New Associate Membership

Membership Information

Adult #1 Name(Required)

Prefix First Last

Gender(Required)

Male
Female

Birth Date(Required)

Religious background(Required)

Jewish

Home Phone

Cell Phone(Required)

Email(Required)

Residence Address(Required)

Street Address City State ZIP Code

Mailing Address (if different from residence)

Street Address City State ZIP Code

Adult #2 Name

Prefix First Last

Gender(Required)

Male
Female

Birth Date(Required)

Religious background

Jewish

Residence Address

Street Address City State ZIP Code

Mailing Address (if different from residence)

Street Address City State ZIP Code

Do you agree to have your information published in our Directory?(Required)

Your contact information (name, address, phone number, email) is published in the JCSVV Membership Directory. This information is ONLY distributed to JCSVV members. Please inform the JCSVV Office of any changes to your phone numbers, address or email.

Yes
No

Emergency Notification(Required)

Please provide the following information for our records. You can use the + sign to add a second contact. Two emergency contacts are requested.

Name	Relationship	Home Phone	Cell Phone

Associate Membership Options

Use the dropdown arrows in boxes below to make selections.

How many payments would you like to make?(Required)

Annual Associate Membership Levels

Bi-Annual Associate Membership Levels

Additional Donation

Payment Options

Payment Method(Required)

Indicate your method of payment by checking one of the options below:

Credit card
Check
E-check
ACH – Automated Clearing House electronic funds transfer
QCD - Qualified Charitable Distribution

I'd like to help defer the cost of processing and credit card fees.

Yes - let me add a 3% credit card processing fee.

Additional 3% fee to help defer the cost of credit card processing fees:

Price: $0.00

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Checks are to be made payable to JCSVV and mailed to: The Jewish Community of Sedona and the Verde Valley, PO Box 13, Sedona, AZ 86339. Please indicate that membership application was submitted online.

Arranged for with your bank, brokerage house or credit union. Please ensure that the check is made out to the JCSVV and “dues payment” is noted on the memo line.

ACH

Account Number Account Type Routing Number Account Holder Name

This is an option you may choose for paying your membership dues.

Qualified charitable distributions (QCDs) have been permanently extended. Individuals can donate up to $100,000 per year directly from a traditional or Roth IRA to qualifying charities. This is attractive to some investors because QCDs can be used to satisfy required minimum distributions (RMDs) from an IRA without having the distribution included in their income.

If you are interested in this option, you may consult your personal financial planner.

Signature(Required)

Use your mouse to sign. If you have a touch screen, use your finger or stylus. To delete signature, simply click the small circular icon at corner of box and sign again.

CAPTCHA

You will receive an email confirmation upon submission.

New Associate Membership

Membership Information

Associate Membership Options

Payment Options

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