Congregation Mishkon Tephilo

The Conservative Synagogue by the Sea

Sanctuary: 206 Main Street Office: 201 Hampton Drive, Venice CA 90291
Office: 310 392-3029 Fax: 310 392-0420 www.mishkon.org

2014-2015 Membership Contribution Form
Single $1,175 Family $1,500
Senior Single (65+ and retired) $750 Senior Family (both 65+ and retired) $850
Young Member (single or married under age 32) $1,020 Preschool Member $775

Honor Membership Levels (Optional INSTEAD OF the Above Categories)
Chai Member $1,800 Supporting Member $2,700
Sustaining Member $3,600 Benefactor $5,400

Financial consideration is available for those who require it. Please contact the office for more information. Mishkon
Tephilo will not turn anyone away due to financial need.

MEMBER NAME(S) Date:
Dues Calculation:
Membership Dues (from above) $
Building maintenance fund (REQUIRED: 10% of dues up to $175) $
Scholarship fund (optional) $250 $
Total $


OPTION A PAY IN FULL
Enclosed is my check for the full amount of my 2014-2015 dues commitment and maintenance fund.

Please charge my credit card for the amount of $ ____________ which represents 2014-2015
dues and maintenance fund.
OPTION B INSTALLMENT PLAN
Enclosed are (10) post-dated checks for my 2014-2015 dues commitment and maintenance fund.

Please charge my credit card for the amount of $____________ in ten (10) monthly installments
for 2014-2015 dues and maintenance fund.

CREDIT CARD INFO:

_________________________________________
Name as it appears on card Please Print MasterCard or Visa Credit Card Number

MM______YY______ ( )
Expiration Date Security Card (on back of card) Area Code Phone Number

________________________ ________________
Billing Address City/State Zip Code

Signature Date
Please return this form with your payment by July 1, 2014.
If your information has changed, please return the completed membership form as well.

I f you have an unpaid balance, we will apply your payment toward that balance first.