Membership Application - Form - Congregation Schaarai Zedek

The synagogue is traditionally known by three names: beit t’fillah (a house of worship), beit midrash (a house of study), and beit k’nesset (a house of gathering).

Schaarai Zedek is a welcoming, inclusive synagogue that embodies these three names. As a house of worship, we pray together in diverse ways, celebrating Shabbat and holidays with meaningful, engaging services. As a house of study, we learn together, from the Amy Gail Buchman Preschool and the Flom Religious School through our seniors, with creative methods, engaging classes, and intriguing lectures. And as a house of gathering, Schaarai Zedek is a place for Jewish families of all types to come together for events including movie nights, community service projects, campfires by the lake, and live music and dancing. Whatever we do, our goal is always to create and support the Jewish community and have fun while we do it.

But most importantly, the bayit that is Schaarai Zedek is not just a house, it is a home. As we pray together, learn together, and gather together, we love being together. Welcome home. Welcome to Schaarai Zedek.

Shalom,
Rabbi Joel Simon

* First Name

* Last Name

* Date of Birth

Mobile Phone

Please use (###) ###-#### format

* Marital Status

Anniversary

Wedding Date if married

Employer/Business Name

Occupation

Business Phone

Please use (###) ###-#### format

Religious Affiliation

Previous Synagogue Affiliation

Name and Address of Previous Synagogue

Have you ever been a member of CSZ?

Friends/relatives who are current members of CSZ

Please list names and relationship to you

Become an active member of Congregation Schaarai Zedek! Opportunities for you to contribute range from Adult Education, to Communications, to Shabbat Greeter. Click here to read more information about our temple activities.

Please select your interests below:

Adult Learning:

Adult EducationHebrew for BeginnersAdult B'nei Mitzvah

Is there a second adult applying for membership?

* First Name

* Last Name

Date of Birth

Mobile Phone

Please use (###) ###-#### format

Employer/Business Name

Occupation

Business Phone

Please use (###) ###-#### format

Religious Affiliation

Previous Synagogue Affiliation

Name and Address of Previous Synagogue

Have you ever been a member of CSZ?

Friends/relatives who are current members of CSZ

Please list names and relationship to you

Adult Learning:

Adult EducationHebrew for BeginnersAdult B'nei Mitzvah

* Primary Address

Apt/Suite/Other

* City

* State

* ZIP

Billing Mailing Preference

Is your billing address the same as your primary address?

YesNoPlease let us know if you have a separate billing address. All financial statements will be sent to your primary address, unless otherwise requested.

Billing Address

Please type the entire billing address, if applicable.

* How many children under the age of 26 live in the family home?

First Name

Last Name

Hebrew Name

Birth Date

Gender

* High School Graduation Year

School

Are you registering this child in Religious School?

First Name

Last Name

Hebrew Name

Birth Date

Gender

* High School Graduation Year

School

Are you registering this child in Religious School?

First Name

Last Name

Hebrew Name

Birth Date

Child 3 - Gender

* High School Graduation Year

School

Are you registering this child in Religious School?

First Name

Last Name

Hebrew Name

Birth Date

Gender

* High School Graduation Year

School

Are you registering this child in Religious School?

Do you have anyone to add for whom you wish to observe yahrzeit (memorial)? If so, please select an option below. To receive yahrzeit notifications, please ensure a date of death is entered.

* Yahrzeits:

* Deceased Name

First and Last

* Date of Death

English Date

Relationship to:

* Relationship type:

Mother, Father, Sibling, etc...

Deceased Name

First and Last

Date of Death

English Date

Relationship to:

Relationship type:

Mother, Father, Sibling, etc...

Deceased Name

First and Last

Date of Death

English Date

Relationship to:

Relationship type:

Mother, Father, Sibling, etc...

Deceased Name

First and Last

Date of Death

English Date

Relationship to:

Relationship type:

Mother, Father, Sibling, etc...

Basic Financial Commitment: The Basic Financial Commitment (also known as Annual Dues) is the minimum level of annual support required for each member. Members are encouraged to contribute more than the minimum through the Torah Circle. The first three months of the annual Basic Financial Commitment is required with the membership application. For Families, the Basic Financial Commitment is based on the age of the oldest applicant.

Single Memberships include 1 Adult and their children under 25 years old.
Family Memberships include 2 Adults and their children under 25 years old.
Associate Memberships must pay dues at another synagogue and be in good financial standing.

* Membership Category

Capital Improvement Fund: In addition to the Basic Financial Commitment, new members are required to make a pledge of $1,500 to the Capital Improvement Fund payable over a five-year period. Singles and families with a head-of-household under 35 years of age may defer payment until they reach age 35 unless a life cycle event occurs within six months of application. The first year payment ($300) is due with the membership application.

* Capital Improvement Fund

Rabbi Richard J. Birnholz Torah Circle: Torah Circle is an opportunity for those who are blessed with the means to make a greater financial commitment to the Temple. Torah Circle funds help provide the programs and activities which enrich our lives and make Congregation Schaarai Zedek an outstanding Reform Jewish congregation.

Rabbi Richard J. Birnholz Torah Circle

Checks are payable to Congregation Schaarai Zedek

If our fee structure causes financial hardship for you, please select "I wish to discuss my Membership" and call Marc LeVine, Executive Director, at (813) 876-2377, ext. 206, to request an application for fee reduction. All applications are reviewed and remain confidential.

* Preferred Payment Method

Congregation Schaarai Zedek Credit Card Authorization Form

I, the undersigned, hereby authorize Congregation Schaarai Zedek to charge my credit card described below for payments I have agreed to in writing. This authorization applies to, but is not limited to, the following:

Membership dues
Capital Improvement fees
Security fees
School and class tuition
Facility use fees
Event fees
Donations, contributions, and any other fees or charges

This authorization will remain in effect until revoked by me in writing.

Cardholder Information:

* Name on Credit Card:

* Billing Address for Credit Card:

Address, City, State, ZIP

* Card Number:

* Expiration Date

* CVV (3- or 4-digit security code):

Authorization Terms:

By signing below, I authorize Congregation Schaarai Zedek to charge the agreed-upon amounts to my credit card. I understand that this authorization will remain in effect until I provide written notice of cancelation, which I may send via email or mail to the synagogue's office.

I agree to notify Congregation Schaarai Zedek of any changes to my card information or if my card is lost, stolen, or otherwise compromised.

I understand that Congregation Schaarai Zedek will process and store my credit card data in compliance with Payment Card Industry Data Security Standards (PCI DSS), and my information will be kept confidential and secure.

I agree to hold Congregation Schaarai Zedek harmless from any loss or damage resulting from declined transactions or incorrect information provided by me.

Cancellation of Authorization:

This authorization may be revoked by submitting a written request to Congregation Schaarai Zedek. Cancelation will be effective after Congregation Schaarai Zedek has received and processed the request.

Authorization Signature:

By signing below, I confirm that I have read and agree to the terms of this authorization.

* Cardholder eSignature

Please type your full name

* Signed on this date:

How to Revoke Authorization:

To cancel this authorization, please send a written request via email to billing@zedek.org or by mail to:

Congregation Schaarai Zedek
3303 W Swann Ave
Tampa, FL 33609

Notes for Staff: