Welcome to Temple Shalom!

Please complete this form to the best of your ability. All information will be maintained at Temple Shalom and treated confidentially. If you have any questions, contact our Coordinator of Belonging, Monica Susman at (972) 661-1365 or msusman@templeshalomdallas.org.

* Please indicate the number of Member Adults in your family

CONTACT INFORMATION

* Confirmation Email Address to acknowledge submission of Belonging Commitment Form

Landline if have one

* Primary Address

* City

* State

* Zip

FAMILY BACKGROUND

Children 25 and younger are included in your membership. We would like information for our records on all your children, regardless of their ages.

How many children are in your family?

Child's Full Name

Child's Birthdate (MM/DD/YYYY)

Child's Hebrew Name

Child's School Name

Marriage/Commitment Date

* How many years have you lived in the Dallas Metroplex?

Is your family currently members of another synagogue?

Please tell us the name and location of your current or former synagogue.

Please list any friends who are Temple Shalom members:

* What is your primary reason for joining Temple Shalom?

* How did you hear about Temple Shalom? Choose all that apply.

INCLUSION

Please tell us about additional adults who live in your home: Name, Hebrew name, date of birth, relationship to Member Adult.

Does anyone in your family have special needs that you wish to disclose? We ask so we can try to accommodate these needs at Temple Shalom.

Is there anything else you would like us to know about your family? We ask so Rabbi Paley and our Director can be of support.

YAHRZEITS (The yearly anniversary of a loved one's death)

Please provide the information about the loved ones you would like to remember each year. You will receive notification so you can attend Shabbat services to say Kaddish (memorial prayer) when the name of your loved one is read.

Number of yarzheits observed

Deceased First Name

Deceased Last Name

Yahrzeit Observed By

Relationship to Observer(s)

Date observed on:

Date of Death (MM/DD/YYYY)

If Associate Household, please write the name and location of your home congregation.

* Please write in an amount meaningful to you for your fiscal year 2024-2025 Belonging Commitment:

If you are under 35, single or married, and would like information about Kehilla membership, a partnership between the J and Temple Shalom, please contact Coordinator of Belonging Monica Susman.

SECURITY ENHANCEMENT

Choose the one that applies to your household:

1 Adult Household: $2702 Adult Household: $350

Total Fiscal Year Commitment: 2024-2025 Belonging Commitment + 2024-2025 Security Enhancement

Choose your billing option

Check(s) made payable to Temple ShalomE-check coming from bankPay by ACHPay by Credit Card

Choose your payment method

My/Our yearly commitment will be paid with a single paymentMy/Our yearly commitment will be divided into two paymentsMy/Our yearly commitment will be divided into monthly payments

Other: (IRA, Trust Distribution, Stock Transfer, etc.)

Checks and other transfer documents may be mailed to Temple Shalom, 6930 Alpha Rd, Dallas, TX 75240.

Contact the Administrative office if you need bank information to arrange e-check payments.

Check all that apply:

ACH DebitDebited on or about the 1st of the monthDebited on or about the 15th of the monthI/We will set up ACH collections through the member portalI/We will provide new ACH information below

Charged on or about the 1st of the monthCharged on or about the 15th of the monthI/We will set up credit card payments through the member portalI/We will provide new credit card information below3% credit card processing fee applies to all credit cards

ACH Information (ONLY if you would like Temple Shalom to set up your payments)

Checking or Savings Account?

CheckingSavings

Name on Bank Account

Bank Account Number

Bank Routing Number

Credit Card Information (ONLY if you would like Temple Shalom to set up your payments)

Name on Credit Card

Billing Address of Card (if home, write "Home")

Card Number

Expiration Date

CVV/Security Code

BUILDING FUND

$1800 (3% credit card fee applied if paid with a credit card). This will be assessed on June 1st of the following fiscal year after you join. It may be paid over a maximum of six years. (This does not apply to Young Adult categories, Associate or Kehilla members but will be assessed once 35 years of age is reached.)

FINANCIAL ASSISTANCE

No member is denied belonging because of financial hardship. A request for an adjusted belonging commitment may be made to Temple Shalom's Executive Director David Lamden.

AUTHORIZATION

As a member of Temple Shalom, I/we understand that I/we am/are making a full-year financial commitment to support the congregation. I/we further understand that the temple depends on this commitment, and I/we will fulfill my/our financial obligations on or before May 31, 2025. If I/we am/are unable to do so, I/we will contact the Executive Director to make alternative payment arrangements. I/we understand that the commitment does not include any Building Fund, Religious School, B’nai Mitzvah or Confirmation fees.

I/we understand that tickets for the High Holy Days will be issued when at least fifty percent (50%) of the annual Belonging Commitment has been paid, or if an accepted payment plan has been established.

By submitting this form for my/our Belonging Commitment, I/we am/are committing to the terms and conditions above.

Please note that you will not have to pay at this time. Clicking the "Submit and Take Me to the Payment Gateway" button simply submits your form.

Should you choose to arrange payments through the member portal, please wait two business days so that we can charge your account before you log in to arrange payments.

2024-2025 New Belonging Application

Welcome to Temple Shalom!