2025-2026 New Member Dues Commitment - Form

Havurah Shalom Membership
Please fill out this form to make your dues commitment for
fiscal year, July 2025-June 2026

Welcome to Havurah Shalom. Your membership ensures that Havurah Shalom continues to be a vibrant welcoming community for all. Your membership allows us to be here for everyone—every week, every season, at times of sorrow and simcha, for learning and celebration, online and in person.

Annual dues are based on the 2025-2026 budget approved at the Congregational Meeting on June 8, 2025. The table below shows suggested dues levels for the different categories of members.

We remain deeply committed to our core value: membership is open to everyone, regardless of the ability to contribute financially. Your presence and participation are what matter most.

(You will find the option to adjust your dues up or down in Step C of this form)

MEMBER INFORMATION

* First name of household member completing this form:

* Last name of household member completing this form:

* Email address of household member completing this form:

* Phone number of household member completing this form:

* Age of oldest member of household:

ANNUAL COMMITMENT
Below, please complete steps A, B, C (optional), and D. If any steps are missing, there may be an error on the page. Please try using another browser or device.

Indicate Your Standard Dues Membership Category

* (Step B) Standard Dues Amount: The Standard Dues Amount is in parentheses at the end of your selection above. Please type that amount here (numerals only).

Adjusting Your Annual Commitment Up or Down

We understand financial situations vary, and we want everyone to feel welcome and supported. Many members choose to adjust their dues - either up or down – based on their current circumstances. We encourage you to self-adjust your dues according to what feels manageable to you. The suggested annual minimum amount is $360 (or $30 per month) for members 24 years old and older. This is an honor system, so you do not need to ask permission, and all self-adjustments are kept strictly confidential. Your presence and participation are what matter most.

If you have questions about self-adjusting, please contact Havurah member Karen Westerman at karen.westerman@havurahshalom.org.

Please enter the amount you wish to add or subtract from your standard dues.

(Optional Step C) ADD to your standard dues amount

Amount to ADD
If you are able, please consider adding to your Standard Dues amount.

(Optional Step C) SUBTRACT from your standard dues amount

Amount to SUBTRACT
You may self-adjust your dues according to your ability to pay.

* (Step D) Total Annual Commitment

If you adjusted your standard dues by adding or subtracting in Optional Step C, type the resulting total here. If you did not adjust, then please retype your standard dues amount again. This box shows your total Annual Commitment for 2025-26.

Prorating Your Annual Commitment

Our dues year runs from July to June. To prorate your dues, divide your total Annual Commitment from Step D by 12. Multiply the result by the number of months from now until June 2026. Type that amount into Total Annual Prorated Dues Commitment (Step E).

(Step E) Total Annual Dues Commitment- Prorated

Our dues year runs from July to June. To prorate your dues, divide your total Annual Commitment from Step D by 12. Multiply the result by the number of months from now until June 2026.

PAYMENT METHODS

* Frequency of Payment

I would like to set up automatic debit for my dues payments.

I would like to set up automatic debit for my dues payments.If you are setting up automatic debit for the first time, please fill out this form, which gives us permission to withdraw directly from your account. This link will also be available on the landing page after you hit submit below. Clicking the auto-debit change link may take you away from this page.

If dues will come from a stock donation, please write below in the "Notes" box the following information:

Number of shares, Stock symbol, Broker, and Approximate date of transfer

Notes

Please enter any additional information here. If you have questions about your dues, you can reach out to Shari Raider, Havurah Finance Manager (shari@havurahshalom.org)