2022 Dues Disclosure Form

CONFIDENTIAL DUES DISCLOSURE FORM
Congregation Beth Shalom
For Calendar Year 2022

Dear Member,

As you know, we are a member organization and utilize your annual contribution to maintain our facility and staff and provide a wide diversity of cultural, educational and holiday programs that are open to the entire community. Without financial support from our members and donors we would not be able to sustain our congregation and our programs.

Individual and Family Membership dues commitments are based on 2.75% of their Adjusted Gross Family Income (IRS Form 1040) up to a $ 120,000 max. However, we will not turn away anyone due to lack of funds – and we are willing to work with you to find a meaningful level of support.

Associate memberships are available for up to 6 months for those who are in a conversion class recognized by the Rabbi of Congregation Beth Shalom, Modesto. Individual associate membership is $25 per month and family associate membership is $50 per month.

Full-Time Students (12 units or more) are $10/month with verification of enrollment in accredited institution .

Congregation Beth Shalom keeps all information on this form in the strictest confidence. Please contact the office at 209-571-6060 to set up an appointment with a member of our Finance Committee if you have any questions about your dues or need to request a dues adjustment.

Doug Highiet Liz Trauring
Janet Rasmussen Bruce Ruskin

IN COMPLIANCE WITH THE ABOVE DUES SCHEDULE, I/WE CALCULATE MY/OUR ANNUAL DUES TO BE. . .

* Indicates required field

Annual Dues Amount *

For BILLING PURPOSES please check one of the boxes listed below. *

Monthly Quarterly Semi-Annually Annually

List the Month *

I/WE WOULD ALSO LIKE TO MAKE A CONTRIBUTION TO THE RABBI SALARY FUND IN THE AMOUNT OF . . .

Annual Rabbi Fund Amount *

For BILLING PURPOSES please check one of the boxes listed below *

Monthly Quarterly Semi-Annually Annually

List the Month *

Member(s) Name *

First

Last

Member(s) Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Additional Names *

Electronic Signature *

Thank you for your continued support of Beth Shalom and ensuring a vibrant Jewish presence in the greater Modesto area.

Submit

PAYMENT OPTIONS:
Checks can be made to "Congregation Beth Shalom" and mailed to

Congregation Beth Shalom
P.O. Box 85
Modesto, CA 95353

or by clicking onto the link below and logging into
our Membership Management System

MMONTHEWEB

Click here for a PDF copy of the Dues Commitment Form

CONFIDENTIAL DUES DISCLOSURE FORMCongregation Beth ShalomFor Calendar Year 2022​​

CONFIDENTIAL DUES DISCLOSURE FORM
Congregation Beth Shalom
For Calendar Year 2022