Household Information

Home Address

City

State

Zip Code

Home Phone

Marital Status

Anniversary Date

Personal Information

Member 1

Member 2

Last Name

First Name

Gender - I identify as:

Date of Birth (m/d/y)

Mobile Phone

Email Address

Occupation/Title

Employer

Work Address

Work Telephone

Work Email

Work Telephone

Work Email

Member 1 Retired?

YesNo

Member 2 Retired?

YesNo

If Retired, Former Occupation

Religious Upbringing:

Hebrew names can be entered using English transliteration or in Hebrew using the Hebrew keyboard. (Click on icon at right of each field.)

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Medical/Emergency Information

Other (please specify)

Are you a blood donor?

YesNo

Are you a blood donor?

YesNo

If yes, indicate blood type

In case of emergency, the Temple should notify:

Relationship

Phone

FAMILY INFORMATION

Children in your home 25 years old and under

CHILD 1

CHILD 2

CHILD 3

CHILD 4

First Name 1

First Name

Last Name

Hebrew Name

Identifies as:

Date of Birth

Make

Name of School/College

Grade/Year

So that we may better accommodate your child's needs, please indicate any physical limitations:

VEHICLE INFORMATION

Vehicle #1

Vehicle #2

Vehicle #3

Vehicle #4

Make

Model

Year

Color

License Plate #

YAHRZEIT INFORMATION

I/We prefer annual reminders by (please select one):

Please Select OneGregorian Date (Secular)Hebrew Date*

*Simply give us the Gregorian (secular) month, date, and year, and we will convert it to the Hebrew date (Ex: June 30, 2000).

Full English Name

Observed by (member's name)

Relationship

Yahrzeit Date

Full English Name

Observed by (member's name)

Relationship

Yahrzeit Date

Full English Name

Observed by (member's name)

Relationship

Yahrzeit Date

Full English Name

Observed by (member's name)

Relationship

Yahrzeit Date

Full English Name

Observed by (member's name)

Relationship

Yahrzeit Date

Full English Name

Observed by (member's name)

Relationship

Yahrzeit Date

INTERESTS

Involvement in Temple life will enhance your experience at Leo Baeck Temple. Please indicate your interest by checking any and all of the following areas:

COMMUNITY COMMITMENT

Membership Categories

Select one if applicableFamily Membership (2 Adults, age 40 and over, with or without children) - $5090Single Membership (1 Adult, age 40 and over, with or without children) - $3410

Our sustainability model for our annual community commitment, is specifically designed for individuals aged 39 and under. Inspired by the biblical concept of terumah, a heartfelt gift offered in support of the community, we encourage you to contribute as generously as you can. Just as the Israelites gave gifts from their hearts to build the Mishkan, the sanctuary our ancestors built in the Book of Exodus, we ask that you strengthen LBT from your heart as well. Our community commitment is our primary source of financial support. It is what enables LBT to fulfill its mission. Your commitment is crucial to sustaining our temple and enabling us to offer religious services, programs, and community outreach throughout the year.

Below is our sustaining level, indicating the base contribution required from each member household to support our congregation (exclusive of school tuitions). We urge you to pledge the most generous amount you can afford, if possible.

Thank you for your commitment to Leo Baeck Temple!

Young Adult Members

Select one if applicableI would like to contribute at the sustaining level of $3,825I would like to contribute another amount and will enter that amount below

Young Adult - Other Amount

Young Adult membership commitment must be a minimum of $300 for single members or $600 for couples.

Sustaining Tzedek at LBT

The Talmud teaches “Kol Yisrael arevim zeh b’zeh” – “all Jews are responsible for one another.” In keeping with that value, Leo Baeck Temple has long embraced the conviction that members who are financially able should be counted upon to help those of our members who are less able to afford membership. Sustaining Tzedek at LBT maintains our egalitarian community, where no one is denied the opportunities of temple membership because of monetary difficulties. Please consider joining this group willing to fulfill the mitzvah of tzedakah by pledging an amount in addition to your standard membership commitment.

I/We would like to fulfill the mizvah of tzedakah by pledging the following amount, in addition to our standard membership contribution:

Suggested donation levels: $18,000, $13,000, $10,000, $5,000, $3,500, $1,500, $720, $360 (enter amount)

ARZA Membership
ARZA: the mission of ARZA is to further progressive Judaism in Israel. The Temple encourages all members to join ARZA.

Dues are $50 per year (enter amount, if applicable)

ARZA Membership

Total

Payment Schedule - I/We would like to pay our Community Commitment as follows:

AnnuallySemi-AnnuallyQuarterlyMonthly (over 10 months July-April)

Please charge all fees to my preferred payment method until further notice.

Community Commitment Form 2025-26

Household Information

Personal Information

Medical/Emergency Information

FAMILY INFORMATION

VEHICLE INFORMATION

YAHRZEIT INFORMATION

INTERESTS

COMMUNITY COMMITMENT

Once you have completed the form above in full, click on the submit button to be redirected to the payment information page.