Membership Application

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Applicant's Information

* Title

* First Name

* Last Name

* Email Address

* Address Line 1

Address Line 2

* City

State

* Zip Code

Country

Home Phone Number

* Mobile Phone Number

* Hebrew Name

* Father's Name

Father's Hebrew Name

* Mother's Full Name

Mother's Hebrew Name

Mother's Maiden Name

* Date of Birth

* Place of birth

Bar/Bat Mitzvah Portion

Date of Marriage

Place of Marriage

Occupation

Business Name

Business Phone

Business Address

Spouse Information (If Applicable)

Title

First Name

Last Name

Email Address

Mobile Phone Number

Hebrew Name

Father's Name

Father's Hebrew Name

Mother's Full Name

Mother's Hebrew Name

Mother's Maiden Name

Date of Birth

Place of birth

Bar/Bat Mitzvah Portion

Occupation

Business Name

Business Phone

Business Address

Children's Information

Click + for each child you would like to enter

Children (Please list in order of birth)

First Name

Last Name

Hebrew Name

Email Address

Date of Birth

Bar/Bat Mitzvah Portion

School (currently attending)

Highest level of Jewish education (if applicable)

Add-On Family Membership

Add-on Family Membership is geared towards parents who would like their children to be assigned a seat in our Main Sanctuary and costs $375 per child.

Is this child an add-on?

YesNo

Nahala (Yahrzeit) Observances

Click + for each memorial anniversary you would like to enter

* First name

* Last name

Hebrew name

* Gender

Please Select OneFemaleMale

English date of death

Before or after sunset?

BeforeAfter

Hebrew date of death

* Date of burial

Burial location

* Mourner name

* Relationship

If any prospective member is a convert to Judaism, please email conversion certificate to breiss@shearithisrael.org

What is the primary motivation for applying at this time?

Previous synagogue affiliation

Other current synagogue affiliation(s)

* Membership type

Please Select OneFull Family Membership - $3000Full Individual Membership - $2175Associate Family Membership - $1375Associate Individual Membership - $925Young Family Membership (both individuals under age 30) - $1000Young Individual Membership (individuals under age 30) - $750

Total

Tue, October 20 2020 2 Marheshvan 5781

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