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CBH Test

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The Executive Director welcomes questions about Bet Haverim partnership at director@bethaverim.org, or 530-758-0842.

Adult Partner #1
Name*
First Last
Second Adult?
- Check this box to fill out for a second adult
Fields for Adult Partner #2 will appear below all fields for #1 when you check this box.
Email*
Phone*
Birth Date
MM slash DD slash YYYY

Including your birth year will help us to plan programs and initiatives of interest to you.
Pronouns
Please let us know if you have preference(s) for how others address you.
Adult Partner #2
Full Name*
Email Address*
Phone*
Birth Date
MM slash DD slash YYYY

Including your birth year will help us to plan programs and initiatives of interest to you.
Pronouns
Please let us know if you have preference(s) for how others address you.
Contact Information
Mailing Address*
Street Address City State ZIP Code
Home Address
If different than mailing address
Children Information
Names and birthdates of children residing with you - birthdates are tremendously helpful to us in planning and designing programs
Home Phone
Agreements, Exclusions, and Directory
Agreement to electronic notice of annual and special meetings
CBH uses electronic communication with partners to save resources. Please check the appropriate box above if you agree to to be notified of all future Annual Meetings and special meetings of Partners solely by email sent to the email address you have listed above. You may withdraw this consent at any time by informing a staff member in the CBH Office.
- Adult Partner #1 - by checking this box, I agree to electronic notification (until such time as I withdraw consent).
- Adult Partner #2 - by checking this box, I agree to electronic notification (until such time as I withdraw consent).
Contact information in CBH Partner Directory
Check one (or several) of the above boxes if you do NOT want some or all of your contact information to be published in the 2020 CBH online Partner Directory.
- Omit my address
- Omit my email(s)
- Omit my phone #(s)
- Do not list me in the Directory
Other instructions about your listing in the CBH Partner Directory
Please let us know if you do NOT want photos of you or specific family members used in CBH media. Please list names, and specify types of media to be avoided (e.g. website, social media).
Please check here if you need a copy of the 2020 Partner Directory.
- Email me a copy, please
- Print and mail me a copy, please
Special Notes
Use to communicate to office coordinator, in case something doesn't "fit" anywhere else.
Pledge Amount
You must submit this form, along with a minimum payment of at least 10% of your Total Partnership Commitment by July 31, 2020, in order to be considered a partner in good standing for 2020-2021 and be eligible for complimentary 2020 High Holy Day tickets. In addition, if you have an unpaid balance from 2019-2020, you must also have contacted the CBH office by that date to establish a payment plan if you have not already done so.

When considering the amount of your Partnership Pledge, please understand that in order for CBH to pay its budgeted operating expenses for the coming year, Total Partnership Commitments for 2020-2021 must average $2,200 per household. Please read this letter from our co-Presidents for more information. Thank you for your generosity.
a. My Partnership Contribution
Please indicate your total annual contribution below. Your pledge will be billed as an annual amount, due in full by June 30, 2021.
b. L'Dor v'Dor Maintenance Fee*
Each CBH partner household contributes $250 per year to help maintain our facility. These funds offset the costs of custodial and landscape maintenance, as well as repair and upkeep of our facility.
c. Total Partnership Commitment (a + b)
Signature*
By typing my name into the boxes below, I hereby pledge to pay the commitment in the summary above by June 30, 2021. I understand that I cannot receive High Holy Days tickets or register children for Religious School until my pledge form is received and my account is in good standing, which may include unpaid commitments from 2019-2020, in addition to progress on my commitments for 2020-2021.
First Last
Payment Options & Information
We encourage Partners to pay all commitments by check, by e-Check, or your bank's "bill pay" function.

If you opt to pay via "bill pay," you may be able to set up automatic monthly payments for the entire fiscal year (July 1, 2020 - June 30, 2021). Please contact your bank if you need assistance.

We do also offer payment by credit card, but when you pay in this manner, approximately 3% of your payment is deducted from your payment by the credit card company as a processing fee. If you choose to pay by credit card, we ask that you consider making an additional one-time voluntary donation of 3% of your Total Partnership Commitment.

Quarterly statements will be mailed to all Partners with a balance due. You may make payments on your account at any time.
Please indicate how you intend to pay your Total Partnership Commitment:*
- I will pay by check. My initial payment of at least 10% of my Total Commitment will be mailed.
- I will pay by e-Check. My initial payment will be at least 10% of my Total Commitment.
- I will pay via my bank's automated bill pay. My initial payment will be at least 10% of my Total Commitment.
- I will pay by credit card and have completed and will return the Credit Card Authorization Form. My initial payment will be at least 10% of my Total Commitment.
Pay by e-Check

Please download, fill out, and return this annual e-Check Authorization contract form. You will need to file an authorization form every year, as the information about your account is not retained at CBH (in order to keep it secure).
Pay by Credit Card

Please download, fill out, and return this annual Credit Card Contract form. You will need to file an authorization form every year, as the information about your account is not retained at CBH (in order to keep it secure).

We offer payment by credit card, but approximately 3% of your payment is deducted by the credit card company as a processing fee. If you choose to pay by credit card, we ask that you consider making an additional one-time voluntary donation of 3% of your total registration costs.
Voluntary credit card processing fee donation
- I volunteer to donate a 3% credit card processing fee in addition to my membership dues.
Credit Card voluntary donation
Price: $0.00
d. My Initial Payment*

A minimum of 10% of your Total Commitment (above) is required.
e. My Remaining Balance (c - d)
f. Your total due today
$0.00
Payment Schedule: I intend to pay my commitment according to the following schedule*
- Monthly payments
- Quarterly payments
- Semi-annual payments
- Annual payment
Name
This field is for validation purposes and should be left unchanged.

CBH Test

Secondary heading.

Bullet Title

Form Title

Adult Partner #1

Adult Partner #2

Contact Information

Agreements, Exclusions, and Directory

Pledge Amount

Payment Options & Information

Pay by e-Check

Pay by Credit Card

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