Payment Test Page

Membership Form 5787

"*" indicates required fields

Membership Status*

New membership

Renewing membership

Member #1 - Name*

First Last

Member #2 - Name

First Last

Member #1 - Email*

Member #2 - Email

Member #1 - Cell Phone*

Member #2 - Cell Phone

Address*

Street Address Address Line 2 City State ZIP Code

Do you wish to have your contact information appear in the membership directory?

Yes, please include my information

Membership Level*

Sustaining Membership - $540

Family Membership - $360

Single Membership - $180

Number of High Holiday Seats (all membership levels include High Holiday seats)*

Payment Method*

Pay by credit card

Pay by Zelle; I will send payment to treasurer@konabethshalom.org

Additional 3% contribution to cover the credit card convenience fee

Price: $0.00

Total Membership Amount

Price: $0.00

Credit Card Information

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

CAPTCHA