Page 9 - CKA July 2017 TAMMUZ — AV 5777

cate or
uali ca ons
re it ar Authori a on
lease print
Credit Card Payment Informa on
If you would like to pay by credit card, or if you choose to pay monthly, please ll out this form. This form includes the 3 Credit Card convenience fee.
Membership ate ories ues
ee Membership le e orm Applica on or
Name Address
City
State/ ip Phone /Email
re it ar n orma on
Please charge my: Visa
Account
E pira onDate: 3-digit Security Code:
Annuall
Quarterl
Monthl
Kokhavim
$9270
$2317.50
$772.50
Chai
$4635
$115 .75
$3 6.25
Congrega onal
$2472
$61
$206
pecialt ues e els i abo earenota or able
Single Adult
$1277.20
$319.30
$106.43
Single Parent Family
$164
$412
$137.33
Senior Single
$741.60
$1 5.40
$61. 0
Senior Family
$1359.60
$339.90
$113.30
Associate (non-vo ng)
Quali ca ons: A member in good standing of another synagogue as veri ed by CKA – or - Reside outside our general area of 60 or moremilesfromCKA–or- Have only non-Jewish adults in household Associate Memberships: Non-Vo ng Members; Not eligible for burial at Kehilat Olam (CKA’s cemetery); Pay non-member fees for rabbinic o cia on, educa on programs, and use of the synagogue for events
chool ui on
lease e ister hil nline
Religious School K- & KAST
Tui on per child: $566.50/School ear
Each addi onal child in family: $504.70/School ear Non-member tui on, per child $ 44.60/School year
Hebrew School
Grades 4th-6th
Tui on per child: $793.10/School ear
Each addi onal child in family: $731.30/School ear
B’Nai Mitzvah Training
7th grade
Tui on per child:
$131 .40/School ear
Each addi onal child in family: $1256.60/School ear
MasterCard
Total Due
Annually
uarterly
Membership Dues
Religious School
Hebrew School
KAST
Friday Night Oneg
$56.65
Other
Jan Herson Fund
Total Payments
Monthly
I hereby authorize Congrega on Kol Ami to charge:
$
S dollars on the:
1st of every month 15th of every month 1st of every uarter
Annually in (specify month) Other
fromthecreditcardindicatedabove. Iunderstandthateachtrans ac on will appear on my regular bank statement. I further under stand that it is my responsibility to no fy Congrega on Kol Ami if there are any changes to my credit card that may a ect my payment.
Signature: /Date:
Return completed form to: Congrega on Kol Ami, 7800 NE 11 th Street, Vancouver, WA 8662