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Current Member Billing Form

Current Member Billing Form

Current Member

  prices.jpg

I agree to pay membership
dues of per year.

I would like to participate in the building maintenance fund:

$_____ - Mikveh Refurbishment

$_____- Lighting

$_____- Security

$_____- General Upkeep

$_____- Kiddush Sponsor

Total

Name
Date

 

Billing Information

Card Type

Card Number Expiration Date


Card Holders First Name Cardholders Last Name

Billing Address (Street Name and Number)

Zipcode


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