Register for USY Membership 2019-20

Welcome! USY is open to 9th-12th Grade. 

In order to participate in most USY functions (i.e. Regional Conventions, Chapter Membership Retreat, etc.) you must pay dues and become an official member of USY. 

Your $90 USY membership dues ($115 for those teens not Adath Family Members) helps to offset administrative and program costs associated with the Youth Department.

If you plan to participate in any of these activities throughout the year, please send this form in and pay your dues now. That way we can be sure to include you on our mailings about conventions, and our fantastic USY programming throughout the year. 

Teen Information


First Parent/Guardian Information

Second Parent/Guardian Information

Emergency Contact

Emergency contact (other than parents) in case of illness. This person MUST be able to come and pick up your child.

Health Information

Does your child have any allergies?
(please enter donation amount with no $ sign)