Chochmat HaLev Membership Form
For the 2019-20 membership year.
I / we are joining as a *
Membership Levels
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.

SPIRIT
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

THOUGHT
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

EMOTION
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

ACTION
I wish to embrace my community in the tangible world.
$85/month – single adult
I / we commit to the following monthly membership dues pledge *
Please type in the MONTHLY amount of your pledge.
Your answer
*
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 15thI 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.
Required
Household Information and Members
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 *
(Last name, First Name)
Your answer
Member One cell number
Please list Member One's cell number
Your answer
Member One email *
Please list Member One's email address
Your answer
Member One's birthdate *
(mm/dd/yyyy)
Your answer
For Two Adult Membership:
Adult Member Two
(Last name, First Name; must be completed for a 2 adult membership)
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 Program?
Thank you!
To set up your monthly payment, please call the office at 510-704-9687.
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