Havurah Questionnaire

Participant Information

Adult 1 Information
First Name
Last Name
Email
Phone

Age


If you prefer, you may tell us your exact age:


Occupation: (If retired, your occupation pre-retirement)


Interests/Hobbies:

ADD ANOTHER ADULT
Yes
Adult 2 Information
First Name
Last Name
Email
Phone

Age


If you prefer, you may tell us your exact age:


Occupation: (If retired, your occupation pre-retirement)


Interests/Hobbies:


Additional Information

If you have children, what are their ages?

Your Preference for a Havurah (Please check all that apply)
FamiliesCouplesSinglesSeniorYoung AdultYoung FamiliesInterest Groups (multigenerational)Other (please specify)

I/We are interested in a Havurah that shares activities such as: (Please check all that apply)
Co-ed Book GroupCooking ClassOutdoor ActivitiesFinance/InvestmentHistory/Current EventsCelebrate Jewish HolidaysMuseum/Art HistoryMovie/TheatreMusic/Music HistoryTravel

Are there any other Temple Emanuel members with whom you would like to be matched?

What additional information can you tell us to better help us match you in a Havurah?

Would you be willing to host the initial Havurah meeting?

YesNo