Membership Form
JACS is supported by institutions, individuals, and membership dues. Half of our support comes from membership fees and contributions — which directly support all of JACS services, providing outreach and education to the Jewish community about addiction and recovery. Annual dues are:
- $36 for an individual;
- $72 for a family;
- $75 for a professional;
- $125 for an Institution;
Simply print this form and mail it with your payment (Check/Money Order/or Credit Card information) to:
JBFCS/JACS
135 West 50th Street, 6th floor
New York, NY 10020
| Name: | _______________________________________ |
| Organization: | _______________________________________ |
| Address: | _______________________________________ |
| City, State Zip: | _______________________________________ |
| Home Phone: | _______________________________________ |
| Work Phone: | _______________________________________ |
| Cell Phone: | _______________________________________ |
| Email: | _______________________________________ |
| (Email is only used for sending notices and updates) |
Please consider an additional donation to JACS.
| MEMBERSHIP DUES* | ADDITIONAL CONTRIBUTIONS | |||||
| $ 36 | [ ] | Individual | $10,000 | [ ] | Corporate Sponsor | |
| $ 72 | [ ] | Family | $5,000 | [ ] | Teen Scholarship Fund Sponsor | |
| $ 75 | [ ] | Professional | $1,000 | [ ] | Benefactor | |
| $125 | [ ] | Institutional | $500 | [ ] | Patron | |
| $275 | [ ] | Donor | ||||
| $100 | [ ] | Sponsor | ||||
| $50 | [ ] | Friend | ||||
| $18 | [ ] | Chai" Donation | ||||
| $_____ | [ ] | Retreat Scholarship Fund** |
* JACS Retreats are for Members only.
** Provides scholarships and loans to qualified individuals to enable them to attend JACS retreats.
Payment Method: Check #_______ | Money Order #_______ | Credit Card
Credit Card: (Circle One) AMERICAN EXPRESS | DISCOVER | MASTER CARD | VISA
Card Number: ______________________________ EXP MM/YR: ____ / 20____
Cardholder Name: ______________________________
