Membership Application 2018-2019

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* First name

* Last name

First name

First name of partner or spouse

Family name

Family name of partner or spouse

* Address

Apt., Suite, PO Box, Floor

* City

* State

* Zip code

Primary person email address

Email of partner or spouse

Home phone

Mobile phone

Primary person mobile phone

Mobile

Mobile phone number of partner or spouse

Benefactor

$4,000.00

In addition to household membership, you will receive 2 extra tickets to the High Holy Day Services, 2 tickets to Casino Night, and 4 tickets to any brunch, lecture, or movie that USH offers throughout the year.

Household

$1800 - 2 adults plus any number of children under the age of 21

Individual

$900 - 1 adult plus any number of children under the age of 21

FT Student / Recent graduate / Senior

First personSecond person

$200

If you are a FT student, recent graduate (within the past 5 years), or senior (70 and older) select "first person" for yourself. If there are 2 adults in your family in one of these categories, also select "second person." The combination of "individual" and Student / Recent graduate / Senior is allowed.

Alumni

First person alumniSecond person alumni

$50 for each adult in this category.

Alumni category is for those who were members of USH and have moved out of our area. Please note that High Holy Day tickets are not included in this category.

When you have completed the application, and completed the payment details, please go to your account page. There you can enter the names and birth dates of your children, and the names of those loved ones whose yahrzeit you wish to be reminded of. If you need help, please contact the VP Membership.

Total

Wed, May 22 2019 17 Iyyar 5779