Membership Form - Form - Temple Sholom

How many adults are in your household?

PERSONAL INFORMATION

Member 1: Last name

Member 2: Last name

Member 1: First name

Member 2: First name

* Member 1: Date of birth

Member 2: Date of birth

Member 1: Place of birth

Member 2: Place of birth

Member 1: Marital status

Member 2: Marital status

* Member 1: Email address

Member 2: Email address

* Member 1: Occupation/Title

Member 2: Occupation/Title

Member 1: Work phone

Member 2: Work phone

Member 1: Cell phone

Member 2: Cell phone

Member 1: Religion

Member 2: Religion

* Member 1: Religious affiliation

* Member 2: Religious affiliation

Member 1: Jewish

By birthBy choice

Member 2: Jewish

By birthBy choice

Member 1: Date and place of conversion

Member 2: Date and place of conversion

Member 1: Hebrew name

Please include your name, your father's name & your mother's name
Example: Isaac ben Abraham v'Sarah (ben = son of, bat = daughter of; v = and)

Member 2: Hebrew name

Please include your name, your father's name & your mother's name
Example: Isaac ben Abraham v'Sarah (ben = son of, bat = daughter of; v = and)

Member 1: Bar/Bat Mitzvah date

Member 2: Bar/Bat Mitzvah date

Member 1: Can you read Hebrew and/or chant Torah?

Read HebrewChant Torah

Member 2: Can you read Hebrew and/or chant Torah?

Read HebrewChant Torah

Date of marriage (if applicable)

Relatives at Temple Sholom

ADDRESS

All mail will be sent to your residence unless otherwise requested.

Number, street & unit number

City

Province

Postal Code

Home phone number

Postal Code

FAMILY INFORMATION

Number of children:

* Applies to each of your children who reside with you.

1st Child

2nd Child

3rd Child

4th Child

Child 1: Last name

Child 2: Last name

Child 3: Last name

Child 4: Last name

Child 1: First name

Child 2: First name

Child 3: First name

Child 4: First name

Child 1: Birth date

Child 2: Birth date

Child 3: Birth date

Child 4: Birth date

Child 1: Gender

Child 2: Gender

Child 3: Gender

Child 4: Gender

Child 1: School grade

Child 2: School grade

Child 3: School grade

Child 4: School grade

Child 1: School Name

Child 2: School Name

Child 3: School Name

Child 4: School Name

Child 1: Hebrew name

Child 2: Hebrew name

Child 3: Hebrew name

Child 4: Hebrew name

Adult children who do NOT reside with you

YAHRZEIT INFORMATION

Please enter the number of people for whom you wish to observe yahrtzeit (memorial)

* A Yahrzeit reminder notice will be sent to you every year.

Please list the names of loved ones for whom you wish Yahrzeit notices sent

(1) Name of deceased and relationship to mourner

(1) Date of death

(1) Time of death

Before sunsetAfter sunset

(1) I'd like to observe the

Gregorian DateHebrew Date

(2) Name of deceased and relationship to mourner

(2) Date of death

(2) Time of death

Before sunsetHebrew Date

(2) I'd like to observe the

Gregorian DateHebrew Date

(3) Name of deceased and relationship to mourner

(3) Date of death

(3) Time of death

Before sunsetAfter sunset

(3) I'd like to observe the

Gregorian DateHebrew Date

(4) Name of deceased and relationship to mourner

(4) Date of death

(4) Time of death

Before sunsetAfter sunset

(4) I'd like to observe the

Gregorian DateHebrew Date

(5) Name of deceased and relationship to mourner

(5) Date of death

(5) Time of death

Before sunsetAfter sunset

(5) I'd like to observe the

Gregorian DateHebrew Date

(6) Name of deceased and relationship to mourner

(6) Date of death

(6) Time of death

Before sunsetAfter sunset

(6) I'd like to observe the

Gregorian DateHebrew Date

Comments

MISCELLANEOUS INFORMATION

How did you hear about Temple Sholom?

Reason(s) for joining our synagogue:

VOLUNTEER OPPORTUNITIES

We welcome our members to become involved in Temple life and activities.
Please check any activities that interest you. We will be in touch!

Member 1: If other above, please specify:

Member 2: If other above, please specify: