Workmen's Circle - Application Page 1

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	MEMBERSHIP APPLICATION

Instructions for Completion:

Print this form to your local printer
Complete the form (required fields are marked with an asterisk "*")
Mail your completed form (along with your check or money order (if applicable) to:

The Workmen’s Circle / Arbeter Ring

ATTN: New Membership
1980 S. Green Rd.
Cleveland, OH 44121

or fax to (Credit Card Applications Only):

(216) 381-2641

APPLICATION (Please Print or Type)
Last Name*		First Name*		Middle Initial		Occupation
Address*			City*		State*		Zip*
Date of Birth*	q Male q Female		Home Phone*			Work Phone
Spouse’s Last Name		First Name		Middle Initial		Occupation
Date of Birth	q Male q Female		Home Phone			Work Phone
Names & Birthdates (Children under 18 are included in the family membership. Please List)
Name			Birthdate			q Male q Female
Name			Birthdate			q Male q Female
Name			Birthdate			q Male q Female
Name			Birthdate			q Male q Female

Were you a previous Workmen’s Circle Member? qYes qNo; Your Spouse?: qYes qNo

Please enroll me/us in the Workmen’s Circle, dedicated to fostering Jewish identity through cultural Jewishness; preserving, promoting and further developing Jewish Culture, Social Justice and Fraternalism.


Signature	Date	Spouse's Signature	Date

I (We) have enclosed a check for $____________________. Please consult the online Dues Computation Guide (if you have any questions, please call 216-381-4515 for assistance).

or, please charge my Credit Card, number: ________________________________ exp: ____ / ____

q Mastercard q Visa q American Express

Membership dues are non-refundable.

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