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YICBH 5785 New Member Application

Welcome to the
Young Israel Congregation,
(also known as YICBH)

Located in beautiful Surfside, Florida, and serving the Communities of Bal Harbour, Bay Harbor Islands, Indian Creek, and Surfside.

NOTE: All New Member Applications are provisional pending approval from our Rabbi.

We ask you to answer the questions on this form so we can update our database with your current address, names of immediate family members, and gabbai / yahrzeit information.

At the bottom of this form you will be able select the appropriate membership type to pay for dues, fees, and High Holiday seats.

Thank you for joining our YICBH family.

For technical help with form issues, email Jared Plitt

Membership Type

INFORMATION: ADULT 1

ENGLISH NAME

* First

* Last

Gender

OTHER DETAILS

* Email

Mobile Phone

Birthdate

INFORMATION: ADULT 2

ENGLISH NAME

First

Last

Gender

OTHER DETAILS

Mobile Phone

Birthdate

Anniversary

ADDRESS INFORMATION

PRIMARY ADDRESS

Would you like to provide a primary address?

Address Line 1

Address Line 2

City

State/Province

Postal Code

Home Phone

SECONDARY ADDRESS

Would you like to provide or update a secondary address?

Secondary Address Line 1

Secondary Address Line 2

Secondary Address City

State/Province

2nd Address Postal Code

CHILDREN'S INFORMATION

Would you like to provide information on any children you have?

How many children do you have?

Children's Information

English Name

Hebrew Name

Date of Birth

GABBAI INFORMATION

Are any bar-mitzvah age men in your family comfortable with:

laining their Bar-Mitzvah Parsha?laining any parsha, with enough advance notice?leading any part of davening?

Bar-Mitzvah Parsha

YAHRZEITS

Would you like to provide yahrzeit information?

How many yahrzeits would you like us to keep track of?

English Name & Relationship

Hebrew Name (transliterated)

English Yahrzeit Date

Hebrew Yahrzeit Date

MEMBERSHIP DUES AND FEES

Required- 5785 Dues

Family Membership	$1,550
Single Membership	$1,150
New Members 40 and Below	$500 first year,

Required- 5785 Fees

Security Assessment	$300
Eruv Council Dues	Included
Building Repair and Reserve Fund	$3,600 (payable in installments beginning within 3 years of membership ).

Optional- High Holiday Seats

Permanent Seats	Included
Member High Holiday Seats	$125 per
Non-Member High Holiday Seats	$360 per

TOTAL OF REQUIRED AND OPTIONAL DUES AND FEES:

Select your membership type from the options below:Option 1. New Family Membership - $1,550 + $300 SecurityOption 2. New Single Membership - $1,150 + $300 SecurityOption 3. New Family Membership, 40 & Below - $500 + $300 SecurityOption 4. New Single Membership, 40 & Below - $500 + $300 Security

Are you a Permanent Seat holder?

How many of your Permanent Seats do you want to reserve for the High Holidays?

Permanent seats needed, Men - (No additional charge)

Permanent seats needed, Women - (No additional charge)NOTE- This selection is for Permanent Seat holders only, please.

How many High Holiday seats do you want to reserve for MEN?

Member High Holiday seats, Men - $125

Non-Member High Holiday seats, Men - $360

How many High Holiday seats do you want to reserve for WOMEN?

Member High Holiday seats, Women - $125

Non-Member High Holiday seats, Women - $360

Total of Dues, Fees, & High Holiday Seats

Tue, July 1 2025 5 Tammuz 5785

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YICBH 5785 New Member Application

Welcome to the Young Israel Congregation, (also known as YICBH)

INFORMATION: ADULT 1

ENGLISH NAME

OTHER DETAILS

INFORMATION: ADULT 2

ENGLISH NAME

OTHER DETAILS

ADDRESS INFORMATION

PRIMARY ADDRESS

SECONDARY ADDRESS

CHILDREN'S INFORMATION

GABBAI INFORMATION

YAHRZEITS

MEMBERSHIP DUES AND FEES

TOTAL OF REQUIRED AND OPTIONAL DUES AND FEES:

Welcome to the
Young Israel Congregation,
(also known as YICBH)