Notice: To complete this form on a cell phone or iPad click here.
First Name:  
Last Name:  
Spouse Name:  

My/Our 2023 Annual Financial Commitment is:   $
Annual Security Assessment (not optional)
In addition to dues for all members age 40 and older
My/Our Total Commitment:   $

Membership Types:
Please select your membership type from one of the boxes below:

  FAMILY: Household with Two Adults

INDIVIDUAL: One-Adult Household

 Sustaining Commitment
 Affiliate (Dual Commitment)

 No one is denied membership because of financial hardship. A request may be made for commitment accommodations by contacting our Accounting Manager, Danielle Barnett, at or (205) 933-8037, ext 244.

UNDER 40 YEARSrefers to the age of oldest person in the household on Dec 31, 2023 SECURITY ASSESSMENToptional until 40 years of age

  39 years  
  38 years  
  37 years  
  36 years & under  

Via PayPal
Note: A 3% processing fee will be added to your on-line PayPal payment.


Please select your installment and payment options below

I/We pledge to pay this year’s Annual Commitment / Security Assessment as
(please check one):

My/Our method of payment is (please check one):

  - Preferred method of payment. 

Name on Account
Routing Number:
Checking Account No.:
By checking this box you are authorizing Temple Emanu-El to perform an
Automatic Bank Draft (ACH) as stated above.


  - Contact Danielle Barnett, Accounting Manager, at 205-933-8037 ext. 244 or at the time you arrange a stock transfer so that we can help
facilitate your gift.

  - All credit card payments incur a 3% processing fee.

Credit Card Type:            
Credit Card No.:
Security Code:
Name on Card:
   (Exactly as it appears on card)

Your banking and credit card information is kept secure using SSL 256-bit encryption.

Send payments to:
Temple Emanu-El 2100 Highland Avenue So. Birmingham, AL 35205
If you have questions, please contact Danielle Barnett, our Accounting Manager, 205-933-8037 ext 244