Membership Application - Form - Congregation Shearith Israel

Applicant's Information

* Title

* First name

* Last name

* Email address

* Address

* City

State

* Zip code

Country

Home phone

* Cell phone

* Hebrew name

* Father’s first and last name

Father's Hebrew name

* Mother’s first and maiden name:

Mother's Hebrew 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

Title

First name

Last name

Email address

Cell phone

Hebrew name

Father’s first and last name

Father's Hebrew name

Mother’s first and maiden name

Mother's Hebrew 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

* First name

Last name

Email address

* Date of birth

Hebrew name

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 $400 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)

Rabbinic reference - name

Rabbinic reference - email

Rabbinic reference - phone

* Membership type

Please Select OneFull Membership: married couples - $3100Full Membership: individuals - $2225Associate Membership: married couples - $1425Associate Membership: individuals - $950Young Membership: married couples (both individuals under age 30) - $1000Young Membership: individuals (under age 30) - $750

Total