2023-2024 TTCBJ Membership and Engagement Form

Welcome to the B'nai Jehudah family!

B’nai Jehudah has so many amazing things happening – programs for all ages and stages, a thriving religious school, and a warm, welcoming environment.

We provide our members with a home, a community and a faith and spiritual connection to enhance your Jewish journey. My goal is to help you accomplish your goal. Since every member’s dynamic is different, I’m here to act as a guide to help you find your place within the B’nai Jehudah family.

Feel free to join us at services or any of our upcoming programs and events and let us know you are here! I would love the opportunity to show you around the building.

Our congregation has a rich history of social justice, community connection and having a positive impact on our community at large. We have so many exciting programs and educational opportunities to help nurture Jewish meaning, connection and continuity.

Welcome Home! We are beyond excited you are part of the B'nai Jehudah family!

Kelley Cowman
Membership Engagement
Office: 913.663.4050
Cell: 913.333.7740
kcowman@bnaijehudah.org

* Mailing Names

Please indicate how you would like mail to be addressed to you and your family (example: Kelley and Ryan Cowman)

Preferred Phone Number

Please indicate a home phone or your preferred contact number for the household.

* Contact Email

Please provide the best email address for this confirmation.

* Residential Street Address

* Residential Address City

* Residential Address State

Residential Address Zip Code

* Additional Addresses

Please Select OneNo Additional addresses neededAlternate Residence AddressBilling AddressBilling and Secondary Address neededPlease indicate if you need an alternate home address, or billing address.

Alternate Residence Type

Seasonal/Vacation HomeP.O. BoxPOA/Trust/LawyerFamily Member/Guardian

Anniversary

Please give anniversary date as mm/dd/yyyy.

Wedding Date

Please give planned wedding date as mm/dd/yyyy.

Alternate Residence Contact

Please provide Contact Name at this address.

Alternate Residence Street

Alternate Residence City

Alternate Residence State

Alternate Residence Zip Code

Billing Address Contact

Please provide Contact Name for this address or Company Name and Contact Name.

Billing Address Street

Billing Address City

Billing Address State

Billing Address Zip

Billing Notes

Please indicate if you have any unique billing information.

* How many adults are applying for membership?

Our system will place the first two Adult information as a primary and secondary member who automatically have full account permissions. These are typically spouses, or partners.

For multi-generational households please select which generation is to be the primary members and then add the additional generation under "Other Adults at Home" as they will not have full account access.

If BOTH generations should be considered full members, please submit separate applications and indicate in the information section which household will be the billing contact.

Adult 1 - Title

* Adult 1 - First Name

Adult 1 - Middle Name

Adult 1 - Last Name

Adult 1 - Preferred First Name

Preferred First Name / Nickname

Adult 1 - Hebrew Name

Please give name in English.

* Adult 1 - Gender

Please Select OneMaleFemaleX

* Adult 1 - Date of Birth

Adult 1 - Pronouns

Please indicate your preferred pronouns: he/him; she/her; they/them

* Adult 1 - Cell Phone

Adult 1 - Email Address

Adult 1 - Assistance Needs

VisionHearingMobilityOtherPlease indicate if you will need assistance for any of these.

Adult 1 - Assistance Needs Detail

Please provide a brief explanation for "other" needs.

* Adult 1 - Religious Background

Adult 1 - Jewish Background

Adult 1 - Previous Synagogue

Adult 1 - Faith

What Faith do you practice or consider yourself?

Adult 1 - Occupation

Adult 1 - Position/Title

Adult 1 - Employer

Adult 1 - Work Phone

Work Address - Business Name

Please provide Company Name for this address.

Work Address - Street

Work Address - City

Work Address State

Work Address Zip

Adult 2 - Title

* Adult 2 - First Name

Adult 2 - Middle Name

* Adult 2 - Last Name

Adult 2 - Preferred First Name

Preferred First Name / Nickname

Adult 2 - Hebrew Name

Please give name in English.

* Adult 2 - Gender

Please Select OneMaleFemaleX

* Adult 2 - Birthday

Adult 2 Pronouns

Please indicate your preferred pronouns: he/him; she/her; they/them

Adult 2 - Cell Phone

Adult 2 - Email Address

Adult 2 - Assistance Needs

VisionHearingMobilityOtherPlease indicate if you will need assistance for any of these.

Adult 2 - Assistance Needs Detail

Please provide a brief explanation for "other" needs.

* Adult 2 - Religious Background

Adult 2 - Jewish Background

Adult 2 - Previous Synagogue

Adult 2 - Faith

What Faith do you practice or consider yourself?

Adult 2 - Occupation

Adult 2 - Position/Title

Employer

Adult 2 - Work Phone

Work Address - Business Name

Please provide Company Name for this address.

Work Address - Street

Work Address - City

Work Address State

Work Address Zip

Click "+" to add Other Adults in the Household

Title

Last Name

First Name

Middle name

Nickname

Preferred First Name

Hebrew Name

Please provide name in English.

Gender

MaleFemaleX

Preferred Pronouns

If left blank we will use the gender consistent pronouns.

Birthdate

Please use the m/d/yyyy format.

Cell Phone

Email Address

Assistance Needs

VisionHearingMobility

Notes

* How many children live in the family home?

Child Status

All are minorssome minors and some adults (living in the home)All are adults (living in the home)Are these children minors or adults?

Child 1 - First Name

Child 1 Middle Name

Child 1 - Last Name

Child 1 Nickname

Preferred First Name

Child 1 - Hebrew Name

Please provide name in English

Child 1 - Gender

MaleFemaleX

* Child 1 - Date of Birth

Child 1 Pronouns

Please indicate child/s preferred pronouns.
Note: if blank corresponding gender pronouns will be used.

Has Child 1 had a bar/bat mitzvah?

Child 1 - Bar/Bat Mitzvah Date

Please put N/A if no B'nai Mitzvah has occured

Child 1 - Secular School Name

Child 1 - Grade

Child 1 Challenges

NonePhysicalLearningSocial/EmotionalDoes Child have health/developmental/learning challenges?

Child 1 Challenges Detail

Please provide an explanation for any Challenges that were identified.

Child 1 Second Parent Name

This is only for cases of a parent that does not reside at the same residence with the child.
Please provide both First & Last Name

Parent 2 -Phone

Parent 2 Email

Parent 2 Address

Parent 2 City

Parent 2 State

Parent 2 Zip

Child 1 - Marital Status

Child 1 - If married/committed - Name of spouse/partner

Child 2 - First Name

Child 2 Middle Name

Child 2 - Last Name

Child 2 - Nickname

Please provide preferred first name

Child 2 - Hebrew Name

Please provide name in English

Child 2 - Gender

MaleFemaleX

* Child 2 - Date of Birth

Child 2 Pronouns

Please indicate child/s preferred pronouns.
Note: if blank corresponding gender pronouns will be used.

Child 2 - Secular School Name

Child 2 - Grade

Child 2 Challenges

NonePhysicalLearningSocial/EmotionalDoes Child have health/developmental/learning challenges?

Child 2 Challenges Detail

Please provide an explanation for any Challenges that were identified.

Has Child 2 had a bar/bat mitzvah?

Child 2 - Bar/Bat Mitzvah Date

Please put N/A if B'nai Mitzvah has not occured

Alternate Parent

Parent 2 is the same as Child 1Parent 2 is differentno alternate parent involved

Child 2 Second Parent Name

This is only for cases of a parent that does not reside at the same residence with the child.
Please provide both First & Last Name

Parent 2 -Phone

Parent 2 Email

Parent 2 Address

Parent 2 City

Parent 2 State

Parent 2 Zip

Child 2 - Marital Status

Child 2 - If married/committed - Name of spouse

Child 3 - First Name

Child 3 Middle Name

Child 3 - Last Name

Child 3 - Nickname

Please provide preferred first name

Child 3 - Hebrew Name

Child 3 - Gender

MaleFemaleX

Child 3 - Date of Birth

Child 3 Pronouns

Please indicate child/s preferred pronouns.
Note: if blank corresponding gender pronouns will be used.

Child 3 - Secular School Name

Child 3 - Grade

Child 3 Challenges

NonePhysicalLearningSocial/EmotionalDoes Child have health/developmental/learning challenges?

Child 3 Challenges Detail

Please provide an explanation for any Challenges that were identified.

Has Child 3 had a bar/bat mitzvah?

Child 3 - Bar/Bat Mitzvah Date

Alternate Parent

Parent 2 is the same as Child 1Parent 2 is the same as Child 2Parent 2 is differentno alternate parent involved

Child 2 Second Parent Name

This is only for cases of a parent that does not reside at the same residence with the child.
Please provide both First & Last Name

Parent 2 -Phone

Parent 2 Email

Parent 2 Address

Parent 2 City

Parent 2 State

Parent 2 Zip

Child 3 - Marital Status

Child 3 - If married/committed - Name of spouse

Child 4 - First Name

Child 4 Middle Name

Child 4 - Last Name

Child 4 - Nickname

Please provide preferred first name

Child 4 - Hebrew Name

Child 4 - Gender

MaleFemaleX

Child 4 - Date of Birth

Child 4 Pronouns

Please indicate child/s preferred pronouns.
Note: if blank corresponding gender pronouns will be used.

Child 4 - Secular School Name

Child 4 - Grade

Child 4 Challenges

NonePhysicalLearningSocial/EmotionalDoes Child have health/developmental/learning challenges?

Child 4 Challenges Detail

Please provide an explanation for any Challenges that were identified.

Has Child 4 had a bar/bat mitzvah?

Child 4 - Bar/Bat Mitzvah Date

Alternate Parent

Parent 2 is the same as Child 1Parent 2 is the same as Child 2Parent 2 is differentno alternate parent involved

Child 4 - Marital Status

Child 4 - If married/committed - Name of spouse

Click "+" to add additional child

Child Last Name

Child First Name

Child Middle name

Nickname

Preferred First Name

Hebrew Name

Please provide name in English.

Gender

MaleFemaleX

Preferred Pronouns

If left blank we will use the gender consistent pronouns.

Child Birthdate

Please use the m/d/yyyy format.

Child Age

Secular School

Child Grade

Notes

Click "+" to add a Yahrzeit

Deceased Title

Deceased First Name

Deceased Middle Name

Deceased Last Name

Date of Death

Please use the format: mm/dd/yyyy

Mourner Name

Please give first and last name.

Relationship

Please indicate how the Deceased is related to the mourner

Remember on:

English DateHebrew DateHebrew Date (died after dark)

* B'nai Jehudah has an online directory only accessible to our members. Would you like to be listed in the directory?

Once logged into their account, members will have the ability to set which personal information is available online.

If you have additional referrals; please list their information in the box provided

Not applicable if you selected NO to having recommendations of people in the Kansas City Jewish community who might be interested in joining the B'nai Jehudah family.

In order to serve you better, please take a few moments to answer the following questions.
Also, please feel free to include any additional information that you feel may be beneficial to us.

What skills, hobbies or interests (i.e. musical talents, public relations experience, party planning, etc…) do you or members of your household have that might be shared with the congregation through our programming, religious school, adult education or worship?

Click on "+" to add skills/hobbies for a household member

Name

Abilities, Interests, Hobbies

Are you related to (i.e. parents, grandchildren, cousins, etc…) or are you friends with current The Temple, Congregation B’nai Jehudah members?

Click "+" to add relationships for the Household

Name

Relationship

Related to:

What was your previous synagogue affiliation?

Please provide synagogue name, city and state.

What activities were you invlolved in there?

How would you like the Temple to help support your family's Jewish Journey? Suggestions? Requests?

How did you hear about The Temple, Congregation B'nai Jehudah?

Referred by:

Other detail:

Do you know another member of the Kansas City Jewish Community that might be interested in becoming a part of the B'nai Jehudah family?

YesNo

If you selected "Yes"

Please list the following information here for all people you think would be interested in joining the B'nai Jehudah family.

1) Referral 1:
- Name
- Email Address
- Phone Number
- Anything we should know about this family?

2) Referral 2:
- Name
- Email Address
- Phone Number
- Anything we should know about this family?

etc.

Reason for Joining

Is there anything else you would like us to know about your family?

ANNUAL COMMITMENTS AND FEES FOR NEW MEMBERS/FULL FAMILY
For Membership Year June 1, 2023 - May 31, 2024/5784

FULL FAMILY MEMBERSHIP FINANCIAL COMMITMENT {TERUMAH} AND VOLUNTARY HIGHER GIVING LEVELS:
Every membership at The Temple, Congregation B’nai Jehudah is vitally important to our community, and every donation is deeply appreciated. If you are able to do so, please consider increasing your support of people and programs throughout our congregational community by increasing your Terumah to a higher level. Your participation will allow us to stabilize, strengthen, and sustain The Temple, Congregation B’nai Jehudah and set it on a course for a healthy and positive future.

Ner Tamid: An Overview

Ner Tamid offers an extraordinary opportunity for B'nai Jehudah supporters to contribute above and beyond the annual sustaining Terumah amount. This dedication to contributing above and beyond their share of our operating costs make it possible for every congregant to participate in the life of our synagogue regardless of financial circumstances. These contributions are a vital component to the financial health of our synagogue. Please consider a gift at the Ner Tamid level to help sustain congregational life and invest in our future.

Thanks to the ongoing support of our generous Ner Tamid donors, B'nai Jehudah is proud to be able to welcome all members, regardless of their financial situation.

* Membership Type

Please Select OneFull MembershipAssociate MembershipPlease note that Associate Membership requires that you maintain a regular membership at another Synagogue.

* Membership Level for June 1, 2023-May 31, 2024

Please Select OneStandard Membership $2,472Associate Member - $732Ner Tamid - Visionary $36,000 and upNer Tamid - Guardian $18,000 - $35,999Ner Tamid - Pillar $9,000 - $17,999Ner Tamid - Foundation $5,000 - $8,999Ner Tamid - Cornerstone $2,750 - $4,999Need to Discuss feesPlease select your membership - Terumah - level for the year.

If you chose Associate Member - Please indicate what Synagogue you are a Primary Member at currently

Please provide name and location of your Primary Synagogue.

Requested Annual Terumah Amount

Please indicate the amount that you feel you can offer for the year.
If giving as a monthly amount please state: per month.

Amount Agreed upon

If you have spoken with the Engagement and Programming Coordinator; Kelley Cowman and reached an agreed on Terumah amount please list it here.

* I/We wish to further assist the congregation by receiving my statement through email:

Please Select OneYesNo, I/we prefer to receive a hard copy statement in the mail but do NOT need a remittance envelopeNo, I/we prefer to receive a hard copy statement in the mail and DO need a remittance envelope

* I/We wish to receive my statements:

Statement Frequency - Other

Please list the months you wish to receive statements.

PAYMENT AUTHORIZATION: I/We understand that:

1. Financial commitments must be current in order to receive High Holy Day admittance and other services.
2. All financial commitments must be paid in full by the end of the fiscal year May 31st, 2023

YOUR MEMBERSHIP WILL BE PROCESSED WITHIN 72 HOURS OF FORM SUBMISSION OF THIS COMPLETED FORM.

* I/We have agree to the financial authorization statements listed above.

I/We have agree to the financial authorization statements listed above.

Wed, October 4 2023 19 Tishrei 5784