Membership Form
	Directions
	Donations

Membership Form
and Policy
5772, 2011-2012

Our members contribute each year on a voluntary basis to cover our actual costs. This year, the amount we need to raise comes out to an average of $785 for each adult member. We expect that some members will be able to give more, and some less. A minimum donation of $18 (chai) will signal your membership in the community.

Any contribution toward high holiday attendance may be applied to membership later in the year. All contributions are fully tax deductible.

Please print out this form and mail it, together with your contribution, payable to Shir Hadash, to our treasurer:
	Hadash Treasurer c/o Jane Getter 128 Warren Street Newton, MA 02459
Name 1	____________________________________________________
	Email ______________________________________________
	Mobile ____________________   Work ___________________
Name 2	____________________________________________________
	Email ______________________________________________
	Mobile ____________________   Work ___________________
Home phone	_____________________________________________________
Address	_____________________________________________________ _____________________________________________________ _____________________________________________________
Children (indicate birth dates)	_____________________________________________________ _____________________________________________________ _____________________________________________________
I/We plan to contribute $___________ to Shir Hadash for the fiscal year 2011-2012:
(  ) Enclosed is a check for the full amount.
(  ) Enclosed is a check for $___________. The balance will be paid in installments.
(  ) Please apply my 2010 high holiday donation of $___________ to this year's membership.