Salary Request Form 2019 Dues

Name*

First Last

Email*

Employment Status

*If you check off any statements for this question, other than "I am Employed", you need not respond further*

My annual income from salary and parsonage from a Cantorial or Jewish Communal Position (not including pension and health insurance payments) at this time is:

I am a joint member with JEA. My current JEA dues are:

(we will deduct 20% of JEA dues paid from Cantors Assembly dues assessment)

I am a joint member with the RA. My current dues assessed by the RA are:

(half of dues assessed by the RA are paid to the RA; half are paid to the CA)

As an aid to those members whose dues are paid by their synagogues, we will, only with your signed permission, send copies of dues invoices and statements, both hard copy and electronic, to a second party. Please complete the following: I hereby request the Cantors Assembly send copies of all invoices and statements relative to my Cantors Assembly dues to the following:

Please list name, position, email, and mailing address of the person you would like to receive a copy of your dues invoice.