Home > The Membership Form Membership Application 1 Welcome2 Membership Information3 Member Information4 Interests and Talents5 Your Synagogue Experience6 Dues7 Amount to Pay Now WelcomeWelcome to Ansche Chesed, a ritually traditional, socially progressive and intellectually vibrant Conservative synagogue on Manhattan’s Upper West Side. An active, engaged center of Jewish life, our community is made up of people both passionate about Torah and tradition and dedicated to building the world through deeds of kindness. Diversity enriches us and we welcome everyone, young and old, individuals and families, traditio-nalists and seekers, LGBTQ and straight, those married to Jews and the intermarried. Membership InformationMembership Type*What type of membership?IndividualSingle adults without childrenFamilyMarried or partnered couples living together with or without children, and single adults with childrenFull-Time StudentPhotocopy of student ID and proof of full-time status requiredOut-of-Town MemberAnyone living outside the New York metro area. NOTE: This membership does NOT include High Holiday ticketsService/Minyan*Which service or minyan(s) do you attend or plan to attend? Sanctuary Service Minyan M’at West Side Minyan Minyan Rimonim Member InformationAdultPlease add the adults who should be included in the membership (up to two people)Adult [gfRepeater-count]First NameLast NameHebrew NameDate of Birth Street AddressCityStateZipcodeEmail Home PhoneCell PhoneEmployerPosition/SpecialtyDaytime PhoneEmail List Please add me to the Ansche Chesed email list. UntitledChildren/DependentsDependent [gfRepeater-count]First NameLast NameHebrew NameDate of Birth SchoolGradeJewish/Religious SchoolUntitledEmergency Contacts*Full NameHome PhoneCell PhoneRelationship YahrzeitsFull NameHebrew NameBefore/After SundownRelationship Interests and TalentsVolunteeringVolunteering is an important aspect of our community. Please let us know if you or anyone in your family would like to be involved in any of these activities (check all that apply): Social Action Men’s Homeless Shelter Adult Programs Family and Children’s Programs Hebrew School Greeting Visitors on Shabbat Hosting Shabbat Meals Leading/Assisting with Services Reading Torah and/or Haftarah (leyning) Giving Divrei Torah (commentary) Attending Daily Morning Minyan Visiting the Sick (Bikkur Cholim) Preparing Bodies for Burial (Chevra Kadisha) Comforting Mourners (Menachem Aveilim) Communications/ Marketing Membership Fundraising/Cultivation Talents and ExpertisePlease let us know if you have any talent(s) or particular expertise which could be called on to help the synagogue (check all that apply): Communications/Marketing Social Media Videography or Photography Interior Design Fundraising or Grant-Writing Systems/IT Music Employment and Nonprofit Law Nonprofit/Synagogue Management Other Your Synagogue ExperienceWhat made you choose to join or renew your membership?*What can we do to make your synagogue experience everything you would wish it to be?* DuesDues Policy and Schedule Dues provide the funds necessary for us to meet our financial obligations and support our activities. Our dues policy asks members to pay annual dues based on their income using the Fair Share Dues Schedule. If you are unable to pay the required amount, even over the course of the year, please call Executive Director Josh Hanft (212-865-0600 ext. 209) or Rabbi Jeremy Kalmanofsky (212-865-0600 ext. 210) to discuss alternative arrangements. No one will be turned away because of an inability to pay and your conversation will be kept strictly confidential. Please Note Membership Year: Our membership year runs from July 1 – June 30 with dues payable on July 1. If you cannot pay the full amount at that time, please make as large an initial payment as possible. Full payment must be made by December 31 of the membership year. Definition of Income: Income for those who are employed is the Gross Income shown on the most recent year’s tax return. Income for couples is their Combined Gross Income shown on the most recent year’s tax return. Those who are self-employed may use the Adjusted Gross Income shown on the most recent year’s tax return, i.e. income remaining after business deductions but before personal deductions. Full-Time Student and Out-of-Town Members: Members in both groups pay a flat fee regardless of income. Supplemental Membership Fees: Membership in Minyan M’at and the West Side Minyan requires a small supplemental fee paid directly to those minyans. To learn more, please visit AnscheChesed.org or email Membership_Mat@188.8.131.52 and/or Membership@westsideminyan.org. Payment Method: You may pay by check or by credit card (VISA or MasterCard only). Payment by check earns a small discount (see dues schedule). Confidentiality: The amount of dues each member pays is kept strictly confidential. Fair Share Dues, by Membership Type Individual Membership: Single adults without children INDIVIDUALS Annual Income Annual Dues From To Check Credit Card 0 – $49,999 $700 $721 $50,000 – $59,999 $850 $875 $60,000 – $69,999 $995 $1,025 $70,000 – $79,999 $1,145 $1,180 $80,000 – $89,999 $1,280 $1,319 $90,000 – $99,999 $1,395 $1,437 $100,000 – $109,999 $1,520 $1,566 $110,000 – $119,999 $1,665 $1,715 $120,000 – $129,999 $1,780 $1,834 $130,000 – $139,999 $1,925 $1,983 $140,000 – $149,999 $2,070 $2,133 $150,000 – $199,999 $2,190 $2,256 $200,000 – $249,999 $2,630 $ $250,000 – $299,000 $3,600 $3,708 $300,000 and above $3,800 $3,914 Family Membership: Married or partnered couples living together with or without children, and single adults with children FAMILIES Annual Income Annual Dues From To Check Credit Card 0 – $49,999 $770 $794 $50,000 – $59,999 $955 $984 $60,000 – $69,999 $1,110 $1,144 $70,000 – $79,999 $1,270 $1,309 $80,000 – $89,999 $1,435 $1,479 $90,000 – $99,999 $1,555 $1,602 $100,000 – $109,999 $1,690 $1,741 $110,000 – $119,999 $1,855 $1,911 $120,000 – $129,999 $1,985 $2,045 $130,000 – $139,999 $2,140 $2,205 $140,000 – $ 149,999 2,295 $2,364 $150,000 – $199,999 $2,410 $2,483 $200,000 – $249,999 $2,835 $2,921 $250,000 – $299,000 $3,600 $3,708 $300,000 and above $3,800 $3,914 Full-Time Students: Photocopy of student ID and proof of full-time status required FULL-TIME STUDENTS Check Credit Card $150 $155 Out-of-town Members: Anyone living outside the New York metro area. OUT-OF-TOWN MEMBERS Check Credit Card $175 $181 Payment Method*Will you submit your payment by check mail or by PayPal?CheckPayPalIndividual Income, Pay by Check*Please select your income range.< $49,999$50,000–$59,999$60,000–$69,999$70,000–$79,999$80,000–$89,999$90,000–$99,999$100,000–$109,999$110,000–$119,999$120,000–$129,999$130,000–$139,999$140,000–$149,999$150,000–$199,999$200,000–$249,999$250,000–$299,000$300,000 and aboveIndividual Income, Pay by PayPal*Please select your income range.< $49,999$50,000–$59,999$60,000–$69,999$70,000–$79,999$80,000–$89,999$90,000–$99,999$100,000–$109,999$110,000–$119,999$120,000–$129,999$130,000–$139,999$140,000–$149,999$150,000–$199,999$200,000–$249,999$250,000–$299,000$300,000 and aboveFamily Income, Pay by Check*Please select your income range.< $49,999$50,000–$59,999$60,000–$69,999$70,000–$79,999$80,000–$89,999$90,000–$99,999$100,000–$109,999$110,000–$119,999$120,000–$129,999$130,000–$139,999$140,000–$149,999$150,000–$199,999$200,000–$249,999$250,000–$299,000$300,000 and aboveFamily Income, Pay by PayPal*Please select your income range.< $49,999$50,000–$59,999$60,000–$69,999$70,000–$79,999$80,000–$89,999$90,000–$99,999$100,000–$109,999$110,000–$119,999$120,000–$129,999$130,000–$139,999$140,000–$149,999$150,000–$199,999$200,000–$249,999$250,000–$299,000$300,000 and aboveFull-time student, Pay by Check* Price: $150.00 Full-time student, Pay by PayPal* Price: $155.00 Out-of-Town, Pay by Check* Price: $175.00 Out-of-Town, Pay by PayPal* Price: $181.00 Security Fee, Pay by Check*If your total income exceeds $59,999, there is an additional security fee of $180. Price: $180.00 Security Fee, Pay by PayPal*If your total income exceeds $59,999, there is an additional security fee of $180. Price: $180.00 Total $0.00 Additional ContributionsAdditional ContributionI would like to make an additional contribution of: Where to direct additional contributionPlease indicate whether you wish your gift to be directed to specific programs or uses: Rabbi’s Discretionary Fund General Synagogue Fund Annual Kol Nidre (Yom Kippur) Appeal Adult Programs Family, Children’s and Teen Programs Music Programming Fund Men’s Homeless Shelter Fund Kiddush Fund Prayer Book Fund High Holiday TicketsMembership in Ansche Chesed includes High Holiday tickets for Individual, Full-Time-Student and Family members, but not for Out-of-Town members. Individual and Full-Time Student members are entitled to one seat each. Family members are entitled to two seats as well as a seat for each child or other dependent between the ages of six and 25; children and other dependents under the age of six do not need tickets. Additional tickets may be purchased for other family members or friends for $175 each. Reservations High Holiday tickets cannot be reserved until dues for the past year have been paid in full and a payment toward dues for the current year has been received. Additional Tickets Payment for additional tickets ($175 each) must be made in full at the time of request. Minyan Rimonim Members of Minyan Rimonim who wish to spend the High Holidays at Ansche Chesed usually attend the Sanctuary Service or the West Side Minyan. Additional Sanctuary Service Tickets Price: $175.00 Quantity: Additional Minyan M'at Tickets Price: $175.00 Quantity: Additional West Side Minyan Tickets Price: $175.00 Quantity: Seating PreferencesWe will do our best to accommodate requests for specific seats so long as membership dues have been received by August 1. If you are a new member, you will have a chance to request specific seats, or seats in a specific section, when you receive the High Holiday mailing toward the end of the summer. I/we would like the same seat(s) as last year and understand that, to be honored, this request must be received by August 1. Total $0.00 Total Dues“As a member/members of Ansche Chesed, I/we affirm that, in addition to any other contribution(s) I/we may make, I am/we are committed to supporting the congregation financially by paying my/our Fair Share Dues as set forth in the schedule above.”Your Total Dues $0.00 Amount to Pay Now*Please enter the amount from Your Total Dues, above, that you can pay after you submit this form.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.