Membership 2025-26 - Form - Congregation Shir Tikvah

Membership Enrollment Form

Household Information

Please fill out the information for yourself and family members (if applicable). Staff will use this information to generate a basic account. We will then be able to provide you with a unique log-in that you can use to edit your profile, add yahrzeit information and more.

Depending on time of year, this initial process may take several business days. Payment is not due at this time.

Let us know if you have additional adults to add to your account. Shir Tikvah recognizes and supports the diversity of individuals, households and families.

* Adult 1 First Name

* Last Name 1

Email 1

* Phone 1

Adult 2 First Name

Last Name 2

Email 2

Phone 2

Adult 1 Occupation

Adult 2 Occupation

Full Name/s and Birthdate/s (mm/dd/yyyy) of Child/ren

Address Line 1

Apt/Unit

State

Zip Code

Fair Share Dues Structure:

Member Dues are on a sliding scale, based on a household's adjusted gross income (Form 1040, line 11). Here is the formula:

$40,000 and lower = 1% (income x .01)
$40,001 and higher = 2% (income x .02), up to a maximum of $4000

Keren Zeriyah (Seed) Fund:

**Required for the first 3 years of membership. Supports synagogue operations (in place of a building fund)

Equivalent of 1 year dues commitment, payable over 3 years (1/3 each year)

Practical Examples:

David M has an adjusted gross income of $60,000/year. He pays $1,200 in dues (2% of $60,000) and $400 in KZ (1/3 of $1,200) for his first three years of membership. Total of $1600 per year.

Sera W has an adjusted gross income of $18,000/year. They pay $180 in dues (1% of $18,000) and $60 in KZ (1/3 of $180) for the first three years of their membership. Total of $240 per year.

Lack of funds should never be a barrier.

We say it and we mean it. The Kiruv Fund was established to subsidize member dues for those with economic hardship (illness, disability, unemployment, etc). To make Shir Tikvah membership accessible to everyone, tell us the amount you are able to afford and the Kiruv Fund will make up the difference. You can indicate the need for financial aid lower on this form.

2025-2026 Membership Commitment

We believe that no one should be excluded from our kehillah due to financial constraints. Please indicate if you would like to be considered for an adjusted membership commitment. This allows us to work together in sustaining our community while accommodating individual circumstances.

* Financial Assistance Request

Please Select OneNo, I am not interested in financial assistance with my membership commitmentYes, I am interested in financial assistance with my membership commitment

ANNUAL MEMBERSHIP COMMITMENT

List the total amount(s) of your 2025-2026 annual commitment here:

* Annual Member Dues

"Fair Share" dues is based on Adjusted Gross Income (Form 1040, line 11)
$40,000 or less = 1% (line 11 x .01)
$40,001 or more = 2% (line 11 x .02)
Maximum of $4000

* Keren Zeriyah (Seed Fund) Commitment

Required of all new members for the first 3 years.
This amount is the equivalent of one year of member dues (left), paid over 3 years at 1/3 each year.
Enter 1/3 of your member dues here

FINANCIAL AID APPLICATION

In addition to Shir Tikvah membership, do you have other regularly occurring Jewish education/activity costs?

Nashira Education Project TuitionBrit Mitzvah FeesOther (describe in box on right)

Other Jewish Education/Activity Costs?

Check if you applied for a scholarship with the Nashira Education Project

Please describe your need for financial assistance with the membership commitment. Please include any extenuating circumstances such as medical bills, college tuition costs, job loss/job change, etc.

Prior to financial aid, my "Fair Share" dues amount is:

"Fair Share" dues is based on Adjusted Gross Income (Form 1040, line 11)
$40,000 or less = 1% (line 11 x .01)
$40,001 or more = 2% (line 11 x .02)

My Keren Zeriyah (Seed Fund) Pledge is:

Required of all new members for the first 3 years.
This amount is the equivalent of one year of member dues (left), paid over 3 years at 1/3 each year.
Enter 1/3 of member dues here

PROPOSED REDUCED DUES COMMITMENT

Tell us how much you can afford to pay for the 2025-26 Membership year

Include BOTH Membership commitment and Keren Zeriyah (Seed fund) pledge.
Enter the annual amount. For example, if you can afford to pay $100 per month, enter $1200 (for those joining in June or July); otherwise, pro-rate the amount based on the number of months remaining in the membership year.
The membership year runs from July 1, 2025 through June 30, 2026.

You will hear from our Administrative Director, JoAnn Bezodis, regarding your request for financial assistance within 3-5 business days. Thank you for your patience

TELL US ABOUT YOURSELF

Unique skill/s

examples include: maintenance and repair, calligraphy, balloon-animals, writing, web-design, jewelry making, face painting, American Sign-Language, make Tik-Tok videos, play a musical instrument...

Payment Information

Please complete this information as thoroughly as possible so our team can accurately and promptly process your payment(s).

Payment Timeline

I understand that if I use a credit card, the system will add a 3% service fee. Shir Tikvah does not collect the revenue from this fee. There is no service fee for payments made with ACH or debit card.

Payments will process on the first of the month, unless another date is requested here:

Thank you for joining Shir Tikvah!

By typing my name below, I confirm that the information I provided for my membership renewal is accurate. I will notify Shir Tikvah promptly of any changes to address, financial/payment information, members of household, etc.

* Signature (typed name counts as a signature)

Shir Tikvah Staff - if you completed this form with a congregant, please type your name here as well.

Date