Notice: To complete this form on a cell phone or iPad click here.
First Name:  
Last Name:  
Spouse Name:  
Address:  
City:  
State:  
Zip:  
Email:  
Phone:  

My/Our Annual Financial Commitment for 2020 is:   $
Annual Security Assessment (New / see below):   $
My/Our Total Commitment:   $


Membership Types:
Please select your membership type in the box below:



  FAMILY: Household with Two Adults

INDIVIDUAL: One-Adult Household
 SECURITY  ASSESSMENT      
(New) For all Members $100   $50
       
 TORAH CIRCLE      
 Tzedakah  
 Shalom
 Simcha
 Kavod
 Beracha
 Chai

 STANDARD
 
 Sustaining Commitment
 Out-of-State
 Affiliate (Dual Commitment)
 36 years & under

 LESS THAN STANDARD
 
 
 No one is denied membership because of financial hardship. A request may be made for  commitment accommodations by contacting our Executive Director, Robin Gotlieb,
 at robin@ourtemple.org or (205) 933-8037, ext 238.




RECOGNITION: Torah Circle Donors will be recognized this year in both the Bulletin and on the
new touchscreen monitor outside the sanctuary. In order to be included in the listings, please
respond with your gift or pledge intentions no later than Dec 31, 2019.

        
        






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

OR

Please select your installment and payment options below



Installment Options:

I/We pledge to pay our Annual Commitment / Security Assessment as follows (please check one):
We kindly request that all one-time payments be received no later than June 30, 2020. Note: the Security Assessment will be applied to the first payments.






Payment Options:
Please indicate your method of payment:


 



  - Contact Danielle Barnett, Accounting Manager, at 205-933-8037 ext. 244 or danielle@ourtemple.org at the time you arrange a stock transfer.


  - Preferred method of payment. 

Name on Account
Address:
City:
State:
Zip:
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.




  - A 3% processing fee will be added for all credit card payments.

Credit Card Type:            
Credit Card No.:
Security Code:
Expiration:    
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 Robin Gotlieb, our Executive Director, 205-933-8037 ext 238