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BJC Membership Application
Please verify reCaptcha before submitting the form.
To start the membership process, please complete out this online form. You will then be sent a link to finalize your membership by setting up an Annual Sustaining Contribution (ASC).
We pride ourselves on ensuring that everyone who wants to join is welcome; no matter what their financial situation, which is why we do not have a set "DUES" amount. However we do expect that every household will make some form of regular financial commitment to sustain our shul. We ask that each household consider giving around 2% of their average household income. You will receive more information about this once you complete this form.
Again, we want to reiterated that everyone is welcomed into our community, regardless of financial capacity.
We look forward to getting you connected into our community.
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Family Last Name(s)
This is how mail will be addressed to your household.
You can use formats such as: Greene Family, Greene-Miller Family,The Greenes & Millers, etc..
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Address 1
Address Line 2
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City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip
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Primary Phone
Please enter the preferred contact phone number for your family
ADULT 1 INFORMATION
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First Name
*
Last Name
How should we address you?
(Nickname, Title, Mr. & Mrs. etc)
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Pronouns
*
Date of Birth
*
Hebrew Name (if applicable)
*
Cell Phone
*
Email
*
Would you like to be on our list for weekly and special event emails?
Yes, Please
No, Thanks
*
Occupation
Business Name or Employer
Growing up, how did your family identify religiously?
Please Select One
Reform
Conservative
Orthodox
Reconstructionist
Traditional
Cultural
Secular
Not-Jewish
ADDITIONAL FAMILY MEMBERS:
*
Is there another adult in your household?
Please Select One
Yes
No
How are the two adults related?
ADULT 2 INFORMATION
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First Name
*
Last Name
How should we address you?
(Nickname, Title, Mr. & Mrs. etc)
*
Pronouns
*
Date of Birth
Hebrew Name (if applicable)
*
Cell Phone
*
Email
*
Would you like to be on our list for weekly and special event emails?
Yes, Please
No, Thanks
*
Occupation
Business Name or Employer
Growing up, how did your family identify religiously?
Please Select One
Reform
Conservative
Orthodox
Reconstructionist
Traditional
Cultural
Secular
Not-Jewish
CHILDREN
*
Do you have child(ren)?
Please Select One
Yes
No
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Child 1 First Name
Child 1 Middle name
*
Child 1 Last Name
Child 1 Nickname (if applicable)
*
Child 1 Pronouns
*
Child 1 Date of Birth
Child 1 Hebrew Name (if applicable)
Child 1 Grade and School, if applicable
*
Do you have more children?
Please Select One
Yes
No
*
Child 2 First name
Child 2 Middle Name
*
Child 2 Last Name
Child 2 Nickname (if applicable)
*
Child 2 Pronouns
Child 2 Date of Birth
Child 2 Hebrew name (if applicable)
Child 2 Grade and School (if applicable)
Do you have more children?
Please Select One
Yes
No
*
Child 3 First name
Child 3 Middle Name
*
Child 3 Last name
Child 3 Nickname (if applicable)
*
Child 3 Pronouns
Child 3 Date of Birth
Child 3 Hebrew name (if applicable)
Child 3 Grade and School (if applicable)
*
Do you have more children?
Please Select One
Yes
No
*
Child 4 First Name
Child 4 Middle Name
*
Child 4 Last Name
Child 4 Nickname (if applicable)
*
Child 4 Pronouns
Child 4 Date of Birth
Child 4 Hebrew Name (if applicable)
Child 4 Grade and School (if applicable)
*
Do you have more children?
Please Select One
Yes
No
AREAS OF INTEREST
*
Which of these events and opportunities are of interest to your family? Please select all that apply.
Adult Social Activities
Adult Learning
Climate Justice/Environmentalism
Cooking/Baking
Chesed/Acts of Lovingkindness
Early Childhood
Israel
Jewish Arts & Culture (Art, Music, Literature...)
Kids Education
Landscaping / Gardening
Leading Services/Reading Torah
Music
Outdoor Recreation
Social Justice
Teens
In what other ways might you want to be involved?
YAHRZEIT INFORMATION
As part of Jewish tradition, we honor loved ones who have passed on the Hebrew anniversary of their death. We would like to include your loved ones in the list of people we remember each year, and we will send a yahrzeit reminder to you each year in advance of the anniversary.
If you know the secular or Hebrew date of death of your loved one(s), please enter it below. If you do not have this information, we can always enter it at a later time.
*
Do you have yahrzeits you would like to observe?
Please Select One
Yes
No
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Name of Deceased
Hebrew Name (if known)
*
Date of Death
Please include day and time, (Gregorian and/or Hebrew) if you have it, including the year.
*
Who is observing the yahrzeit?
*
Deceased's relationship to the mourner
*
Do you have another yahrzeit you would like to observe?
Please Select One
Yes
No
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Name of Deceased
Hebrew Name (if known)
*
Date of Death
Please include day and time, (Gregorian and/or Hebrew) if you have it, including the year.
*
Who is observing the yahrzeit?
*
Deceased's relationship to the mourner
*
Do you have another yahrzeit you would like to observe?
Please Select One
Yes
No
*
Name of Deceased
Hebrew Name (if known)
*
Date of Death
Please include day and time, (Gregorian and/or Hebrew) if you have it, including the year.
*
Who is observing the yahrzeit?
*
Deceased's relationship to the mourner
*
Do you have another yahrzeit you would like to observe?
Please Select One
Yes
No
*
Name of Deceased
Hebrew Name (if known)
*
Date of Death
Please include day and time, (Gregorian and/or Hebrew) if you have it, including the year.
*
Who is observing the yahrzeit?
*
Deceased's relationship to the mourner
*
Do you have another yahrzeit you would like to observe?
Please Select One
Yes
No
*
Name of Deceased
Hebrew Name (if known)
*
Date of Death
Please include day and time, (Gregorian and/or Hebrew) if you have it, including the year.
*
Who is observing the yahrzeit?
*
Deceased's relationship to the mourner
*
Do you have another yahrzeit you would like to observe?
Please Select One
Yes
No
*
Name of Deceased
Hebrew Name (if known)
*
Date of Death
Please include day and time, (Gregorian and/or Hebrew) if you have it, including the year.
*
Who is observing the yahrzeit?
*
Deceased's relationship to the mourner
Welcome to Beth Jacob! We will be in touch with you as soon as possible.
Fri, March 29 2024 19 Adar II 5784