New Membership Application - Form

FAMILY INFORMATION

* Member type

* Street Address 1

Street Address 2

* City

* State

* Zip

Home Phone

* Family Tribe

How did you learn about Shaarei Tikvah? (choose up to 3)

What is the main motivation for joining Shaarei Tikvah at this time?

Do you (or your partner, if applicable) have any relatives at Shaarei Tikvah?

Names and Relationship

Would you be interested in being connected with another Shaarei Tikvah family?

Using what criteria?

INDIVIDUAL(S) INFORMATION

* Title of Primary Adult on Account

i.e., Dr./Ms./Mrs./Mr., other

Title of Secondary Adult on Account

i.e., Dr./Ms./Mrs./Mr., other

* First Name of Primary Adult on Account

First Name of Secondary Adult on Account

* Last name of Primary Adult on Account

Last Name of Secondary Adult on Account

* Gender of Primary Adult on Account

Pronoun of Primary Adult on Account

Other Gender of Primary Adult on Account

Gender of Secondary Adult on Account

Pronoun of Secondary Adult on Account

Other Gender of Secondary Adult on Account

Hebrew name of Primary Adult on Account (no parent name)

Hebrew name of Secondary Adult on Account (no parent name)

Father's Hebrew name of Primary Adult on Account (no parent name)

Father's Tribe of Primary Adult on Account

Is Father of Primary Adult on Account Living?

LivingDeceased

Father's Hebrew name of Secondary Adult on Account (no parent name)

Father's Tribe of Secondary Adult on Account

Is Father of Secondary Adult on Account Living?

LivingDeceased

Mother's Hebrew name of Primary Adult on Account (no parent name)

Mother's Tribe of Primary Adult on Account

Is Mother of Primary Adult on Account Living?

LivingDeceased

* Mother's Hebrew name of Secondary Adult on Account (no parent name)

* Mother's Tribe of Secondary Adult on Account

Is Mother of Secondary Adult on Account living?

LivingDeceased

* Email of Primary Adult on Account

Email of Secondary Adult on Account

Cell phone of Primary Adult on Account

Cell phone of Secondary Adult on Account

Birth date of Primary Adult on Account

Birth date of Secondary Adult on Account

Wedding anniversary

Occupation of Primary Adult on Account

Occupation of Secondary Adult on Account

Employer of Primary Adult on Account

Employer of Secondary Adult on Account

In what religious tradition was the Primary Adult on Account raised?

Is Primary Adult on Account a Jew by choice?

Month/Year of conversion

In what religious tradition was the Secondary Adult on Account raised?

Is the Secondary Adult on Account a Jew by choice?

month/year of conversion

Did the Jewish upbringing and education of Primary Adult on Account include: (please check all that apply)

Bar/Bat MitzvahReligious/Hebrew SchoolJewish day school

Did the Jewish upbringing and education of Secondary Adult on Account include: (please check all that apply)

Bar/Bat MitzvahReligious/Hebrew SchoolJewish day school

Does the Primary Adult on Account own a cemetery plot?

Where is the plot located?

Does the Secondary Adult on Account own a cemetery plot?

Where is the plot located?

CHILDREN INFORMATION

How many children do you have (regardless of where they live)?

First Name

Middle Name

Last Name

Nickname

Gender

If other, how does the child identify?

Pronoun(s)

Does this child live with you?

Is this child married?

Spouse Full Name

Birthdate

Born after Sunset?

Hebrew Date if known

Tribe

Hebrew Name (without parents)

Father Hebrew Name (if different than adult on account)

Mother Hebrew Name (if different than adult on account)

Email (do not enter parent email)

Cell (do not enter parent cell)

Current School

Current Grade/Level

YAHRZEIT INFORMATION

How many yahrzeits are observed by your immediate family?

Full English Name of Deceased

Full Hebrew Name of Deceased

Gender of Deceased

If other, how did this person identify?

Deceased preferred pronoun

Who observes this yahrzeit?

Who was the deceased to the yahrzeit observer?

English Date of Death

Passed after sunset?

Hebrew date of death if known

Cemetery

OTHER INFORMATION

Please check the activities that interest the Primary Adult on Account:

Social Action/Tikkun OlamAdult Jewish Education (attending a class)Adult Jewish Education (leading a class)Softball TeamWebsite/Communications/Social MediaRitual Participation (reading Torah, leading tefila, giving a d'var Torah, etc)Social Event Planning

Please check the activities that might interest the Secondary Adult on Account:

Does anyone in your household have skills or talents you'd be willing to share with us?

Other information (if needed)

Thank you for your membership submission.

We will be back in touch with you shortly!