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TTCBJ Membership and Engagement Form
Please verify reCaptcha before submitting the form.
The Temple, Congregation B'nai Jehudah is a reform congregation located in Overland Park, Kansas. Our congregation has a rich history, and there are a number of exciting programs and educational opportunities to help nurture Jewish meaning, connection and continuity.
Membership includes all members of a household family unit, which may be single individuals, married or committed couples, single parents, adult family members residing in the home and unmarried children. We do have reduced membership for those under the age of 30. We accept all households regardless of their financial situation.
I can't wait to welcome you to the B'nai Jehudah Family!
Kelley Cowman
Membership Engagement and Programming Coordinator
Office: 913.663.4050
Cell: 913.333.7740
engagement@bnaijehudah.org
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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.
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Contact Email
Please provide the best email address for this confirmation.
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Residential Street Address
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Residential Address City
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Residential Address State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Residential Address Zip Code
*
Additional Addresses
Please Select One
No Additional addresses needed
Alternate Residence Address
Billing Address
Billing and Secondary Address needed
Please indicate if you need an alternate home address, or billing address.
Alternate Residence Type
Seasonal/Vacation Home
P.O. Box
POA/Trust/Lawyer
Family Member/Guardian
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Marital Status
Please Select One
Single
Engaged
Married
Partners
Widow/Widower
Separated
Divorced
Please indicate your current marital status.
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?
Please Select One
One Adult
Two Adults
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
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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 One
Male
Female
X
*
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
Vision
Hearing
Mobility
Other
Please 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
Please Select One
Jewish
Considering Conversion
Non-Jewish
Non-Religious
Adult 1 - Jewish Background
Reform
Conservative
Orthodox
Reconstructionist
Jew-by-Choice
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 One
Male
Female
X
*
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
Vision
Hearing
Mobility
Other
Please 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
Please Select One
Jewish
Considering Conversion
Non-Jewish
Non-Religious
Adult 2 - Jewish Background
Reform
Conservative
Orthodox
Reconstructionist
Jew-by-Choice
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
Male
Female
X
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
Vision
Hearing
Mobility
Notes
*
How many children live in the family home?
Please Select One
No Children
One Child
Two Children
Three Children
Four Children
Child Status
All are minors
some 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
Male
Female
X
*
Child 1 - Date of Birth
Child 1 Pronouns
Please indicate child/s preferred pronouns.
Note: if blank corresponding gender pronouns will be used.
Child 1 - Residence
Resides with both parents
Resides with Mother
Resides with Father
Resides with Guardian
Adult Child - lives in home
Adult Child Lives elsewhere
Has Child 1 had a bar/bat mitzvah?
Please Select One
Yes
No
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
None
Physical
Learning
Social/Emotional
Does 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
Please Select One
Single
Married
Committed Relationship
Divorced
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
Male
Female
X
*
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
None
Physical
Learning
Social/Emotional
Does 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?
Please Select One
Yes
No
Child 2 - Bar/Bat Mitzvah Date
Please put N/A if B'nai Mitzvah has not occured
Child 2 - Residence
Resides with both parents
Resides with Mother
Resides with Father
Resides with Guardian
Adult Child - lives in home
Adult Child Lives elsewhere
Alternate Parent
Parent 2 is the same as Child 1
Parent 2 is different
no 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
Please Select One
Single
Married
Committed Relationship
Divorced
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
Male
Female
X
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
None
Physical
Learning
Social/Emotional
Does 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?
Please Select One
Yes
No
Child 3 - Bar/Bat Mitzvah Date
Child 3 - Residence
Resides with both parents
Resides with Mother
Resides with Father
Resides with Guardian
Adult Child - lives in home
Adult Child Lives elsewhere
Alternate Parent
Parent 2 is the same as Child 1
Parent 2 is the same as Child 2
Parent 2 is different
no 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
Please Select One
Single
Married
Committed Relationship
Divorced
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
Male
Female
X
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
None
Physical
Learning
Social/Emotional
Does 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?
Please Select One
Yes
No
Child 4 - Bar/Bat Mitzvah Date
Child 4 - Residence
Resides with both parents
Resides with Mother
Resides with Father
Resides with Guardian
Adult Child - lives in home
Adult Child Lives elsewhere
Alternate Parent
Parent 2 is the same as Child 1
Parent 2 is the same as Child 2
Parent 2 is different
no alternate parent involved
Child 4 - Marital Status
Please Select One
Single
Married
Committed Relationship
Divorced
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
Male
Female
X
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 Date
Hebrew Date
Hebrew Date (died after dark)
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B'nai Jehudah has an online directory only accessible to our members. Would you like to be listed in the directory?
Please Select One
Yes - please list me in the directory
No - do not list me 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:
Adult A (Primary Member)
Adult B (Second Member)
Both
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?
Website
Publication/Ad
Referred
Other
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?
Yes
No
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 Membershi
p Year June 1, 2022 - May 31, 2023/5783
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.
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Membership Type
Please Select One
Full Membership
Associate Membership
Please note that Associate Membership requires that you maintain a regular membership at another Synagogue.
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Membership Level
Please Select One
Standard Membership $2,258
Ner Tamid - Visionary $36,000 and up
Ner Tamid - Guardian $18,000 - $35,999
Ner Tamid - Pillar $9,000 - $17,999
Ner Tamid - Foundation $5,000 - $8,999
Ner Tamid - Cornerstone $2,500 - $4,999
Need to Discuss fees
Associate Member - $660
Please 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 One
Yes
No, I/we prefer to receive a hard copy statement in the mail but do NOT need a remittance envelope
No, 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:
Please Select One
Monthly
Quarterly (June, September, December, March)
Semi-Annually (June, December)
Annually (June)
Other
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 UPON RECEIPT OF THIS COMPLETED FORM. WELCOME!!!
*
I/We have agree to the financial authorization statements listed above.
I/We have agree to the financial authorization statements listed above.
Mon, May 12 2025 14 Iyar 5785