Membership Application

Membership Type(Required)

Full Member
Program Registration Only

**Kindly note that an adult must be the main person on the application.

Membership Type (Full Member)(Required)

Family (includes children 5 and above) - $350 (Membership Fee per Month), $1,000 (Security/Building Fee per Year)
Couple - $235 (includes children under 5) - (Membership Fee per Month), $1,000 (Security/Building Fee per Year)
Single - $150 (Membership Fee per Month), $500 (Security/Building Fee per Year)
Young Professional (21-35 years old, not living in parent's home) - $125 (Membership Fee per Month), $250 (Security/Building Fee per Year)
Older Adult (age 62 or older) - $150 (Membership Fee per Month), $250 (Security/Building Fee per Year)
International (excluding Tri-State area) - $150 (Membership Fee per Month), $250 (Security/Building Fee per year)

Membership Type (Program Registration Only)(Required)

Couple (Program Registration Only – Couple plus children under 5 yrs old)
Family (Program Registration Only – Membership for up to 2 Adults and all dependents living in their household)

Applicant Information

Name(Required)

Hebrew Name(Required)

Birth Date(Required)

Gender(Required)

Current Address(Required)

Email(Required)

Phone(Required)

Mailing Address (if different than above)

Employer

Occupation

Synagogue Affiliation or Rabbi (past or present, if any)(Required)

Father's English Name(Required)

Mothers's English Name(Required)

Father's Hebrew Name(Required)

Mothers's Hebrew Name(Required)

Spouse

Name(Required)

Hebrew Name(Required)

Birth Date(Required)

Gender(Required)

Current Address (if different than above)

Email(Required)

Phone(Required)

Synagogue Affiliation or Rabbi (past or present, if any)

Father's English Name(Required)

Mothers's English Name(Required)

Father's Hebrew Name(Required)

Mothers's Hebrew Name(Required)

Do you have one or more children under 5 years old?(Required)

Yes
No

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Other Fields

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Children

(DO NOT REMOVE)

Please provide two member referrals for your application to be processed(Required)

If you would like to expedite the membership process please provide your credit card information below. Your credit card will not be charged unless you have been accepted as a member.

Please make sure to add your full credit card number, the CVV number, the expiration date and the zip code associated with the card

If accepted, please share my email and phone number with our welcome committee.

If accepted, please share my email and phone number with our welcome committee.

Signature(Required)

Date(Required)

Login to Moise Safra Center

Applicant Information

Spouse

Other Fields

weekly schedule