Membership Commitment 2024-2025 - Form

ADULT 1 INFORMATION

* First Name

Middle Name

* Last Name

Maiden Name

if applicable

* Birthdate (MM/DD/YYYY):

* Gender

* Pronouns

* Cell

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Tribe at Birth

Is there a second adult applying for Membership?

ADULT 2 INFORMATION

* First Name

Middle Name

* Last Name

Maiden Name

if applicable

* Birthdate (MM/DD/YYYY):

* Gender

* Pronouns

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Tribe at Birth

HOUSEHOLD INFORMATION

* Address Line 1

Apt./Suite

* City

* State

* Zip

Membership Commitment

* I/We agree tp [ay the $500 Security Fee.

I/We agree tp [ay the $500 Security Fee.

* IT IS UNDERSTOOD AND AGREED THAT YOUR MEMBERSHIP WILL AUTOMATICALLY BE RENEWED EACH YEAR UNLESS A NOTICE OF TERMINATION IS RECEIVED IN WRITING AT LEAST THIRTY (30) DAYS PRIOR TO THE RENEWAL YEAR ON JULY 1.

IT IS UNDERSTOOD AND AGREED THAT YOUR MEMBERSHIP WILL AUTOMATICALLY BE RENEWED EACH YEAR UNLESS A NOTICE OF TERMINATION IS RECEIVED IN WRITING AT LEAST THIRTY (30) DAYS PRIOR TO THE RENEWAL YEAR ON JULY 1.

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