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Beth Jacob Membership Form
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Welcome to Beth Jacob Congregation. We are a Jewish community that comes together to nurture
relationships with God and each other. We are a Conservative synagogue that values Torah (study),
Avodah (reverential service) and Gemilut Hasadim (acts of loving
-
kindness), where every person has an
equal opportunity to be part of our community, regardless of ability, special needs, or financial status.
We
’
re glad you
are interested in joining us as a member! Please fill out the form below so we can have some basic information about you and your family. We will be in touch with you shortly for more information, to discuss financial support for the synagogue that works for you, and to help you find meaningful connections within our community.
*
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..
*
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
*
Zip
*
Primary Phone
Please enter the preferred contact phone number for your family
ADULT 1 INFORMATION
*
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
ADDITIONAL FAMILY MEMBERS:
*
Is there another adult in your household?
Please Select One
Yes
No
How are the two adults related?
ADULT 2 INFORMATION
*
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
*
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
Early Childhood
Cooking/Baking
Israel
Social Justice
Social-Action
Teens
Leading Services/Reading Torah
Family Activities
Tikkun Olam/Acts of Lovingkindness
Kids Education
Jewish Arts & Culture (Art, Music, Literature...)
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
*
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
*
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.
Sun, October 2 2022 7 Tishrei 5783
