24/25 Membership and Mitzvah Pledge - Form

1) Name and preferred pronouns

2) Representing the following household members (names and preferred pronouns)

3) I have read through both the 24/25 Member Agreement

Click here to see the membership agreement

4) Our household agrees to the obligations and benefits of membership listed therein.

5) Meeting the operational needs of TBS in year 24/25 requires an average pledge of $2600 per member household. If you can pledge at that amount, please do. Pledging more goes a long way to supporting our community as some member households are unable to pledge at that level. As always, any pledge amount is appreciated and money is never a barrier to membership. We would like to make a sustaining pledge (mitzvah pledge) for the 24/25 year in the total amount of:

6) Billing frequency preferences

Please bill me for a one time payment for the full amountPlease send me a bill monthlyPlease send me a bill quarterlyOther, will list in notes

7) Billing method preference

I prefer to receive my bills online (default)I prefer to receive my bills via mail

8) Pay method preferences

I prefer to pay online via credit card or ACHI prefer to pay via check mailed to the temple

9) Autopay preferences

I do not want to set up autopayPlease contact me to set up autopay

10) Volunteer Preferences

My household plans to contribute at least 4 volunteer hours this yearMy household does not anticipate being able to volunteer this year and we are including and additional donation to our Mitzvah pledge in lieu of volunteeringMy household does not anticipate being able to volunteer this year and we are unable to make a donation in lieu of volunteer hours at this time.

Photo Release

yesnoI, hereby authorize Temple Beth Sholom (TBS) and its staff, board, members and clergy to photograph, film, or videotape me while at TBS events and activities. I understand that any photograph, sound recording, motion picture, or video taken of me under this Media Release agreement is for the purpose of collecting or representing factual information in the interest of serving TBS’s mission. I hereby assign TBS all rights, title, and interest, including copyright, in and to any and all such photographs, sound recordings, motion pictures, or videos, and I hereby irrevocably authorize TBS staff, board, members and clergy, without limitation, to reproduce, copy, sell, exhibit, publish, or distribute any and all such photographs, sound recordings, motion pictures, or videos in perpetuity for the purposes expressed above. I further release and forever discharge TBS, its officers, agents, contractors, and employees from any and all claims and demands arising out of or in connection with the use of said photographs, sound recordings, motion pictures, or videos, including but not limited to any and all claims for invasion of privacy, defamation, or copyright infringement. I have read and understood the provisions of this Media Release agreement, and understand that I am free to obtain advice from legal counsel of my choice, at my expense, to interpret these provisions. By signing below, I acknowledge that I have freely and voluntarily entered into this agreement.

11) Notes (optional)