New Member Commitment

Please fill in all the information below. The Ongoing Improvements payment may be spread over six years and can be deferred for the first year of membership. Dues are an annual commitment.

	Contact Information
Name: *
Address: *
City, State, Zip: *
Phone: *
E-mail: *
Confirm E-Mail: *
	Ongoing Improvements Fund - $3,000
Payment Over: *
Beginning: *
Payment By: *	Check Charge Card (information below)
	Total Dues Pledge Amount - $1,600
Dues Payment: *
Other Schedule:
Payment Method: *	Check Charge Card Stock Transfer

Check Amount: *

Stock Name: *
Number Of Shares: *
	Please direct your broker to send to: Northern Trust Securities, DTC# 0226 into Congregation Solel Acct # NT2-093343.

Charge Card: *
Account Number: *
Expiration Date: *
Amount: *
Authorized Signer: *

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New Member Commitment