TEMPLE SHALOM
MEMBERSHIP PLEDGE FORM
2011
Congregant: Names: ______________________________________
Address: ______________________________________
City, St, Zip ______________________________________
Telephone: Home ______________ Work______________ Cell __________________
E-Mail Addresses: ______________________________________
______________________________________
FAX number: _________________________
The minimum amount of dues per family unit for the fiscal year commencing
January 1, 2011, and ending December 31, 2011 is as follows:
Individuals/families 30 years of age or older: $720.00 per year
Individuals/families between the ages of 22 and 30: $360.00 per year
Full Time Students: $ 50.00 per year
You may also choose to pay fair share dues which is 1% of gross income; however, minimum dues must be met. Families or individuals with financial limitations should speak confidentially with the Treasurer or President about reduction to these amounts. Members joining after the first quarter may pro-rate their dues.
Amount Pledged: $____________________ To be Paid:
_____ Annually
_____ Semi-Annually
_____ Quarterly
_____ Monthly
Signature: _____________________________________________________
Please sign and return this form to:
Treasurer
Temple Shalom
P.O. Box 53711
Lafayette, Louisiana 70505-3711
Checks should be made payable to Temple Shalom.
*All questions should be directed to Treasurer Mr. Lee Feist at 845-641-3541 or
Lee.Feist@Verizon.net