New Membership Form -

Please fill in the following form as best you can. If you have any questions please call our office.

Also note: The most important thing to our community is that everyone has an opportunity to become part of it, regardless of financial considerations. Our Treasurer is ready to work with you confidentially to find a way for you to join! Please email him directly with a request for Dues Relief and he will work with you to arrange a plan that works for you. ronb@canadasportswear.com

New Membership Form

Date (M/D/Y)
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Adult #1*
Please enter your name and preferred prefix/title
Prefix First Last
Adult #1 Hebrew Name (Transliteration)
Hebrew Name
Adult #1 Cell Phone #
Adult #1 Email*
Adult #1 Date of Birth )m/d/y)
MM slash DD slash YYYY
Adult #1 Occupation*
Adult #2
Please enter your name and preferred prefix/title
Prefix First Last
Adult #2 Hebrew Name (Transliteration)
Hebrew Name
Adult #2 Cell Phone #
Adult #2 Email
Adult #2 Date of Birth (m/d/y)
MM slash DD slash YYYY
Adult #2 Occupation
Date of Marriage (If applicable) (m/d/y)
MM slash DD slash YYYY
Children's Information
Name Birthday Hebrew Name (transliteration)
Emergency Contact Information*
Name Relationship Tel
How did you hear about Am Shalom?*
Were you a member of another congregation in the past?*
- Yes
- No
If yes, where?
How long have you lived in Barrie?*
Please enter a number greater than or equal to 0.
If new to Barrie, what community did you live in previously?
Do you have Burial Plot Priveledges?*
- Yes
- No
Who, if anyone, in the congregation referred you to join ?
If you are related to an existing member of the congregation, please indicate who:
What community organizations do you belong to?
Yahrzeit Information
This information is required in order to send reminder letters to you.
English Name Hebrew Name (transliteration) Relationship (eg. John's Mother) English Date of Death (dd/mm/yyyy) Hebrew Date of Death (dd/mm/yyyy)
Volunteer Opportunities
Am Shalom has many different committees or volunteer opportunities. Please indicate where you would like to volunteer or help out in any way:
- Volunteer at Delta Bingo (Tuesdays 8pm-10pm, once every 2-3 months)
- Clean up for an hour after events - put out trash, wipe tables, set things straight
- Help in the kitchen before or after Kiddush or an event (set up, food prep, clean up)
- Join our Chesed committee, to help anyone in the Am Shalom and larger community that is sick, injured, has has a recent death in the family, is pregnant or just had a baby.
- Helping to organize an event such as Mitzvah Day, Channukah party, Anniversary party, Movie night, etc.
- Offer expertise in your field. For example, if you are an art or yoga teacher, you can offer a lesson to members. Any skills you can offer free of charge are greatly appreciated.
- Offer to drive an elder to or from synagogue
- Make phone calls to members prior to events.
- Offer to transport people to outings, such as Matzah Factory visit
- Sign up for a position on the Board of Directors. This commitment is about 40 hours per year, depending on the position.
Membership*
Membership - For this year only we are offering New Members a discounted price from the usual $800 single/$1500 family price. Please choose either Single or Family membership (Single parents are single) Am Shalom makes a practice of working with members and of doing everything we can to ensure new members aren’t turned away from becoming a part of our community for financial reasons. If you require dues relief please indicate so here and our treasurer will contact you. Please note: our year is from May 1 through April 30.
- Single $400/ $33.33 per month
- Family $600 / $50 per month
- TBD - Dues Relief Requested
add Free* Jewish Heritage School deposit (ages 4-13) Quantity
Thanks to some very generous donors, we are able to offer our Jewish Heritage School for free on the condition your child attends at least 70% of the classes (19/27). The $400 deposit will be refunded at the end of the school year. (You may choose to donate it to Am Shalom or put it towards next year's dues at that time.)
Price: $ 400.00 CAD
Building Fund*
Building Fund is a lifetime contribution of $1000 per single (includes single parent) or $1800 per family. Please enter what amount you would like to contribute this year. (Most members do $300-$600 a year). When your contribution is complete you will receive a leaf on our Tree of Life in the synagogue lobby.
- Add total BF Single $1000
- Add total BF Family $1800
- Add BF $600 / $50 per month
- Add BF $300 / $25 per month
- Add BF $120 / $10 per month
- I can not add anything to BF at this time
Fair Share amount
This is a share support system for membership contributions. It is based on the concept that all shall give according to the blessing which has been given us. Note: we do not ask for any tax information from you, this is on a self-assessment basis. Please add the amount indicated in the chart below to make total dues about 2% of income.
- Income less than $80,000 add 0
- Income $80,000 - $90,000 add $100
- Income $90,001 - $100,000 add $200
- Income $100,001 - $110,000 add $600
- Income $110,001 - $120,000 add $800
- Income $120,001 - $130,000 add $1000
- Income $130,001 - $140,000 add $1200
- Income $140,001 - $150,000 add $1400
- Income $150,001 - $175,000 add $1600
- Income $175,001 - $200,000 add $1800
- Income $200,001 or more add $2000 (or more by selecting multiple amounts)
Total
Total amount pledged. Payment will be arranged with the office.
$ 0.00 CAD
Payment Frequency*
Please indicate whether you wish to pay in one lump sum or by 12 equal monthly payments. (Taken on the 15th of each month)
- I wish to pay in one lump sum
- I wish to pay in 12 equal payments on 15th of each month
CAPTCHA
Payment method
Please indicate how you wish to pay. If you wish to pay by Credit Card please enter your credit card information (Name on card, Number and Expiry Date) here and then hit Submit. You may also send in one or 12 post-dated cheques, dated for the 15th of each month, if you prefer. Thank you.

New Membership Form

New Membership Form

Contact Info

Shabbat Times

Member of RJCC

Name	Birthday	Hebrew Name (transliteration)

Name	Relationship	Tel

English Name	Hebrew Name (transliteration)	Relationship (eg. John's Mother)	English Date of Death (dd/mm/yyyy)	Hebrew Date of Death (dd/mm/yyyy)