Mid-Year Application - Congregation Beth El Binah

Membership Application Instructions

To apply for membership in Beth El Binah, please complete either the printable or online form below.

The printable form is a PDF file. After printing it and filling it out, please send it to the mailing address on the form.
To complete your application online, fill in the online form below and press "Submit".

After your application is processed, you will receive instructions to log in to your online account.

Note: If you are an existing member, please use the renewal form instead. To access the renewal form, under the MEMBERSHIP drop-down menu, select RENEWAL. (You need to be logged in to your account to see this option. If you have difficulty logging in, please contact the webmaster.)

For questions about the membership process, please contact our membership chair. If you have trouble with the online form, contact the webmaster.

For contact information, see Contact Us.

Printable Membership Application Form

Click here to download the membership application form (PDF).

Online Membership Application Form

Passover Madness Sale!

This form is for the membership drive ending April 17, 2016.

* Number of adults

Please indicate the number of adults in the household.

Adult 1

* Adult 1 Name

First-name Last-name

* Adult 1 Birth Date

* Adult 1 Email Address

Adult 1 Mobile Phone

Adult 1 Occupation

Adult 1 Business Phone

Adult 2

* Adult 2 Name

First-name Last-name

Adult 2 Birth Date

Adult 2 Email Address

Adult 2 Mobile Phone

Adult 2 Occupation

Adult 2 Business Phone

Household Information

* Street Address

* City, State, ZIP

Home Phone

Couple's Anniversary

Children (still living at home)

* Number of Children

* Child 1 Name

First-name Last-name

* Child 1 Birth Date

* Child 2 Name

First-name Last -name

* Child 2 Birth Date

* Child 3 Name

First-name Last-Name

* Child 3 Birth Date

* Child 4 Name

* Child 4 Birth Date

Yahrzeits

You can supply yahrzeit information here, or fill it in later after your online account is created.

Name of Deceased 1

Date of Death 1

Relationship to Mourner 1

Name of Mourner 1

Name of Deceased 2

Date of Death 2

Relationship to Mourner 2

Name of Mourner 2

Name of Deceased 3

Date of Death 3

Relationship to Mourner 3

Name of Mourner 3

Name of Deceased 4

Date of Death 4

Relationship to Mourner 4

Name of Mourner 4

Payment Information

**Membership Levels**
Level	Single	Household	Benefits Include
Shalom	~~$325~~ $162	~~$425~~ $212	High Holiday Tickets *
Mitzvah	~~$425~~ $212	~~$625~~ $312	High Holiday + Passover Tickets *
Aliyah	~~$575~~ $287	~~$825~~ $412	High Holiday + Passover Tickets *
Chai	~~$1275~~ $637	~~$1525~~ $762	Passover Seder Tickets and the members are recognized as underwriters of High Holiday services *
Student	~~$125~~ $62	–	High Holiday Tickets *
Out of Town	~~$100~~ $50	~~$100~~ $50	*

* For this special membership drive, all membership levels include Passover Tickets. (Single memberships include 1 ticket; household memberships include 1 ticket per person listed on this application.) To qualify for this offer, we must receive your initial payment by April 17.

Beth El Binah will not deny membership due to financial need.
Please contact any board member to discuss dues relief.

Number of Passover tickets

If you plan to attend the Passover Seder, please indicate here the number of tickets you require.

* Membership Level

Select your membership level. Refer to the table above.

* Payment method

Please specify whether you would like to pay in full by check now or be billed.

If you wish to by PayPal, or pay in installments, please choose the option to be billed. After your application is processed, the treasurer will send you a statement along with instructions for making your payment.

Message to Treasurer (optional)

You may include a message to the Treasurer regarding your account.

Please mail your check to:

Beth El Binah
PO BOX 191188
Dallas TX 75219

On your check, please write "New Member" and be sure that your name appears on the check as it does on this application.

After your membership application has been processed, the treasurer will send you a statement which will include instructions for submitting your payment(s).