Membership Application

Baruch Haba - welcome to our congregation! In order to involve you as much as possible in our community, we want to be sure to have accurate information about you and your family. We look forward to having you as a member of our community.
Personal Information
Adult 1

First NameLast Name
Email Adult 1
example@example.com
Adult 1 Date of Birth

MonthDayYear
Date
Anniversary (if applicable)
Adult 1 Phone Number

Area CodePhone Number
Adult 2

First NameLast Name
Email Adult 2
example@example.com
Adult 2 Phone Number

Area CodePhone Number
Adult 2 Date of Birth

MonthDayYear
Date
Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState

Zip Code

Household Children (if applicable)
Child 1

First NameLast Name
Child 1 Date of Birth

MonthDayYear
Date
Would you like to enroll this child in Religious School?

YesNo
Child 2

First NameLast Name
Child 2 Date of Birth

MonthDayYear
Date
Would you like to enroll this child in Religious School?

YesNo
Child 3

First NameLast Name
Child 3 Date of Birth

MonthDayYear
Date
Would you like to enroll this child in Religious School?

YesNo
Child 4

First NameLast Name
Child 4 Date of Birth

MonthDayYear
Date
Would you like to enroll this child in Religious School?

YesNo

Yahrzeits
Name of Deceased

First NameLast Name
Relationship
Date of Death

MonthDayYear
Date
Name of Deceased

First NameLast Name
Relationship
Date of Death

MonthDayYear
Date
Name of Deceased

First NameLast Name
Relationship
Date of Death

MonthDayYear
Date
Name of Deceased

First NameLast Name
Relationship
Date of Death

MonthDayYear
Date
Name of Deceased

First NameLast Name
Relationship
Date of Death

MonthDayYear
Date
Name of Deceased

First NameLast Name
Relationship
Date of Death

MonthDayYear
Date

Volunteering
Volunteering is a great way to meet other members! Please indicate interest in serving on a committee.
Do any members of your household have talents or interests they would like to share with the community (i.e. teaching Hebrew, Israeli dancing, cooking, repair work)?
Would you or your family like to take part in leading our service?

YesNot at this time
Do you have any other interests or concerns?

Membership Dues
Family Membership
- under 30 years old: $750
- 30-65 years old: $1050
- 65+: $950
Single Membership
- under 30 years old: $350
- 30-65 years old: $775
- 65+: $675
Full-Time Student Membership
- Full-time with student ID: $100
Membership payment is due at the time of application unless other arrangements have been made. Please contact treasurer@bethisraelbath.org with questions.

We accept Mastercard and Visa payments online (+3% credit card processing fee applies)

To pay Online return to the Membership Page after clicking on the Submit button below.

Or checks may be mailed to:

Beth Israel Congregation

PO BOX 244

Bath, ME 04530
Should be Empty: