Membership Application - Form - Congregation Shearith Israel

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 $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 - phone

First Year’s Dues: Since our membership year starts in July, members who join from January through June can pay 50% of the full year’s rate. The rates below reflect that reduction:

* Membership type

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

Total