which member?)

Date of Death

Before or After Sundown?

(to determine Hebrew date)

Before sundown

After sundown

When would you like to be reminded?

Hebrew anniversary date

English anniversary date

SECTION 6: FINANCIAL INFORMATION

Congregation Shalom of San Antonio is an inclusive congregation that welcomes all who seek connection to Jewish life. While all may participate in worship services and education classes, benefits of membership include pastoral care, life cycle celebrations, and high quality educational programs for children and adults, and being part of a really special community. Most activities are offered at no additional fees for any Congregation member who wishes to attend. We depend on our members in order to meet the financial obligations associated with these benefits. Our Congregation operations are funded primarily through a Shared Member Commitment. The sustaining contribution level is $2,500, which reflects the actual cost per member household to maintain our Congregation Shalom staff and activities. We ask that each member household fairly assess its own Commitment level and contribute according to their ability to support and sustain the Congregation. We realize that not everyone will be able to contribute at the sustaining contribution level, while others who are able will generously contribute more, and we are grateful for each and every contribution. We want you to know that your involvement in our Congregational community is what is most important to us, and no one will ever be denied membership because of their financial circumstances. Feel free to contact Adam Falkiewicz, Congregation Shalom Treasurer, at (210) 535-7773 or adam@clflawfirm.com to discuss any concerns about your financial commitment in confidence. We ask that you please make your Annual Membership Commitment Pledge for July 1, 2023-June 30, 2024. You may indicate whether you would like to be invoiced quarterly, semi-annually, annually, or not at all. We ask that, if possible, you include your first quarter payment with your application. We are grateful to have you as a member of Congregation Shalom and we thank you for your support.

Amount Pledged 7/1/2023-6/30/2024

Please indicate whether you would like to be invoiced:

Quarterly

Semi-Annually

Annually

None Needed

Amount This Payment:

Please Select Payment Method:

Check – Send to address at top of page 1.

Credit card – Go online to https://tinyurl.com/3xbkkp5m or scan the QR Code to pay by PayPal or credit card