Membership Application

Adult Members

Last Name*

First Name*

MI

Gender

Name you wish to be called

Title you prefer

Family Titles for used on envelopes (e.g. Mr & Mrs, Dr and Mrs, none)

Birthdate*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Email*

Marital Status

Wedding Date (if applicable)

Are You Jewish?

Yes
No

Job Title/Occupation

Employer

Business Phone

Full Hebrew Name (including parents)

Kohen, Levi, or Israel

Kohen
Levi
Israel

Is your mother Jewish?

Yes
No

Did you grow up?

Orthodox
Conservative
Reform

Your Bar/Bat Mitzvah Date (if applicable)

Conversion Date (if applicable)

Previous Congregational Affiliation Name

City

State

Yahrzeit Information: Jewish custom calls for observing the anniversary of the death of parents, children, spouse, sibling according to the Jewish calendar. Please complete the information below, if pertinent, so that we may remind you of Yahrzeit dates.

Deceased Relative #1 - Information

Name of Deceased

Relationship to You

Secular Date Deceased

Time of Death

Day
Night

Deceased Relative #2 - Information

Name of Deceased

Relationship to You

Secular Date Deceased

Time of Death

Day
Night

Deceased Relative #3 - Information

Name of Deceased

Relationship to You

Secular Date Deceased

Time of Death

Day
Night

Deceased Relative #4 - Information

Name of Deceased

Relationship to You

Secular Date Deceased

Time of Death

Day
Night

Adult 2

Last Name

First Name

MI

Gender

Name you wish to be called

Title you prefer

Family Titles for used on envelopes (e.g. Mr & Mrs, Dr and Mrs, none)

Birthdate

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Email

Marital Status

Wedding Date (if applicable)

Are You Jewish?

Yes
No

Job Title/Occupation

Employer

Business Phone

Full Hebrew Name (including parents)

Kohen, Levi, or Israel

Kohen
Levi
Israel

Is your mother Jewish?

Yes
No

Did you grow up?

Orthodox
Conservative
Reform

Your Bar/Bat Mitzvah Date (if applicable)

Conversion Date (if applicable)

Denomination (if not Jewish)

Previous Congregational Affiliation Name

City

State

Yahrzeit Information

Deceased Relative #1 - Information

Name of Deceased

Relationship to You

Secular Date Deceased

Time of Death

Day
Night

Deceased Relative #2 - Information

Name of Deceased

Relationship to You

Secular Date Deceased

Time of Death

Day
Night

Deceased Relative #3 - Information

Name of Deceased

Relationship to You

Secular Date Deceased

Time of Death

Day
Night

Children

Child 1

Last Name

First Name

MI

Address

Street Address Address Line 2 City State ZIP Code

Gender

Email

Hebrew Name

Birthdate

Grade

School

Child 2

Last Name

First Name

MI

Address

Street Address Address Line 2 City State ZIP Code

Gender

Email

Hebrew Name

Birthdate

Grade

School

Child 3

Last Name

First Name

MI

Address

Street Address Address Line 2 City State ZIP Code

Gender

Email

Hebrew Name

Birthdate

Grade

School

Child 4

Last Name

First Name

MI

Address

Street Address Address Line 2 City State ZIP Code

Gender

Email

Hebrew Name

Birthdate

Grade

School

Is there any additional information you would like us to know about your family? (i.e. illness, special needs, skills/talents to share)

Are you interested in getting involved or learning more about any areas of Temple Emanuel?

Are you related to other members at Temple Emanuel? If so, please include name(s) and relationship

Why did you select Temple Emanuel?*

I would like to enroll my child(ren) in

Preschool
Religious School

I would like to opt in to /opt out of the Membership Directory. I understand that by opting in, I agree to have my name, address, email and phone number published.*

Opt In
Opt Out

I/We agree that Temple Emanuel may /may not use photographs in electronic or print form in which my/our family may appear for publicity purposes.*

May
May Not

Do any of your family members have physical restrictions of which we should be aware?

Please know that Temple Emanuel is an open and inclusive community. We look forward to welcoming you.

I/We hereby join the Temple Emanuel community, and agree to support its religious, educational and cultural activities.

Adult Members

Children

Welcome to our Temple Emanuel Community!