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Membership Application
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ADULT 1 INFORMATION
Title
Please only include if other than Mr/Mrs/Ms
*
First Name
Nickname
Middle Name
*
Last Name
Gender
Please Select One
Female
Male
Other/Non-binary
Pronouns
*
Email Address
Cell
Birthdate
Maiden Name
Hebrew Name
Tribe at Birth
Please Select One
Kohen
Levi
Yisrael
Jew by Choice
Father Hebrew Name
Mother Hebrew Name
Business Name
Occupation
Business Phone
Special Skills or Areas of Expertise
ADULT 2Â INFORMATION (IF NEEDED)
Title
Please only include if other than Mr/Mrs/Ms
First Name
Nickname
Middle Name
Last Name
Gender
Please Select One
Female
Male
Other/Non-binary
Pronouns
Email Address
Cell
Birthdate
Maiden Name
Hebrew Name
Tribe at Birth
Please Select One
Kohen
Levi
Yisrael
Jew by Choice
Father Hebrew Name
Mother Hebrew Name
Business Name
Occupation
Business Phone
Special Skills or Areas of Expertise
HOUSEHOLD INFORMATION
*
Home Street Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
Home Phone Number
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Anniversary
CHILDREN
Please click on the + button to add each child.
First Name
Nickname
Middle Name
Last Name
Gender
Please Select One
Female
Male
Other/non-binary
Pronouns
Birthdate
After Sunset?
After Sunset?
Tribe
Please Select One
Kohen
Levi
Yisrael
Hebrew Name
Father Hebrew Name
Mother Hebrew Name
YAHRZEITS
Please click on the + button to add each yahrzeit.
English Name of Deceased
Hebrew Name of Deceased
Gender of Deceased
Please Select One
Female
Male
Other/non-binary
English Date of Death
After Sunset?
After Sunset?
Observe Hebrew or English Date?
Please Select One
Hebrew
English
Mourner in Family
Relationship to Mourner
Cemetery
Is there anything else you would like to share with us?
FAIR SHARE STATEMENT
In place of a dues requirement, Temple Beth Sholom operates on the basis of Fair Share – the philosophy that makes each of us responsible for the other. It allows those of us who can assume a larger share of the financial burden, based on our own assessment of ability, to do so. The Fair Share commitment of each member, each year, contributes the major portion of Temple income to cover operating expenses. Our Building Fund charge, payable over 5 years, also helps maintain our House of Worship and Religious Schools. High Holiday tickets are allotted based on family composition.
*
MEMBERSHIP RENEWAL: By checking this box I indicate that I understand and agree that my membership will automatically be renewed each year unless a notice of termination is received in writing at the synagogue office at least thirty (30) days prior to the renewal year on July 1.
MEMBERSHIP RENEWAL: By checking this box I indicate that I understand and agree that my membership will automatically be renewed each year unless a notice of termination is received in writing at the synagogue office at least thirty (30) days prior to the renewal year on July 1.
Sun, December 10 2023 27 Kislev 5784