Your
name:_____________________________________________________________
Name
of Spouse or Partner:________________________________________________
Children
under 18, with
names and dates of birth:______________________________
_______________________________________________________________________
Address:_______________________________________
e-mail:________________
Town:_________________________________
State:___________ Zip: _____________
Home
phone:_________________ Work phone:______________ Fax: ______________
Membership Contribution
|
Sustaining Membership
|
$360
|
|
Family Membership
|
$250
|
|
Single Membership
|
$150
|
Suggested non-member Contribution
|
High Holiday Services only
|
$50 per person
|
|
High Holiday Services (Kama'aina) |
$25 per person
|
Children under 18 complimentary
At
Yizkor, please remember the
following persons:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Yizkor Contribution
($18
or any amount):
$ _________
Building Fund Contribution:
$ _________
Total
enclosed:
$ _________
Please make your check payable to Congregation
Kona Beth Shalom
and mail it along with this Application to:
KONA
BETH SHALOM
c/o
Ruth
Ader, Treasurer
73-1232
Melo Melo
Kailua-Kona
Hawaii 96740
No
one will be turned away from Services for inability to pay.
Please
call Barry Blum (322-6004) or Joel Gimpel (325-4991) if you have any questions.