Membership Application


Adult Members

Adult 1
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
Street Address
City
State
Zip
Home Phone
Cell Phone
Email
Marital Status
Wedding Date (if applicable)
Are You Jewish? YesNo
Job Title/Occupation
Employer
Business Phone
Full Hebrew Name (including parents)
KohenLeviIsrael
Is your mother Jewish? YesNo
Did you grow up? OrthodoxConservativeReformReconstructionist
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
DayNight
Deceased Relative #2 - Information
Name of Deceased
Relationship to You
Secular Date Deceased
DayNight
Deceased Relative #3 - Information
Name of Deceased
Relationship to You
Secular Date Deceased
DayNight
Adult 2
Last Name
First Name
MI
Gender
Name you wish to be called
Title you prefer
Birthdate
Cell Phone
Email
Job Title/Occupation
Employer
Business Phone
Full Hebrew Name (including parents)
KohenLeviIsrael
Is your mother Jewish? YesNo
Did you grow up? OrthodoxConservativeReformReconstructionist
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
DayNight
Deceased Relative #2 - Information
Name of Deceased
Relationship to You
Secular Date Deceased
DayNight
Deceased Relative #3 - Information
Name of Deceased
Relationship to You
Secular Date Deceased
DayNight

Children

Child 1
Last Name
First Name
MI
Street Address (if different)
City
State
Zip
Gender
Email
Hebrew Name
Birthdate
Grade
School
Child 2
Last Name
First Name
MI
Street Address (if different)
City
State
Zip
Gender
Email
Hebrew Name
Birthdate
Grade
School
Child 3
Last Name
First Name
MI
Street Address (if different)
City
State
Zip
Gender
Email
Hebrew Name
Birthdate
Grade
School
Child 4
Last Name
First Name
MI
Street Address (if different)
City
State
Zip
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.

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.

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.

Welcome to our Temple Emanuel Community!