Request edit access
Chochmat HaLev Membership Renewal Form
For the 2019-20 membership year.
Thank you for renewing your Chochmat HaLev Membership!
I / we are renewing as a
One Adult Household
Two Adult Household
Jewish mystical tradition teaches that we live simultaneously in four worlds: the world of action, the world of emotion, the world of thought, and the world of spirit. At Chochmat HaLev, we value the many aspects of each of these worlds.
I wish to sustain the fire and essence of our community into the future.
$220/month – one-adult household
$430/month – two (or more)-adult household
I wish to support the opportunities of our community to learn by supporting our teachers, spiritual leaders.
$175/month – one-adult household
$340/month – two (or more)-adult household
I bring the offerings of my heart: myself and my sacred family to this community.
$125/month – one-adult household
$240/month – two (or more)-adult household
I wish to embrace my community in the tangible world.
$85/month – single adult
I / we commit to the following monthly membership dues of
Please type in the amount of your pledge, or give us a specific instruction like "Please increase my current donation by 10%"
I agree that the dues amount selected above may be charged/debited on the 15th day of each month beginning July 15, 2019. If I have already paid monthly dues on or after July 2019, and the amount above will begin on the next time there is a 15th
I understand that charges/debits will continue until I cancel. I understand that my membership will automatically renew for subsequent fiscal years (July 1 to June 30) at the dues amount I am paying this year, or the new minimum dues amount for that fiscal year, whichever is higher. I understand that I will be given at least 45 days’ notice of the new minimum dues for subsequent fiscal years and if that increase represents a hardship I can request an adjustment.
I understand that I can cancel my membership at any time in this fiscal year or any subsequent fiscal year. However, I may cancel my membership for a fiscal year in which I receive free or discounted member High Holiday tickets only after I have paid one of the following: (1) total dues equal to the full nonmember price for those tickets or (2) twelve months' dues at my agreed dues rate.
I agree to the statements above
Household Membership Information
Adult Member One Name
(Last name, First Name)
Member One email
Please list Member One's email address
Member One cell number
Please list Member One's cell number.
Adult Member Two
(Last name, First Name)
Member Two cell number
Please list Member Two's cell number
Member Two's email
Please list Member Two's email address
If your family has grown since July 2018, mazel tov! And please let us know your new child's name and date of birth.
List your new children
(First Name, Last Name, Date of Birth)
Any other updates?
Let us know if there is something not covered in the questions above.
Is your family interested in the Urban Shtetl Family Education Program?
If you are already a monthly member, we will adjust your monthly payments to reflect your new membership amount (if applicable). If you have any questions, please call the office and leave a message on the main line at 510-704-9687.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service