TBT Membership Application - Temple Beth Tikvah Bend

TBT Membership Application 2023-2024

Please complete all sections of this application:

Welcome to Central Oregon's friendliest Jewish Reform congregation! Pull up a seat at Shabbat services, Shabbat dinners, holiday services and celebrations, family and children's programs, Torah study, Adult Education, Social Action, and events planned just for fun.
MEMBER INFORMATION:
Name (1)*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Email (1)*
Primary Phone # (1)*
Is this number a cell phone?
- Yes
- No
Do you have another (home) phone you want listed?*
- Yes
- No
Home Phone #
Is there another person at this address to be listed as a Member?*
- Yes
- No
Name (2)*
Email (2)*
Cell Phone # (2)*
Is Central Oregon your primary residence?*
- Yes
- No
Please tell us your top three (3) reasons for joining TBT so that we can connect you to the right services and activities.
Your reasons for joining TBT*
Hold CONTROL or COMMAND (Mac) key then use your cursor to select your top three reasons for joining.
Are you on Facebook?*
- Yes
- No
On Facebook? You can stay informed of events and activities going on at Temple Beth Tikvah as well as connect with your friends in the congregation through our private Members Group.

If interested, please provide your Facebook user name(s) below and TBT's Facebook Administrator will "friend" you and give you access to our private Members group.
Member1 Facebook username
Member2 Facebook username
Privacy: We take your privacy seriously with the information and images that we may collect.
May we use photos of you taken at TBT events on our private Facebook page?:*
- Yes
- No
- If I can see the photo(s) first
May we use photos of your children taken at TBT events on our private Facebook page?*
- Yes
- No
- If I can see the photo(s) first
- Not applicable
Dates to celebrate: Provide your special dates below and we will send you warm wishes in TBT's monthly newsletter.
Wedding Anniversary
Month
Day
Year
Birthday for Member 1*
Month
Day
Year
Birthday for Member 2*
Month
Day
Year
How many children/dependents do you have?*
- 0
- 1
- 2
- 3
- 4 or more
Name of Child/Dependent 1*
Birthdate for Child/Dependent 1*
Month
Day
Year

(Please include Year, for school purposes)
Name of Child/Dependent 2*
Birthdate for Child/Dependent 2*
Month
Day
Year

(Please include Year, for school purposes)
Name of Child/Dependent 3*
Birthdate for Child/Dependent 3*
Month
Day
Year

(Please include Year, for school purposes)
Name of Child/Dependent 4*
Birthdate for Child/Dependent 4*
Month
Day
Year

(Please include Year, for school purposes)
NOTE: If you have more than 4 children/dependents, please submit the additional names and birthdates to the TBT Treasurer at TBTtreasurer@gmail.com.
Yahrzeits: Yahrzeit is observed each year at Shabbat services at the anniversary of a death. Please list below their names, dates, and relationships (and to whom they are related, i.e. Jane's Mother). If you need to add more names later, send to the TBT Treasurer at TBTtreasurer@gmail.com.
How many Yahrzeits do you wish to honor?*
- 0
- 1
- 2
- 3
- 4 or more
Name of Yahrzeit 1*
Relationship to Yahrzeit 1*
Date of Death for Yahrzeit 1*
Month
Day
Year
Name of Yahrzeit 2*
Relationship to Yahrzeit 2*
Date of Death for Yahrzeit 2*
Month
Day
Year
Name of Yahrzeit 3*
Relationship to Yahrzeit 3*
Date of Death for Yahrzeit 3*
Month
Day
Year
Name of Yahrzeit 4*
Relationship to Yahrzeit 4*
Date of Death for Yahrzeit 4*
Month
Day
Year
NOTE: If you have more than 4 Yahrzeits you wish to honor, please submit those names, relationships, dates of death to the TBT Treasurer at TBTtreasurer@gmail.com.
What’s the best way to become part of the TBT community? Attend services and events. Sit on committees. Get involved. Working together is the best way to create shared experiences that lead to friendships and good times.

Please have the following 3 questions completed by each adult family member.
How do you enjoy spending your free time?
Hold CONTROL or COMMAND (Mac) key then use your cursor to select all that apply.
What skills or experiences can you share with TBT? Everyone has something special to offer. Think about your experience and what you enjoy, for example — cooking, baking, music, fundraising, finance, event planning administration, organizing, teaching. Whether you have expertise in a specific subject or simply a passion you enjoy, we value the talent, energy and ideas you contribute.
Share your skills
Use the box above to tell us about your skills and experience.
As a small congregation, we rely on our members to help us run our operation. Even a small commitment of your time and skills can provide a significant benefit - for you and the community. Please indicate the areas in which you can volunteer (check as many as apply).
Volunteer Opportunities
Hold CONTROL or COMMAND (Mac) key then use your cursor to select the areas that you might like to help with.
Member 2: How do you enjoy spending your free time?
Hold CONTROL or COMMAND (Mac) key then use your cursor to select all that apply.
What skills or experiences can you share with TBT? Everyone has something special to offer. Think about your experience and what you enjoy, for example — cooking, baking, music, fundraising, finance, event planning administration, organizing, teaching. Whether you have expertise in a specific subject or simply a passion you enjoy, we value the talent, energy and ideas you contribute.
Member 2: Share your skills
Use the box above to tell us about your skills and experience.
As a small congregation, we rely on our members to help us run our operation. Even a small commitment of your time and skills can provide a significant benefit - for you and the community. Please indicate the areas in which you can volunteer (check as many as apply).
Member 2: Volunteer Opportunities
Hold CONTROL or COMMAND (Mac) key then use your cursor to select the areas that you might like to help with.
YOUR MEMBERSHIP PLEDGE:
Thank you for joining Temple Beth Tikvah. The suggested annual membership pledge is $1,000 per household. Your donation supports our resident Rabbi, Johanna Hershenson, and the many worship services, celebrations, events, and activities available to our TBT community. While your financial contribution funds the congregation, it is your time, effort, ideas, and involvement that we value most.
We never want finances to be a barrier to your participation in our congregation. If you are unable to pay the suggested pledge, please enter an amount that fits your financial circumstances.
We appreciate any additional donation you may choose to make so that we can expand our programs and help subsidize our members who cannot afford the suggested pledge amount.

If you have any questions or concerns, contact our Treasurer at treasurer@bethtikvahbend.org or (541) 388-8826. Your financial information is kept strictly confidential.

Please enter your Pledge amount for the current fiscal year – through June 30th and also provide your planned Pledge amount for the next full fiscal year July 1 – June 30. The amounts do not have to be the same. Note that you can always adjust your pledges, if necessary, by contacting our TBT Treasurer.
Initial Membership Pledge $*

(Enter your pledge amount thru June 30th)
Additional Donation $

(Enter additional donation, optional)
TOTAL FIRST YEAR MEMBERSHIP PLEDGE: $
$0.00
Next Year's Annual Membership Pledge $*
Payment Schedule and Method: You may pay your Annual Membership Pledge by check or credit card. Please indicate your expected payment schedule and method.
Planned initial payment schedule:*
- One-time
- Semi-Annual
- Quarterly
- Monthly
Planned initial payment method:*
- Check (preferred)
- Credit Card
After completing your Membership Application and CAPTCHA prompt, click the "Submit" button and wait for the Thank You confirmation message; this may take a few seconds.

You will also receive a confirmation email. If you have any problems, please contact us at: shalom@bethtikvahbend.org
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