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 the Shaarei Tikvah buddy program?

Our membership committee will connect you with a member buddy to welcome you to our community.

Using what criteria?

INDIVIDUAL(S) INFORMATION

* Title of Adult 1

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

Title of Adult 2

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

* First Name of Adult 1

First Name of Adult 2

* Last name of Adult 1

Last Name of Adult 2

* Gender of Adult 1

Pronoun of Adult 1

Other Gender of Adult 1

Gender of Adult 2

Pronoun of Adult 2

Other Gender of Adult 2

Hebrew name of Adult 1 (no parent name)

Father's Hebrew name of Adult 1 (no parent name)

Father's Tribe of Adult 1

Is Father of Adult 1 Account Living?

LivingDeceased

Mother's Hebrew name of Adult 1 (no parent name)

Mother's Tribe of Adult 1

Is Mother of Adult 1

LivingDeceased

Hebrew name of Adult 2 (no parent name)

Father's Hebrew name of Adult 2 (no parent name)

Father's Tribe of Adult 2

Is Father of Adult 2 Living?

LivingDeceased

* Mother's Hebrew name of Adult 2 (no parent name)

* Mother's Tribe of Adult 2

Is Mother of Adult 2 living?

LivingDeceased

* Email of Adult 1

Email of Adult 2

Cell phone of Adult 1

Cell phone of Adult 2

Birth date of Adult 1

Birth date of Adult 2

Wedding anniversary

Occupation of Adult 1

Occupation of Adult 2

Employer of Adult 1

Employer of Adult 2

In what religious tradition was Adult 1 raised?

Is Adult 1 a Jew by choice?

Month/Year of conversion

Synagogue Affiliation Adult 1

List any previous synagogue affiliations.

In what religious tradition was the Adult 2 raised?

Is the Adult 2 a Jew by choice?

month/year of conversion

Synagogue Affiliation Adult 2

List any previous synagogue affiliations.

Did the Jewish upbringing and education of Adult 1 include: (please check all that apply)

B'nei MitzvahReligious/Hebrew SchoolJewish day school

Did the Jewish upbringing and education of Adult 2 include: (please check all that apply)

B'nei MitzvahReligious/Hebrew SchoolJewish day school

Does Adult 1 own a cemetery plot?

Where is the plot located?

Does the Adult 2 own a cemetery plot?

Where is the plot located?

CHILDREN'S INFORMATION

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

If you have children, please be sure to complete their information below.

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

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

No one is ever turned away for financial need. Check this box if you would like to speak to someone about financial arrangements.

No one is ever turned away for financial need. Check this box if you would like to speak to someone about financial arrangements.All information is kept confidential.

Other information (if needed)

Thank you for your membership submission.

We will be back in touch with you shortly!