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Kol Nidre Appeal
High Holidays
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New Membership Application
FAMILY INFORMATION
*
Member type
Please Select One
Regular - Family
Regular - Single
Associate - Family
Associate - Single
*
Street Address 1
Street Address 2
*
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
Home Phone
*
Family Tribe
Cohen
Levi
Yisrael
None Set
How did you learn about Shaarei Tikvah? (choose up to 3)
Read about it in the paper
Saw an ad (not online)
Online search
Friends belong
Saw the building
Know it from living in the community
Childrens' friends attend the religious school
What is the main motivation for joining Shaarei Tikvah at this time?
Worship services
Religious School
Shaarei Tikvah Clergy
Special program/activities
Referred by friend
Location
choose up to 2.
Do you (or your partner, if applicable) have any relatives at Shaarei Tikvah?
Please Select One
Yes
No
Names and Relationship
Would you be interested in being connected with another Shaarei Tikvah family?
Please Select One
Yes
No
Using what criteria?
Please Select One
Similar ages to adults
Similar ages to children
Interfaith
Home address
Religious Upbringing
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
Please Select One
Female
Male
Other
None
Pronoun of Primary Adult on Account
Other Gender of Primary Adult on Account
Gender of Secondary Adult on Account
Please Select One
Female
Male
Other
None
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
Please Select One
Cohen
Levi
Yisrael
Unknown
Is Father of Primary Adult on Account Living?
Living
Deceased
Father's Hebrew name of Secondary Adult on Account (no parent name)
Father's Tribe of Secondary Adult on Account
Please Select One
Cohen
Levi
Yisrael
Is Father of Secondary Adult on Account Living?
Living
Deceased
Mother's Hebrew name of Primary Adult on Account (no parent name)
Mother's Tribe of Primary Adult on Account
Please Select One
Cohen
Levi
Yisrael
Unknown
Is Mother of Primary Adult on Account Living?
Living
Deceased
*
Mother's Hebrew name of Secondary Adult on Account (no parent name)
*
Mother's Tribe of Secondary Adult on Account
Please Select One
Cohen
Levi
Yisrael
Unknown
Is Mother of Secondary Adult on Account living?
Living
Deceased
*
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?
Please Select One
Conservative Jewish
Reform Jewish
Orthodox Jewish
Secular/unaffiliated Jewish
Not Jewish
Is Primary Adult on Account a Jew by choice?
Please Select One
Yes
No
Month/Year of conversion
In what religious tradition was the Secondary Adult on Account raised?
Please Select One
Conservative Jewish
Reform Jewish
Orthodox Jewish
Secular/unaffiliated Jewish
Not Jewish
Is the Secondary Adult on Account a Jew by choice?
Please Select One
Yes
No
month/year of conversion
Did the Jewish upbringing and education of Primary Adult on Account include: (please check all that apply)
Bar/Bat Mitzvah
Religious/Hebrew School
Jewish day school
Did the Jewish upbringing and education of Secondary Adult on Account include: (please check all that apply)
Bar/Bat Mitzvah
Religious/Hebrew School
Jewish day school
Does the Primary Adult on Account own a cemetery plot?
Please Select One
Yes
No
Where is the plot located?
Does the Secondary Adult on Account own a cemetery plot?
Please Select One
Yes
No
Where is the plot located?
CHILDREN INFORMATION
How many children do you have (regardless of where they live)?
0
1
2
3
4
5
6
7
8
9
10
First Name
Middle Name
Last Name
Nickname
Gender
Please Select One
Female
Male
Other
None
If other, how does the child identify?
Pronoun(s)
Does this child live with you?
Please Select One
Yes
No
Is this child married?
Please Select One
Yes
No
Spouse Full Name
Birthdate
Born after Sunset?
Born after Sunset?
Hebrew Date if known
Tribe
Please Select One
Cohen
Levi
Yisrael
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?
0
1
2
3
4
5
6
7
8
9
10
Full English Name of Deceased
Full Hebrew Name of Deceased
Gender of Deceased
Please Select One
Female
Male
Other
None
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?
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 Olam
Adult Jewish Education (attending a class)
Adult Jewish Education (leading a class)
Softball Team
Website/Communications/Social Media
Ritual 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:
Social Action/Tikkun Olam
Adult Jewish Education (attending a class)
Adult Jewish Education (leading a class)
Softball Team
Website/Communications/Social Media
Ritual Participation (reading Torah, leading tefila, giving a d'var Torah, etc)
Social Event Planning
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!
Wed, January 20 2021 7 Shevat 5781