Chochmat HaLev 2017-2018 Membership Renewal Form
Thank you for renewing your Chochmat HaLev Membership
I / we are renewing as a *
Pledge Amount and Payment
2017-2018 Dues Rates:
Sustaining Community Member
o One-adult household $200+ /month
o Two-adult household $400+ /month
Supporting Community Member
o One-adult household $110+ /month
o Two-adult household $210+ /month
Conscious Community Member
o One-adult household: $75+ /month
o Two-adult household: $140+ /month
o Under 40 years old: One-adult $40 /month, Two-adult $75 /month

I / we commit to the following membership dues pledge of *
Please type in the amount of your pledge.
Your answer
as *

I agree that the dues amount selected above may be charged/debited on the first day of each month beginning July 1, 2017. If I have already paid monthly dues on or after July 2017, and the amount above is an increase, I agree to be charged/debited the difference for the applicable months.

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.

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Required
Update Household Membership Information
Has your information changed?
Mailing Address : Number, Street & Apt (if applicable)
Your answer
Mailing Address City, State, Zip
Your answer
Home Phone
Please list your home phone number
Your answer
Adult Member One Name *
(Last name, First Name)
Your answer
Member One email *
Please list Member One's email address
Your answer
Member One cell number
Please list Member One's cell number
Your answer
Member One's birthdate
(mm/dd/yyyy)
Your answer
For Two Adult Membership:
Adult Member Two
(Last name, First Name)
Your answer
Member Two cell number
Please list Member Two's cell number
Your answer
Member Two's email
Please list Member Two's email address
Your answer
Member Two's birthdate
(mm/dd/yyyy)
Your answer
Children Under 21
Children under 21 are included in the membership
Child One
(Last name, first name)
Your answer
Child One Birthdate
(mm/dd/yyyy)
Your answer
Child Two
(Last name, first name)
Your answer
Child Two Birthdate
(mm/dd/yyyy)
Your answer
Child Three
(Last name, first name)
Your answer
Child Three Birthdate
(mm/dd/yyyy)
Your answer
Additional Children
Please list Firstname, Lastname and birthdate for all additional children
Your answer
Urban Shtetl *
Is your family interested in the Urban Shtetl Family Education Program?
Volunteer
Volunteers are crucial to Chochmat Halev, and volunteering is a great way to become more connected in the Chochmat community.
Committees *
Please indicate if you would be willing to serve on any of the following committees:
Required
Tasks *
Please indicate if you have skills and/or interest in the following:
Required
You're almost there! Please contact the office at 510-704-9687 if you need to update your payment information. THANK YOU FOR BEING A PART OF OUR COMMUNITY!
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