Membership Application | Agudath Israel of Madison

If you have previously submitted an application, you do not need to submit one again unless there are additions or changes. You may proceed straight to the payment page.

Where applicable, you may click on the keyboard icon to type in Hebrew.

Membership Application

Head of Household:

Title: *

Name: *

First

Last: *

Last

Email: *

Cell Phone:

Carrier:

Spouse:

Title:

Name:

First

Last:

Last

Email:

Address: *

City: *

State: *

Zip Code: *

Home Phone: *

Name for Aliyah:

Please list all occasions when you are a chiyuv for an Aliyah (if applicable).
Please be specific as to the reason (ie. yahrtzeit for father etc.):

Hebrew Date 1:

Reason 1:

Hebrew Date 2:

Reason 2:

Hebrew Date 3:

Reason 3:

Membership Dues per Family........$400
Shalosh Seudos Sponsorship........$100
Locker (Renewals Only).............$54

Payment: *

I will pay my dues online

I will pay my dues by check

Shalosh Seudos:

I would like to sponsor Shalosh Seudos on the following Shabbos(im):

Shalosh Seudos Parsha 1:

Shalosh Seudos Occasion 1:

Shalosh Seudos Parsha 2:

Shalosh Seudos Occasion 2:

Locker Rental:

I would like to renew my locker rental (locker number must be entered below).

Locker #:

Please click the box below: