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Congregation Agudas Achim - Membership Application
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Membership Application
Welcome to the Agudas Achim family! Your participation and active involvement is the most valuable asset to us as we hope it will become for you as well.
MEMBER FAMILY INFORMATION
*
Is there more than one Adult on the membership account?
Please Select One
Yes
No
PRIMARY MEMBER INFORMATION
*
First Name
*
Last Name
Hebrew Name
*
Email Address
Mobile Phone
Date of Birth
Tribe
Cohen
Levi
Yisrael
None Set
*
Gender
N/A or Unknown
Male
Female
Occupation
Name of Business
Business Phone
Conversion Date
(if applicable)
Conversion Rabbi
(if applicable)
Military
Active
Reserve
Retired
Branch
Marital Status
Single
Divorced
Widowed
Married
Anniversary Date
Your involvement is welcomed in all areas of synagogue life. Please indicate your interest below:
Heintz Preschool
Inda Posner Religious School
Men's Club
Sisterhood
Social Action
Caring & Kindness
Youth/Young Adult
Participation in Services/Rituals
Please list any other skills, experiences, areas of interest or training that may be beneficial to our synagogue:
SECONDARY MEMBER INFORMATION
*
First Name
*
Last Name
Hebrew Name
Email Address
Mobile Phone
Date of Birth
Tribe
unknown
Kohen
Levi
Yisrael
Gender
N/A or Unknown
Male
Female
Occupation
Name of Business
Business Phone
Conversion Date (if applicable)
Conversion Rabbi (if applicable)
Military
Active
Reserve
Retired
Branch
Your involvement is welcomed in all areas of synagogue life. Please indicate your interest below:
Heintz Preschool
Inda Posner Religious School
Men's Club
Sisterhood
Social Action
Caring & Kindness
Youth/Young Adult
Participation in Services/Rituals
Please list any other skills, experiences, areas of interest or training that may be beneficial to our synagogue:
HOME AND ADDRESS INFORMATION
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
Home Phone
ADDITIONAL INFORMATION
Number of years in San Antonio:
Came to San Antonio from:
Previous/Current Synagogue Affiliation (Name/City)
Family or Friends affiliated with Congregation Agudas Achim (Name/Relationship)
In case of emergency or death, please contact (Name/Relationship/Phone)
CHILDREN INFORMATION
How many children are in your family?
none
1
2
3
4
*
Child 1 First Name
*
Child 1 Last Name
Nickname
Hebrew Name
written in English if known
*
Gender
Please Select One
Male
Female
Date of Birth
Bar/Bat Mitzvah Date
Email
Grade
School/Occupation
Address/City/State/Zip
if not living with you
*
Child 2 First Name
*
Child 2 Last Name
Nickname
Hebrew Name
written in English if known
*
Gender
Please Select One
Male
Female
Date of Birth
Bar/Bat Mitzvah Date
Email
Grade
School/Occupation
Address/City/State/Zip
if not living with you
*
Child 3 First Name
*
Child 3 Last Name
Nickname
Hebrew Name
written in English if known
*
Gender
Please Select One
Male
Female
Date of Birth
Bar/Bat Mitzvah Date
Email
Grade
School/Occupation
Address/City/State/Zip
if not living with you
*
Child 4 First Name
*
Child 4 Last Name
Child 4 Nickname
Hebrew Name
written in English if known
*
Gender
Please Select One
Male
Female
Date of Birth
Bar/Bat Mitzvah Date
Email
Grade
School/Occupation
Address/City/State/Zip
if not living with you
YAHRZEIT INFORMATION
How many yahrzeits are you observing?
none
1
2
3
4
Deceased's Full Name
Hebrew Name
Written in English if Known
Date of Death
After Sundown?
Yes
No
Gender of Deceased
Male
Female
Observer
Relationship
Deceased's Full Name
Hebrew Name
Written in English if Known
Date of Death
After Sundown?
Yes
No
Gender of Deceased
Male
Female
Observer
Relationship
Deceased's Full Name
Hebrew Name
Written in English if Known
Date of Death
After Sundown?
Yes
No
Gender of Deceased
Male
Female
Observer
Relationship
Deceased's Full Name
Hebrew Name
Written in English if Known
Date of Death
After Sundown?
Yes
No
Gender of Deceased
Male
Female
Observer
Relationship
Do you own a cemetery plot?
Please Select One
No
Yes
Location
DUES AND FEES
The annual commitment to Congregation Agudas Achim includes Synagogue membership for the member, his/her spouse and children, High Holy Day tickets, eligibility to enroll one’s children in our Inda Posner Religious School (fees are additional), a discounted rate at our Heintz Preschool and a discounted rate on the purchase of cemetery plots in our Memorial Gardens Cemetery.
Congregation Agudas Achim’s fiscal year is from January—December. All completed membership applications are submitted to the Board of Trustees for final approval. Board approval must be obtained before membership is finalized.
Annual Membership Dues |
The Annual Membership Dues structure at Congregation Agudas Achim is a flat rate based on age and member household. Congregation Agudas Achim welcomes commitments at an enhanced level. Provisions for dues adjustment and relief will be considered in a strictly confidential manner by the Dues and Accounts Review Committee. Every member of our Congregation is asked to reassess their commitment annually.
Dual Membership |
Fifty percent (50%) of CAA’s appropriate category rate if Dual Membership is with another San Antonio congregation. Building Maintenance Fee and Security Fee will be assessed.
Associate/Out of State Membership
| This membership category is only available to prospective members who are not residents in the San Antonio area. No Building Maintenance Fee and no Security Fee will be assessed.
Choose your membership category below for your monthly dues rate.
Do you qualify for Dual Membership?
Please Select One
No
Yes
Fifty percent (50%) of CAA’s appropriate category rate if Dual Membership is with another San Antonio congregation
Choose Your Membership Household Type
Please Select One
Single
Couple
Family
Single Parent w/ Children
Associate/Out of state
Choose Your Membership Household Type
Please Select One
Single
Couple
Family
Single Parent w/ Children
Choose Your Age Range
Corresponding single rates are listed below
Please select one
Age 28 or younger
29-34
35-74
75+
Choose Your Age Range
Corresponding single rates are listed below
Please select one
Age 28 or younger
29-34
35-74
75+
Your Dues Rate for a Single Membership, aged 28 or younger is $47/month.
Your Dues Rate for a Single Membership, aged 29-34 is $95/month.
Your Dues Rate for a Single Membership, aged 35-74 is $142/month.
Your Dues Rate for a Single Membership, aged 75+ is $72/month.
Your Dues Rate for a Dual Single Membership, aged 28 or younger is $23.50/month.
Your Dues Rate for a Dual Single Membership, aged 29-34 is $47.50/month.
Your Dues Rate for a Dual Single Membership, aged 35-74 is $71/month.
Your Dues Rate for a Dual Single Membership, aged 75+ is $36/month.
Choose Your Age Range
Corresponding couple rates are listed below
Please select one
Age 28 or younger
29-34
35-74
75+
Choose Your Age Range
Corresponding couple rates are listed below
Please select one
Age 28 or younger
29-34
35-74
75+
Your Dues Rate for a Couple Membership, aged 28 or younger is $86/month.
Your Dues Rate for a Couple Membership, aged 29-34 is $142/month.
Your Dues Rate for a Couple Membership, aged 35-74 is $189/month.
Your Dues Rate for a Couple Membership, aged 75+ is $119/month.
Your Dues Rate for a Dual Couple Membership, aged 28 or younger is $43/month.
Your Dues Rate for a Dual Couple Membership, aged 29-34 is $71/month.
Your Dues Rate for a Dual Couple Membership, aged 35-74 is $94.50/month.
Your Dues Rate for a Dual Couple Membership, aged 75+ is $59.50/month.
Choose Your Age Range
Corresponding family rates are listed below
Please select one
Age 28 or younger
29-34
35-74
Choose Your Age Range
Corresponding family rates are listed below
Please select one
Age 28 or younger
29-34
35-74
Your Dues Rate for a Family Membership, aged 28 or younger is $95/month.
Your Dues Rate for a Family Membership, aged 29-34 is $189/month.
Your Dues Rate for a Family Membership, aged 35-74 is $228/month.
Your Dues Rate for a Dual Family Membership, aged 28 or younger is $47.50/month.
Your Dues Rate for a Dual Family Membership, aged 29-34 is $94.50/month.
Your Dues Rate for a Dual Family Membership, aged 35-74 is $114/month.
Choose Your Age Range
Corresponding single parent rates are listed below
Please select one
Age 28 or younger
29-34
35-74
Choose Your Age Range
Corresponding single parent rates are listed below
Please select one
Age 28 or younger
29-34
35-74
Your Dues Rate for a Single Parent Membership, aged 28 or younger is $72/month.
Your Dues Rate for a Single Parent Membership, aged 29-34 is $142/month.
Your Dues Rate for a Single Parent Membership, aged 35-74 is $189/month.
Your Dues Rate for a Dual Single Parent Membership, aged 28 or younger is $36/month.
Your Dues Rate for a Dual Single Parent Membership, aged 29-34 is $71/month.
Your Dues Rate for a Dual Single Parent Membership, aged 35-74 is $94.50/month.
Your Dues Rate for an Associate Membership is $275/month.
Please Select One
I agree to pay these fees
I will need to speak with someone about financial assistance
I agree to be enrolled in auto pay for monthly dues and fees and have my payment method on file charged monthly.
I agree to be enrolled in auto pay for monthly dues and fees and have my payment method on file charged monthly.
I want to join Congregation Agudas Achim Sisterhood ($36/annually)
I want to join Congregation Agudas Achim Sisterhood ($36/annually)
I want to join Congregation Agudas Achim Mens Club ($36/annually)
I want to join Congregation Agudas Achim Mens Club ($36/annually)
ADDITIONAL MEMBERSHIP FEES
Security Fee* |
This fee of $120 is used to defray the cost of safety and security at Congregation Agudas Achim. The Security Fee is billed over the course of 12 month installments with your membership dues.
Torah Restoration Fee* |
This fee of $18 is billable until the year 2025 for the purpose of raising funds specifically to repair and restore our 10 beautiful Torahs. Torah Restoration Fee is billed over the course of 12 month installments with your membership dues.
Building Maintenance Fee* |
This fee, equivalent to 10% of annual membership dues per year, is used to defray the cost of non-budgeted improvements to the building and grounds. This fee is prorated during the first year of membership and continues as a yearly flat rate every year after. Building Maintenance Fee is billed over the course of 12 month installments with your membership dues.
* All these fees do not apply to Associate members.
*
I agree to the above fees.
I agree to the above fees.
ENHANCED GIVING SOCIETY (ENHANCED DUES)
I would like to give monthly at the following level above my standard dues and fees
Chai
$18 per month
Double Chai
$36 per month
Mensch
$50 per month
Mensch Plus
$100 per month
Yitzirah
$150 per month
Tefillah
$300 per month
Tikkun Olam
$600 per month
Mizvot
$1,050 per month
Tzedek
$1,500 per month
Emet
$3,000 per month
Shalom
$6,000 per month
Wed, December 4 2024 3 Kislev 5785
