2025/5786 TBT MEMBER HIGH HOLIDAY REGISTRATION

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MEMBER INFORMATION

Member First Name *

Member Last Name *

Your Email *

Your Cell Phone *

# of Adult Members *

# of Child Members (18 & Under) *

2nd Adult Member First Name *

2nd Adult Member Last Name *

2nd Adult Email *

2nd Adult Cell Phone

Are you a Pillar Member? *

Please Select Your Pillar Level *

Defenders of the Torah
Keepers of the Flame
Guardians of the Temple

MEMBER SERVICE ATTENDANCE

2 Guests Name

Please check the services you plan to attend either in person or virtually. *

Erev Rosh Hashanah (Mon. Sept 22, 7:30pm)
Rosh Hashanah Family (Tue. Sept. 23, 9am)
Rosh Hashanah Morning (Tue. Sept. 23, 10:15am)
Kol Nidre (Wed. Oct. 1, 7:30pm)
Yom Kippur Family (Thurs. Oct. 2, 9am)
Yom Kippur Morning (Thurs. Oct. 2, 10:15am)
Yom Kippur Afternoon (Thurs. Oct. 2, 4pm)
Yom Kippur N’ilah (Thurs. Oct. 2, ~5:15pm)

PILLAR MEMBER GUESTS

As a Keeper of the Flame, you may bring up to 2 guests. How many Pillar Guests would you like to bring?

As a Guardian of the Temple, you may bring up to 4 guests. How many Pillar Guests would you like to bring? (copy)

Holidays Pillar Guest 1 Will Attend *

Rosh Hashanah
Yom Kippur
Both

Pillar Guest 1 Name *

First

Last

Pillar Guest 1 Email *

Pillar Guest 1 Cell Phone *

Holidays Pillar Guest 2 Will Attend *

Rosh Hashanah
Yom Kippur
Both

Pillar Guest 2 Name *

First

Last

Pillar Guest 2 Email *

Pillar Guest 2 Cell Phone *

Holidays Pillar Guest 3 Will Attend *

Rosh Hashanah
Yom Kippur
Both

Pillar Guest 3 Name *

First

Last

Pillar Guest 3 Email *

Pillar Guest 3 Cell Phone *

Holidays Pillar Guest 4 Will Attend *

Rosh Hashanah
Yom Kippur
Both

Pillar Guest 4 Name *

First

Last

Pillar Guest 4 Email *

Pillar Guest 4 Cell Phone *

MEMBER GUESTS

TBT Members may bring guests to High Holiday Services. Guests for Family Services Only are FREE. Guests for all other services include a reduced fee – $100 per holiday.

Would you like purchase Member Guest tickets? *

# of Adult Member Guests (18 and Over) *

# of Child Member Guests (Under 18)

Holidays Adult Member Guest 1 Will Attend *

Family Services Only – $0.00
Rosh Hashanah – $100.00
Yom Kippur – $100.00
Both – $200.00

Adult Guest 1 Name *

First

Last

Adult Guest 1 Email *

Adult Guest 1 Cell Phone *

Holidays Adult Member Guest 2 Will Attend *

Family Services Only – $0.00
Rosh Hashanah – $100.00
Yom Kippur – $100.00
Both – $200.00

Adult Guest 2 Name *

First

Last

Adult Guest 2 Email *

Adult Guest 2 Cell Phone *

Holidays Adult Member Guest 3 Will Attend *

Family Services Only – $0.00
Rosh Hashanah – $100.00
Yom Kippur – $100.00
Both – $200.00

Adult Guest 3 Name *

First

Last

Adult Guest 3 Email *

Adult Guest 3 Cell Phone *

Holidays Adult Member Guest 4 Will Attend *

Family Services Only – $0.00
Rosh Hashanah – $100.00
Yom Kippur – $100.00
Both – $200.00

Adult Guest 4 Name *

First

Last

Adult Guest 4 Email *

Adult Guest 4 Cell Phone *

BREAK-THE-FAST

Would you like to join us for Break-the-Fast (Thurs. Oct. 2, 6pm)?

# of Adults (13 years old and over)

Price: $25.00

# of Children (4-12 years old)

Price: $15.00

# of Children (3 and under) – FREE

Price: $0.00

ADDITIONAL CONTRIBUTION

We appreciate any additional support you would like to provide this year to support our community.

Would you like to make an additional contribution?

What level contribution would you like to donate?

$18
$36
$54
Other

Other Amount

YIZKOR BOOKLET

Would you like to add any Yahrzeits for the Yizkor Booklet?

English Name *

First

Last

Date of Death

Before/After Sunset

As a cherished Pillar Member, you may include a message in the Yizkor Booklet. Please provide your message here.

As gratitude for your contribution, you may include a message in our Yizkor Booklet. Please provide your message here.

SUMMARY AND PAYMENT

Preferred Payment Type *

Credit Card (Processing Fees Apply)
Check

Processing Fees

Price: $0.00

Total

Item Quantity Qty Total

There are no products selected.

Holidays Adult Member Guest 1 Will Attend – Family Services Only 1 $0.00

Holidays Adult Member Guest 1 Will Attend – Rosh Hashanah 1 $100.00

Holidays Adult Member Guest 1 Will Attend – Yom Kippur 1 $100.00

Holidays Adult Member Guest 1 Will Attend – Both 1 $200.00

Holidays Adult Member Guest 2 Will Attend – Family Services Only 1 $0.00

Holidays Adult Member Guest 2 Will Attend – Rosh Hashanah 1 $100.00

Holidays Adult Member Guest 2 Will Attend – Yom Kippur 1 $100.00

Holidays Adult Member Guest 2 Will Attend – Both 1 $200.00

Holidays Adult Member Guest 3 Will Attend – Family Services Only 1 $0.00

Holidays Adult Member Guest 3 Will Attend – Rosh Hashanah 1 $100.00

Holidays Adult Member Guest 3 Will Attend – Yom Kippur 1 $100.00

Holidays Adult Member Guest 3 Will Attend – Both 1 $200.00

Holidays Adult Member Guest 4 Will Attend – Family Services Only 1 $0.00

Holidays Adult Member Guest 4 Will Attend – Rosh Hashanah 1 $100.00

Holidays Adult Member Guest 4 Will Attend – Yom Kippur 1 $100.00

Holidays Adult Member Guest 4 Will Attend – Both 1 $200.00

# of Adults (13 years old and over) 0 $0.00

# of Children (4-12 years old) 0 $0.00

# of Children (3 and under) – FREE 0 $0.00

What level contribution would you like to donate? – $18 1 $18.00

What level contribution would you like to donate? – $36 1 $36.00

What level contribution would you like to donate? – $54 1 $54.00

What level contribution would you like to donate? – Other 1 $0.00

Other Amount 1 $0.00

Processing Fees 1 $0.00

Total $0.00

$0.00

Stripe Credit Card *

Please include “High Holidays” in the note section of your personal or electronic check and mail it to:

Temple Beth Torah
ATTN: Treasurer
PO Box 2020
Centreville, Virginia 20122

2025/5786 HIGH HOLIDAY TBT MEMBER REGISTRATION

MEMBER INFORMATION

MEMBER SERVICE ATTENDANCE

PILLAR MEMBER GUESTS

MEMBER GUESTS

BREAK-THE-FAST

ADDITIONAL CONTRIBUTION

YIZKOR BOOKLET

SUMMARY AND PAYMENT

Please include “High Holidays” in the note section of your personal or electronic check and mail it to: