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Young Israel of Wavecrest & Bayswater On Line Membership Form

MEMBERSHIP TYPES:

Family $450*

Single/Widow(er)/Divorcee $250*

Associate (non-resident) $100

* Plus a $100 building maintenance fee until $1500 or 15 years is reached.

THE FOLLOWING FEES MAY ALSO APPLY:

Building Maintenance Fund $100 Welfare Fund (1st yr $8) $4 Sisterhood dues $25 Youth Dept Dues (See seperate Youth Registration Form
FAMILY INFORMATION
Family Name*
Home Address*
Wedding Anniversary
Home Phone*
Home fax
YOUR INFORMATION
Title Mr. Mrs. Miss Rabbi Dr.
Given Name (English)
Hebrew Name
Date Of Birth
Father is a: Cohen Levi Yisroel
Email
Cell Phone
Employer
Business Address
Business Phone
Fax
Address
SPOUSE INFORMATION
Title Mr. Mrs. Rabbi Dr.
Given Name (English)
Hebrew Name
Date Of Birth
Father is a: Cohen Levi Yisroel
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
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
To 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.