Striar Jewish Community Center

For more information please call (781) 341-2016

To apply for membership in Striar JCC you can fill in this form and either submit it electronically or click here to open a form you can print to be mailed or faxed with your payment.

Directions:

When you have completed the form to your satisfaction, click on the "Submit" button at the bottom of the form. You can use the TAB key to move between fields.

This page is secure for credit card transactions.

Please note:

This application page is for credit card transactions only.
If you prefer to pay by check or automatic payment via Electronic Funds Transfer (EFT), please contact the Membership Department at 781-341-2016, ext. 262, 299, , .

Fields in red are required

You are:

Married Single

Your Birthdate:

(MM/DD/YY) format

First Name:

Last Name:

Home Address:

City/Town:

Apt:

State:

Zip:

E-mail:

Home Telephone:

Spouse's Name:

Spouse's Birthdate:

(MM/DD/YY) format

First Name:

Last Name:

In case of emergency:

Notify:

Relationship:

Phone:

Your Children:	(MM/DD/YY) format
Name: Male Female	Birthday:
Name: Male Female	Birthday:
Name: Male Female	Birthday:
Name: Male Female	Birthday:
Name: Male Female	Birthday:

About You:

Your Occupation:		Spouse's Occupation
Business Name:		Business Name:
Bus. Address:		Bus. Address:
City:		City:
State:	Zip:	State:	Zip:
Phone:		Phone:

Voluntary Information:
Jewish Non-Jewish Intermarried

Synagogue/Church: Location:

MEMBERSHIP CATEGORY: (required)
Click here for membership categories and fees
Family	Senior - Full Privilege	Individual
Family	Individual	Adult
Single Parent	Couple	Teen, College Student
Couple
Health Spa Membership (Additional to regular Membership)
Men's Health Spa Women's Health Spa

Payment Options (Required)

Choose the payment plan that is best for you:

PLEASE NOTE:
This form is on a secure server. Any credit card information you enter is encrypted for your protection.

Payment in full by MasterCard or Visa

12 monthly installments by MasterCard or Visa dated the 1st of the month
(consecutive months only, please).

If paying by credit card, please enter your information (MasterCard and Visa only):
Exact name on card:
Card Number:
Security Code
Card Type:	MasterCardVisa
Expiration:

Please click the Submit button only once. This may take several seconds to complete.

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