New Family Membership

Membership Information

Adult #1 Name*

Prefix First Last

Marital Status*

Married

Single

Gender

Male

Female

Birth Date*

Religious background*

Jewish

Other

Home Phone

Cell Phone*

Email*

Residence Address*

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

Male

Female

Birth Date*

Religious background*

Jewish

Other

Mailing Address (if different from first family member listed above)

Street Address City State ZIP Code

Do you agree to have your information published in our Directory?*

Member 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

EMERGENCY NOTIFICATION*

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

Family Membership Options

Use the dropdown arrows in boxes below to make selections.

How many payments would you like to make?*

Annual Family Membership Levels

Bi-Annual Family Membership Levels

Quarterly Family Membership Levels

Monthly Family Membership Levels

Additional Annual Donation

Additional Bi-Annual Donation

Additional Quarterly Donation

Additional Monthly Donation

Optional Security Assessment - $100/member/year (Annual payment)

Optional Security Assessment - $50/member/2x year (Bi-Annual payments)

Optional Security Assessment - $25/member/4x year (Quarterly payments)

Optional Security Assessment - $8.33/member/12x year (Monthly payments)

Additional Synagogue Security Assessment Contribution (Annual payments)

Additional Synagogue Security Assessment Contribution (Bi-Annual payments)

Additional Synagogue Security Assessment Contribution (Quarterly payments)

Additional Synagogue Security Assessment Contribution (Monthly payments)

Women’s Havurah Membership for 2024-2025 (Annual payment)

Yes, I would like to join ($25)

No, not at this time

Women’s Havurah Membership for 2024-2025 (Bi-Annual payments)

Yes, I would like to join (Two payments of $12.50 each)

No, not at this time

Women’s Havurah Membership for 2024-2025 (Quarterly payments)

Yes, I would like to join (Four payments of $6.25 each)

No, not at this time

Women’s Havurah Membership for 2024-2025 (Monthly payments)

Yes, I would like to join (Twelve payments of $2.08 each)

No, not at this time

Payment Options

Payment Method*

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

Credit card

Check

E-check

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

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.

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*

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 Family Membership

Membership Information

Family Membership Options

Payment Options

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