Young Israel of Wavecrest & Bayswater On Line Membership Form Membership Dues - Family - Check one *Pillar - $1000 *Partner - $500 Friend - $180 Membership Dues - Single/Divorced/Widowed - Check one *Pillar - $500 *Partner - $250 Friend - $90 *Pillars & Partners will have full membership rights. Membership dues include National Council & Sisterhood dues. FAMILY INFORMATION Family Name* Home Address* Home Phone* Wedding Anniversary Male Head of Household Title* Mr. Mrs. Miss Rabbi Dr. Given Name (English) Hebrew Name Date Of Birth You are a: Cohen Levi Yisroel Marital Status Married Single Divorced Widowed Email Cell Phone Employer Business Address Business Phone Fax Female Head of Household Title Mr. Mrs. Rabbi Dr. Given Name (English) Hebrew Name Date Of Birth Father is a: Cohen Levi Yisroel Marital Status Married Single Divorced Widowed Email Cell Phone Employer Business Address Business Phone Fax CHILDREN English Name Hebrew Name Age Birthday School English Name Hebrew Name Age Birthday School English Name Hebrew Name Age Birthday School English Name Hebrew Name Age Birthday School English Name Hebrew Name Age Birthday School English Name Hebrew Name Age Birthday School English Name Hebrew Name Age Birthday School English Name Hebrew Name Age Birthday School YAHRTZEITS English Name hebrew Name Relationship Enlish date Hebrew Date Do You want a Memorial plaque for the above Person? Yes No If yes is checked, we will contact you regarding details English Name hebrew Name Relationship Enlish date Hebrew Date Do You want a Memorial plaque for the above Person? Yes No If yes is checked, we will contact you regarding details English Name hebrew Name Relationship Enlish date Hebrew Date Do You want a Memorial plaque for the above Person? Yes No If yes is checked, we will contact you regarding details English Name hebrew Name Relationship Enlish date Hebrew Date Do You want a Memorial plaque for the above Person? Yes No If yes is checked, we will contact you regarding details English Name hebrew Name Relationship Enlish date Hebrew Date Do You want a Memorial plaque for the above Person? Yes No If yes is checked, we will contact you regarding details English Name hebrew Name Relationship Enlish date Hebrew Date Do You want a Memorial plaque for the above Person? Yes No If yes is checked, we will contact you regarding details Payment I will pay by check To pay by check, make out check to YIWB and send it to: Young Israel of Wavecrest & Bayswater 2716 Healy Ave. Far Rockaway, NY 11691 I will Pay On-Line After pressing the "Submit" button and verifying that the information you entered is correct. go to the home page and press the "Donate" button . I will pay by automatic monthly installments: If automatic installments is selected, we will contact you regarding details.