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New Member Form

Family Information

Adult 1:

Adult 2:

Dependent Information

Dependent 1:

Dependent 2:

Dependent 3:

Dependent 4:


Please check all of the Ner Shalom Committees in which you would like to participate.

Please provide any other areas that you would like to volunteer that were not listed above. If you have additional ideas regarding ways to support Congregation Ner Shalom, please feel free to list them here.

Membership Dues Commitment

In accordance with the current dues schedule, my/our membership dues category for the current year is as selected above.

I am currently active duty military and would like to have my membership month to month. I would also like to take advantage of the 10% active duty discount for military members.

Building Fund Pledge 

Please select one of the above building fund pledges.

Payment Schedule 

I/we will remit the Dues and Building Fund payments in accordance with the above schedule.

I/we wish to donate an additional sum in support of Ner Shalom by increasing our annual dues by the specified amount.

NOTE: No one will be turned away from membership for financial reasons. Members who feel they have unique or unusual financial hardships may contact the President or the Treasurer, who will be happy to work with you to reach an arrangement concerning dues (including payment plans and discounts) in a completely private manner.  We feel It is more important for you to be a part of our community as a member and contribute what you can, than to not be a member at all. 

Membership Terms 

By checking the above box, I agree to the following conditions:

  1. I/we agree to pay during such annual dues as may be fixed by the Board of Trustees, in accordance with the By-Laws of the Congregation. 

  2. As a member of Ner Shalom I/we shall abide by all the rules and regulations of the Congregation. 

Email will be the only method that account statements and billing will be communicated to our members. This is to reduce the expense that printing and mailings cost the Temple.

Please let us know the member of our congregation who referred you to us.

Please enter how you heard about us.

Signature Block 

Signature/Print Name

Signature/Print Name


Sat, May 28 2022 27 Iyyar 5782