Member Details

Please create a username and password to be able to access your data and make the necessary updates in the future.

Address:

Tel #:

Password
Confirm Password
(Please indicate day/night for birthdays as this affects the Hebrew date)
First
Last

Spouse Details

Address:

Tel #:

(Please indicate day/night for birthdays as this affects the Hebrew date)
First
Last

Marital Status

Children


Please indicate day/night for birthdays as this affects the Hebrew date.

Nachalot/Yahrtzeits

Additional Details

Payment Information

Standard Membership
Individual ---------------- $260 annually
Family ---------------- $260 annually
Membership dues are billed annually and are due by Rosh Hashana that year. High Holiday Seats are not included.
Please find enclosed a check in the amount of $ Please mail your check along with updated applicant form to: I authorize the Hechal Shalom to charge my credit card $ Card # Exp Date CVV Code Signature
Membership is renewed each year unless you notify us otherwise. All contributions are tax deductible to the fullest extent allowed by law.
For Further Information, Please Contact:

0000000000000

We reserve the right of granting membership pending review of application and pertinent documents.