Membership Application

Adult Applicant #1
Adult #1 - Name*
Prefix First Last
Adult #1 - Gender*
Adult #1 - Date of Birth*
Adult #1 - Email*
Adult #1 - Cell Phone*
Adult #1 - Relationship Status
Anniversary Date
Adult Applicant #2
Adult #2 - Name
First Last
Adult #2 - Gender
Adult #2 - Date of Birth
Adult #2 - Email
Adult #2 - Cell Phone

Home Information
Primary Street Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Do you have a secondary address
- Yes, I have a secondary address
Secondary Address
Street Address Address Line 2 City State ZIP Code
Preferred Family Mailing Label Title
e.g., Mr. & Mrs. Robert Smith; Judy & Robert Smith; Dr. Judy Katz & Mr. Bob Smith; Ms. Judy Katz & Ms. Ellen Gold

Business Information
Adult #1 - Job Position/Title
Adult #2 - Job Position/Title
Adult #1 - Employer
Adult #2 - Employer
Adult #1 - Business Address
Street Address Address Line 2 City State ZIP Code
Adult #2 - Business Address
Street Address Address Line 2 City State ZIP Code
Adult #1 - Business Phone
Adult #2 - Business Phone
Adult #1 - Business Email
Adult #2 - Business Email

Children
How many children do you have?
Child #1 - Name
First Last
Child #1 - Gender
- Male
- Female
Child #1 - Hebrew Name
Child #1 - Date of Birth
Child #1 - Jewish Education
Does your child attend, or will your child attend, any of the following?
Child #1 - Bar/Bat Mitzvah Year
Child #1 - Secular School & Grade
If after June 1, indicate class/grade child will enter in September.
Child #2 - Name
First Last
Child #2 - Gender
- Male
- Female
Child #2 - Hebrew Name
Child #2 - Date of Birth
Child #2 - Jewish Education
Does your child attend, or will your child attend, any of the following?
Child #2 - Bar/Bat Mitzvah Year
Child #2 - Secular School & Grade
If after June 1, indicate class/grade child will enter in September.
Child #3 - Name
First Last
Child #3 - Gender
- Male
- Female
Child #3 - Hebrew Name
Child #3 - Date of Birth
Child #3 - Jewish Education
Does your child attend, or will your child attend, any of the following?
Child #3 - Bar/Bat Mitzvah Year
Child #3 - Secular School & Grade
If after June 1, indicate class/grade child will enter in September.
Child #4 - Name
First Last
Child #4 - Gender
- Male
- Female
Child #4 - Hebrew Name
Child #4 - Date of Birth
Child #4 - Jewish Education
Does your child attend, or will your child attend, any of the following?
Child #4 - Bar/Bat Mitzvah Year
Child #4 - Secular School & Grade
If after June 1, indicate class/grade child will enter in September.
Is there anything special about your family that you would like to share with us?
Are there any special accomodations that would enhance your (or your family's) membership experience?

Religious Background
Adult #1 - In what religious tradition were you raised?
Adult #2 - In what religious tradition were you raised?
Adult #2 - Are you a:
- Kohen
- Levi
- Yisrael
Adult #1 - Your Hebrew Name
Adult #2 - Your Hebrew Name
Adult #1 - Father's Hebrew Name
Adult #2 - Father's Hebrew Name
Adult #1 - Mother's Hebrew Name
Adult #2 - Mother's Hebrew Name
Adult #1 - Tell us about your Jewish journey:
Adult #2 - Tell us about your Jewish journey:
Yahrzeit Observances
Anniversary of a loved one's death)
Name of Deceased Relationship Secular Date of Death Before/After Sunset

Jewish Geography
Please tell us the names of any relatives or friends at Temple Israel Center, and how you are related.
How long have you been an area resident?
Where did you move from (if applicable)?
Please list any present or former synagogue affiliation(s):
Making It Official
Adult #1 - Signature*
I hereby make application for membership at Temple Israel Center and, upon acceptance, do agree to abide by its by-laws, including my financial obligations as a member of Temple Israel Center.
Adult #2 - Signature
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Membership Application

Step 1 of 7

Adult Applicant #1

Adult Applicant #2

Home Information

Business Information

Children

Religious Background

Making a Connection

Jewish Geography

Making It Official

In This Section

Name of Deceased	Relationship	Secular Date of Death	Before/After Sunset