Test

Membership Information

Adult #1

Other:

Marital Status

Married

Single

Anniversary Date

Name

First Last

Nickname

Hebrew Name

Please complete:

Son / Daughter of and

Gender

Male

Female

Birth Date

Religious background

Jewish

Other

Home Phone

Cell Phone

Residence Address

Street Address City State ZIP Code

Billing Address (if different from residence)

Street Address City State ZIP Code

Firm/Company (if applicable)

Name Occupation

Retired

Yes

Business Address (if applicable)

Street Address City State ZIP Code

Business Phone

Fax

Adult #2

Name

First Last

Nickname

Hebrew Name

Son of and

Gender

Male

Female

Birth Date

Religious background

Jewish

Other

Residence Address

Street Address City State ZIP Code

Billing Address (if different from residence)

Street Address City State ZIP Code

Business Address (if applicable)

Street Address City State ZIP Code

Business Phone

How did you hear about the JCSVV?

Referred by

Local Newspapers

JCSVV Sign

Website

JCSVV Events

Referred by other:

Reasons for joining the JCSVV – check all that apply:

Religious Services

Rabbi

Other reasons

What are you looking for as a JCSVV member?

JCSVV MEMBERSHIP DIRECTORY

Your contact information (name, address, phone number, email) is published in the JCSVV Membership Directory. This information is ONLY distributed to JCSVV members.

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

Yes

Please inform the JCSVV Office of any changes to your phone numbers, address or email.

EMERGENCY NOTIFICATION

Please provide the following information for our records:

Notify

Name Relationship

Home Phone

Cell Phone

Notify

Name Relationship

Home Phone

Cell Phone

Donating your IRA distributions to a charity

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.

If you would like the name of a local financial advisor, please contact us.

Jewish Community of Sedona and the Verde Valley
PO Box 13, Sedona, AZ 86339 ○ 928.204.1286 ○ https://www.jcsvv.org ○ https://www.jcsvv.org/contact

FAMILY MEMBERSHIP DUES COMMITMENT FORM

July 1, 2022 – June 30, 2023

Receipt of this completed form to the JCSVV office, along with your dues payment, will establish your financial commitment for the membership year.
Please inform the JCSVV Office of any changes to your address, phone numbers or email.

Select your desired level of membership and payment plan by checking the boxes below.
Choosing a higher level of dues in one of the Tzedakah Circles provides an extra measure of financial support for the synagogue, thereby making possible programs that inspire us, teach us, and connect us to each other.

FAMILY MEMBERSHIP

BASIC LEVEL

Annual - $1930

Quarterly - $483

Monthly - $161*

TZEDAKAH CIRCLES:

Circle of Brachot – Blessing - Annual - $2430

Circle of Brachot – Blessing - Quarterly - $608

Circle of Brachot – Blessing - Monthly - $203*

TZEDAKAH CIRCLES:

Circle of Chesed – Goodness - Annual - $2930

Circle of Chesed – Goodness - Quarterly - $733

Circle of Chesed – Goodness - Monthly - $244*

TZEDAKAH CIRCLES:

Circle of Chochmah - Wisdom - Annual - $3430

Circle of Chochmah - Wisdom - Quarterly - $858

Circle of Chochmah - Wisdom - Monthly - $286*

TZEDAKAH CIRCLES:

Circle of Tikvah – Hope - Annual - $3930

Circle of Tikvah – Hope - Quarterly - $983

Circle of Tikvah – Hope - Monthly - $328*

* PayPal will automatically charge you for monthly and quarterly options. For yearly renewal please renew through the renewal forms.

Type Name

First & Last

Date

Type Name

First & Last

Date

YAHRZEITS

Memorial Dates for Loved Ones

Please remember to update our Yahrzeit Information as needed.

I/We wish to have the following Yahrzeits honored:

Name of Deceased

English Date of Death

Hebrew Date of Death will be determined by the Hebrew calendar.

Select

Before Sunset

After Sunset

Hebrew Name (if known)

Person to be notified

Relationship to Deceased

Address

Street Address City State / Province / Region ZIP / Postal Code

Name of Deceased

English Date of Death

Hebrew Date of Death will be determined by the Hebrew calendar.

Select

Before Sunset

After Sunset

Hebrew Name (if known)

Person to be notified

Relationship to Deceased

Address

Street Address City State / Province / Region ZIP / Postal Code

Name of Deceased

English Date of Death

Hebrew Date of Death will be determined by the Hebrew calendar.

Select

Before Sunset

After Sunset

Hebrew Name (if known)

Person to be notified

Relationship to Deceased

Address

Street Address City State / Province / Region ZIP / Postal Code

Please indicate any additional names below:

Name

First Last

Name

First Last

Name

First Last

For information on the purchase of plaques for our Memorial Wall, please contact the JCSVV office at 928.204.1286 or http://www.jcsvv.org/contact for the appropriate form, or just click on the MEMORIAL WALL PLAQUE ORDER FORM Link on the website: https://www.jcsvv.org/donate/memorial-wall-plaques/.
JCSVV, PO Box 13, Sedona, AZ 86339 • 928.204.1286 • contact us • https://www.jcsvv.org/

PAYMENT OPTIONS:

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

CREDIT CARD / PAYPALWhen you click on the Submit button below, you will be taken to a secure place to enter your Credit Card or PayPal information.

CHECKChecks 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.

E-CHECK - 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 – Automated Clearing House electronic funds transfer Please send a voided check to JCSVV, P.O. Box 13, Sedona, AZ 86339. Once the information is recorded electronically, the check will be destroyed. ACH information will be stored electronically for the current fiscal year and then discarded.

I authorize the Jewish Community of Sedona and the Verde Valley, at my request, to debit the bank account indicated on my voided check for my membership dues.
Yes, I authorize.

Please be assured that no one will be denied membership in the JCSVV for financial reasons.

Every family or individual who desires to be a member of our community is valued and important. It is the goal of the Board of Directors that all those wishing membership become active and participating members.

If your situation requires a dues adjustment different from the amount stated, please contact the President, Milt Small, at 928.204.1286 or email the JCSVV Office at .

*All communications are confidential.

Payment Methods

When you click Submission button below, your Membership form will be submitted, and you will be taken to the options to pay either by Check, Credit Card or PayPal.

Type First and Last Name

Today's Date
MM slash DD slash YYYY

New Family Membership TEST

Membership Information

JCSVV MEMBERSHIP DIRECTORY

EMERGENCY NOTIFICATION

Donating your IRA distributions to a charity

FAMILY MEMBERSHIP DUES COMMITMENT FORM

FAMILY MEMBERSHIP

YAHRZEITS

Please indicate any additional names below:

PAYMENT OPTIONS:

Payment Methods

When you click Submission button below, your Membership form will be submitted, and you will be taken to the options to pay either by Check, Credit Card or PayPal.

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