Congregational Renewal Form 2022-2023 - Ramat Shalom Synagogue

June 1, 2022 to May 31, 2023

11301 W. Broward Boulevard, Plantation, FL 33325 954-472-3600/ Fax 954-472-3622 ramatshalom@ramatshalom.org

Household Information

Family Name: *

Home Phone: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Adult 1 Name: *

Adult 1 Cell Phone: *

Adult 1 Email: *

Adult 2 Name:

Adult 2 Cell Phone:

Adult 2 Email:

Does Ramat Shalom have permission to share your contact information with the congregation? *

Name, Grade, School, and Email for ALL CHILDREN (including college and university) as of August 2022

Child 1 Name:

Child 1 Identified Gender:

Child 1 Grade:

Child 1 School:

Child 1 Email:

Child 2 Name:

Child 2 Identified Gender:

Child 2 Grade:

Child 2 School:

Child 2 Email:

Child 3 Name:

Child 3 Identified Gender:

Child 3 Grade:

Child 3 School:

Child 3 Email:

Please Refer To The Fee Schedule To Complete The Following:

Congregational Fees

Opportunities to Give!

Congregational Fees (Section A on Fee Sheet):

Torah School Assistance Fund:

Registration Fee $100 (waived before 6/15):

Gift of the Heart Scholarship Fund:

Torah School/iServe Fees (Section B on Fee Sheet):

Sam & Laura Hoffman Scholarship Fund:

Torah School Registration Fee $100 (waived before 6/15):

Burning the Mortgage Fund:

Additional Fees

Congregational Fees SUB-TOTAL :

Security: (Required per household)

$200.00

Additional Fees SUB-TOTAL:

Kochavim (Youth Choir):

$80/child

Opportunities to Give SUB-TOTAL:

TOTAL:

*Separate application for Torah School and youth programs MUST be completed for each child.

Payment Options

Pay in Full
Pay in 4 Installments, $12/payment installment fee (payments due: 6/1, 8/1, 10/1, 12/1)
Pay in 10 Installments, $12/payment installment fee (payments due monthly beginning on 6/1)

NOTE: If you are paying in installments, please contact our office. Whenever possible, we appreciate your payment by check or cash. All credit card transactions will be assessed a 3% convenience fee.

Payment Information

Check #:

Check Amount Enclosed:

Am. Express, Visa, MasterCard, Discover Account #:

Expiration Date:

Name (as it appears on credit card):

Credit Card Billing Address:

Address Line 1

Address Line 2

City

State

Zip Code

The congregational year for Ramat Shalom begins June 1st, 2022. I understand that membership dues are payable annually and are not transferable or refundable. In the event that I am unable to meet any of these payments or require a change in my payment arrangement, it is my obligation and responsibility to notify the Director of Administration to avoid losing my membership-in-good-standing and the attendant rights.

Electronic Signature: *

Date: *

By clicking Submit, I authorize Ramat Shalom to automatically charge the above credit card according to the method of payment specified above. *

Click to accept

June 1, 2022 to May 31, 2023

Household Information

Name, Grade, School, and Email for ALL CHILDREN (including college and university) as of August 2022

Please Refer To The Fee Schedule To Complete The Following:

Congregational Fees

Opportunities to Give!

Additional Fees

Payment Information

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