Email address (required) Today's date Adult name (1) Adult name (2) if applicable Street address City/state/zip Phone number Children? YesNo Child 1 name: Child 1 date of birth: Will child 1 attend Jewish Cultural School? YesNoChild 2 name: Child 2 date of birth: Will child 2 attend Jewish Cultural School? YesNoChild 3 name: Child 3 date of birth: Will child 3 attend Jewish Cultural School? YesNoMore than 3 children? YesNo Child 4 name: Child 4 date of birth: Will child 4 attend Jewish Cultural School? YesNo Child 5 name: Child 5 date of birth: Will child 5 attend Jewish Cultural School? YesNo Child 6 name: Child 6 date of birth: Will child 6 attend Jewish Cultural School? YesNoMembership & Tuition (Check all that apply) Individual Membership: $330/year or 4 payments of $82.50Family Membership, no children: $480/year or 4 payments of $120College Age Student: $100/year or 4 payments of $25Family membership with one child in JCS: $650/year or 4 payments of $162.50Each additional child: $110/year or 4 payments of $27.50Chai for refreshments (optional): $18Additional contribution (optional)Payment will be: Sent by check for the full amountSent in 4 equal payments by check, the first one nowSent by PayPal for the full amountSent in 4 equal payments by PayPal, the first one nowDiscussed directly with the treasurer (Seth Binder 612-386-5705)Total amount: You may send in your payment either:by check, mailed to Or Emet Treasurer Seth Binder, 3820 Lyndale Avenue S., Minneapolis, MN 55409digitally via this PayPal link (a check is preferred if possible, since we lose a fraction of PayPal contributions to transaction fees)Payment amount sent: If you would like to become more involved in congregational activities, check this box and we will contact you! YesAre you a new member or currently unlisted in the directory? YesNoΔ
