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Membership 5786, 2025-26

All completed membership forms and seat reservations for High Holiday 5786 are due by Sept. 1, 2025.

Rosh Hashanah 5786 is Monday Sept. 22, 2025.
Membership Application 5786, 2025-2026
Full Name*
First Name Last Name
Please Select: *

Returning Members with no changes to info on fileReturning Members with changes to info on fileI/we are new members
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Community Name*

Second Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number

Area Code Phone Number
Cell Phone Number*

Area Code Phone Number
Spouse's Name
First Name Last Name
Spouse's E-mail
Full Time Residents:
Family - $1500
Single - $750

Part-Time Residents:
Family - $850
Single - $450
Full Time Residents

Family - $1,500Single - $750
Part-Time Residents Less than 4 months in Florida

Family - $850Single - $450
Full Time Residents with Promo 5% Discount

Family - $1425Single - $712.50
Part-Time Residents Promo 5% Discount Less than 4 months in Florida

Family - $726.25Single - $427.50
Community Dues Applies To All Membership Categories

$500 CAMPUS ARMED SECURITY$180 ANNUAL MAINTENANCE COMMUNITY ERUV, MIKVAOT, KOLLEL$2000 CAMPUS EXPANSION CAMPAIGN (2 year payment option)
Members receive 2 seats with full family membership. Each additional @$200 per seat.
Please reserve my 5786 HH seats

2 seats (included in full family membership)Non-Member, $275 per seat
Members: Number of additional seats:
$200/seat
Non-Members: Number of seats:
$275/seat
Please register me for the following

Listing in Community High Holiday Card ($18 per family name)Annual Membership Jewish Womens Circle ($50)
Yahrzeit Information
Full English and Hebrew name, family name and relationship. For Aliyot Etc.
Full Name
English Name Hebrew Name Last Name
Father's Name
Date of Passing

Month Day Year
Please Select

AMPM
Relationship
Full Name
English Name Hebrew Name Last Name
Father's Name
Date of Passing

Month Day Year
Please Select

AMPM
Relationship
Full Name
English Name Hebrew Name Last Name
Date of Passing

Month Day Year
Please Select

AMPM
Relationship
Contact me regarding Yahrzeit Plaques to be installed in perpetuity, Main SanctuaryI wish to have my loved ones listed in the 5786 Yizkor Memorial Book
Total

$0.00

Payment

Credit Card Paypal eCheck Check

Postal / Zip Code

Country

Should be Empty:

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