2011 Membership 1. Question Title * 1. Please enter your personal contact information below. Section #2 will ask for information about other members of your household, if applicable. Your Name: * Hebrew name for being called up to the Torah (___ ben/bat ___): Address: Apt./Unit #: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code: Email address: * Your Home Number: Question Title * 2. Household information (please fill out based on persons who live with you as applicable): Name of spouse/partner: Hebrew name of spouse/partner for being called up to the Torah (___ ben/bat ___): Spouse/partner email address: Spouse/partner cell phone number: Name of Child 1: Age of Child 1: Name of Child 2: Age of Child 2: Name of Child 3: Age of Child 3: Name of Child 4: Age of Child 4: Name(s) of other persons in household: Relationship(s) of other persons in household: Question Title * 3. If you would like to become a member of Minyan Tehillah, please pick the option that is appropriate for you. Notes on Membership: - Family dues have increased substantially this year because of the addition of increased children's programming and family support during davening throughout the year. - Only dues-paying members may vote in minyan elections. - These are suggested dues based on the minyan's budget. You may give any amount towards your membership but must select a membership option below to be considered a member. Quantity Family membership with child/ren over 1 (includes 2 adult high holiday seats and seats for children, plus children's programming throughout the year):$650 1 2 3 4 5 Family membership with child/ren over 1 (includes 2 adult high holiday seats and seats for children, plus children's programming throughout the year):$650 Quantity menu Family membership with child under 1 (includes 2 adult high holiday seats and seat for child): $450 1 2 3 4 5 Family membership with child under 1 (includes 2 adult high holiday seats and seat for child): $450 Quantity menu Couple membership (includes 2 adult high holiday seats): $400 1 2 3 4 5 Couple membership (includes 2 adult high holiday seats): $400 Quantity menu Individual membership (includes 1 adult high holiday seat): $185 1 2 3 4 5 Individual membership (includes 1 adult high holiday seat): $185 Quantity menu Student/Senior membership (includes 1 adult high holiday seat): $120 1 2 3 4 5 Student/Senior membership (includes 1 adult high holiday seat): $120 Quantity menu Question Title * 4. If you do NOT want to become a member, but would like to attend High Holiday services, please choose one of the following options: Quantity High Holiday attendance only: $150 per person 1 2 3 4 5 High Holiday attendance only: $150 per person Quantity menu Rosh Hashanah attendance only: $110 per person 1 2 3 4 5 Rosh Hashanah attendance only: $110 per person Quantity menu Yom Kippur attendance only: $60 per person 1 2 3 4 5 Yom Kippur attendance only: $60 per person Quantity menu Student High Holiday attendance only: $90 per person 1 2 3 4 5 Student High Holiday attendance only: $90 per person Quantity menu Student Rosh Hashanah attendance only: $60 per person 1 2 3 4 5 Student Rosh Hashanah attendance only: $60 per person Quantity menu Student Yom Kippur attendance: $30 per person 1 2 3 4 5 Student Yom Kippur attendance: $30 per person Quantity menu Question Title * 5. High Holiday Childcare: Minyan Tehillah is offering childcare during High Holiday services for children ages 2 and up. As in past years, the minyan is committed to subsidizing 50% of the cost of this childcare. You MUST pre-register your child(ren) to guarantee childcare. If you do not pre-register your child, s/he may be cared for (resources permitting) for an additional $10/day, charged after the holidays, to cover the cost of contingency planning. While we will not be providing childcare for children under the age of 2, parents with children in that age range are welcome to use the childcare space. number of children over 2 Rosh Hashanah Day 1 ($15/child) 1 2 3 4 Rosh Hashanah Day 1 ($15/child) number of children over 2 menu Rosh Hashanah Day 2 ($15/child) 1 2 3 4 Rosh Hashanah Day 2 ($15/child) number of children over 2 menu Yom Kippur (night and day) ($35/child) 1 2 3 4 Yom Kippur (night and day) ($35/child) number of children over 2 menu Please note names, ages, and allergies, of all children who will be attending (please separate multiple names with commas). Question Title * 6. While most of Tehillah’s budget comes from membership dues, we recognize that it may not work for everyone to pay these amounts for membership. Please give what you can, as we value your presence and participation, and we appreciate your generosity.Please enter the amount you are paying for your membership/ seat reservations here. Question Title * 7. Please note the amount you owe for childcare here. Question Title * 8. Total the membership, seat reservations, and/or childcare costs above, decide how much you can contribute, and type in that amount below. Once you complete the questions on this page you will be taken to a PayPal page to pay.**PLEASE REMEMBER THIS AMOUNT FOR THE PAYPAL DONATION PAGE** Question Title * 9. In order to offer davening and programming throughout the year, Minyan Tehillah relies on the support of numerous community volunteers. Please tell us which of the following volunteer tasks you might be interested in. Being an "on-timer" (arriving at 9:35 am once a month) Kiddush buying (will be reimbursed) Kiddush setup Kiddush cleanup Schlepping with a car Schlepping without a car Arriving early to set up chairs Holiday or social event coordination Small lunch/dinner coordination Friday night davening coordination Chesed support Reading Torah Leading services Giving divrei torah/halacha Teaching learning sessions (e.g., "lunch-n-learns") Childcare help Hospitality support Assistance with one time programming Assistance with family programming Website support Question Title * 10. Please confirm the number of seats you are planning on having for each holiday. Since not all members will be in town for each holiday, this information will help us to obtain an accurate count. Number of adult seats R"H Day 1 1 2 3 4 5 6 R"H Day 1 Number of adult seats menu R"H Day 2 1 2 3 4 5 6 R"H Day 2 Number of adult seats menu Erev Y"K Kol Nidre 1 2 3 4 5 6 Erev Y"K Kol Nidre Number of adult seats menu Y"K Day 1 2 3 4 5 6 Y"K Day Number of adult seats menu Question Title * 11. We are assessing interest in having services in the evening on Rosh Hashanah. If you are interested, please indicate the number of men and women who can commit to being on time. # of Men # of Women Erev RH 1 2 3 4 Erev RH # of Men menu 1 2 3 4 Erev RH # of Women menu Second Night RH 1 2 3 4 Second Night RH # of Men menu 1 2 3 4 Second Night RH # of Women menu Question Title * 12. Our services are completely lay lead and lay organized. Would you be willing to help with making part of High Holiday services happen by: Yes/No Helping buy/shlep supplies in advance Yes No Helping buy/shlep supplies in advance Yes/No menu Hosting one or more guests at a holiday meal? Yes No Hosting one or more guests at a holiday meal? Yes/No menu Set-up for Rosh Hashanah? Yes No Set-up for Rosh Hashanah? Yes/No menu Clean-up after Rosh Hashanah? Yes No Clean-up after Rosh Hashanah? Yes/No menu Set-up for Yom Kippur? Yes No Set-up for Yom Kippur? Yes/No menu Clean-up after Yom Kippur? Yes No Clean-up after Yom Kippur? Yes/No menu Assistance during services? Yes No Assistance during services? Yes/No menu Other Question Title * 13. Would you like to have your information (name, address, email address, children's names, and phone number(s)) included in a community directory? Yes No Question Title * 14. If you are not currently receiving Minyan Tehillah's weekly emails and would like to be added to the email list, please write your email address below. Question Title * 15. Important Dates: The ritual committee and board are continuing an initiative to collect community members' important dates. This information may be used to ask people to have honors during services, help remind people if they are interested in sponsoring davening or kiddush, or help facilitate a requested shiva minyan. Some ideas of dates to include are birthdays, wedding or bar/bat mitzvah anniversaries, yahrzeits, thesis defense dates, etc. If you have more than 4 dates to enter, email the additions to minyantehillah@gmail.com. Example entries Event 1: Carol's birthday Hebrew date: 1 Tishrei English date: September 15 Event 2: Bob's bar mitzvah anniversary Hebrew date: Parashat Noach English date: n/a Event 1: Hebrew date: Secular date: Event 2: Hebrew date: Secular date: Event 3: Hebrew date: Secular date: Event 4: Hebrew date: Secular date: Please again note your total dollar amount in question #8 before continuing on to PayPal. Thank you for your support! Question Title * 16. If you answered YES above, is there any of your information that you would NOT like included in the directory? Address Email address Children's names Phone number Done
