Membership Dues Adjustment Request Form

Membership Dues Adjustment Request

Please fill out this confidential form to request an adjustment to your membership dues. Thank you!
  • I certify my statement above is correct and true to the best of my knowledge. I agree to making automatic monthly payments and will provide Congregation Bonai Shalom current payment method information. I understand that in addition to paying my adjusted amount I will be assessed a $10 per month fee to be applied to our building fund.