Membership Application Form

* Address

* City

* State

* Zip Code

Home Phone

* First Name

Middle Name

* Last Name

* Email

* Primary Phone

* Birthdate

Place of Birth

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Religious Affiliation

Other

Occupation

Employer

Work Phone

* Marital Status

Anniversary Date (if applicable)

* Is there a second Adult applying for Membership?

* First Name

Middle Name

* Last Name

Preferred Name

* Email

* Primary Phone

* Birthdate

Place of Birth

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Religious Affiliation

Other

Occupation

Employer

Work Phone

Marital Status

* How many names would you like added to our yahrzeit list?

* Deceased name

* Date of Death

* Relationship to

* Relationship

* Deceased name

* Date of Death

* Relationship to

* Relationship

* Deceased name

* Date of Death

* Relationship to

* Relationship

* Deceased name

* Date of Death

* Relationship to

* Relationship

* How many children live in your home?

* Child 1 - First Name

* Child 1 - Middle Name

* Child 1 - Last Name

Child 1 - Preferred Name

Child 1 - Hebrew Name

* Child 1 - Birthdate

* Child 1 - Name of Current School

* Child 1 - Grade

* Child 1 - Is the child being raised Jewish?

* Child 1 - Will this child be attending Religious School at Temple Israel?

Child 1 - If previosuly attended Religious School, list Congregation and City

Child 1 - Bar/Bat Mitzvah Date

Child 1 - Bar/Bat Mitzvah Congregation

Child 1 - Bar/Bat Mitzvah City

* Child 2 - First Name

* Child 2 - Middle Name

* Child 2 - Last Name

Child 2 - Preferred Name

Child 2 - Hebrew Name

* Child 2 - Birthdate

* Child 2 - Name of Current School

* Child 2 - Grade

* Child 2 - Is the child being raised Jewish?

* Child 2 - Will this child be attending Religious School at Temple Israel?

Child 2 - If previosuly attended Religious School, list Congregation and City

Child 2 - Bar/Bat Mitzvah Date

Child 2 - Bar/Bat Mitzvah Congregation

Child 2 - Bar/Bat Mitzvah City

* Child 3 - First Name

* Child 3 - Middle Name

* Child 3 - Last Name

Child 3 - Preferred Name

Child 3 - Hebrew Name

* Child 3 - Birthdate

* Child 3 - Name of Current School

* Child 3 - Grade

* Child 3 - Is the child being raised Jewish?

* Child 3 - Will this child be attending Religious School at Temple Israel?

Child 3 - If previosuly attended Religious School, list Congregation and City

Child 3 - Bar/Bat Mitzvah Date

Child 3 - Bar/Bat Mitzvah Congregation

Child 3 - Bar/Bat Mitzvah City

* Child 4 - First Name

* Child 4 - Middle Name

* Child 4 - Last Name

Child 4 - Preferred Name

Child 4 - Hebrew Name

* Child 4 - Birthdate

* Child 4 - Name of Current School

* Child 4 - Grade

* Child 4 - Is the child being raised Jewish?

* Child 4 - Will this child be attending Religious School at Temple Israel?

Child 4 - If previosuly attended Religious School, list Congregation and City

Child 4 - Bar/Bat Mitzvah Date

Child 4 - Bar/Bat Mitzvah Congregation

Child 4 - Bar/Bat Mitzvah City

* Please indicate your membership category:

Our relationship with you is a covenant. The only way for us to fulfill our commitment to you is for you to contribute to the success of our community.

* Please describe your financial situation or reasons for dues relief.

Upon submission of this form, you will receive an email from Temple Israel staff with the instructions to fill out the required dues relief form.

* Please check the box to agree to a $75 annual assessment for major building repairs

Please check the box to agree to a $75 annual assessment for major building repairs

* Please check the box to agree to a $75 annual assessment for building security

Please check the box to agree to a $75 annual assessment for building security

I/We would like to learn more about how I/We can leave a lasting legacy to Temple Israel. Please contact me.

If you would consider adding an additional amount to your covenant for the good and welfare for Temple Israel, this would be greatly appreciated. We expect some members to have financial challenges during the coming year and this will have an impact on the community's overall finances.

Please enter the additional contribution amount in the box above.

Total

Please click the submit button below to proceed to our payment page and arrange your dues covenant.

Mon, September 27 2021 21 Tishrei 5782