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New Membership Application
Please verify reCaptcha before submitting the form.
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 the Shaarei Tikvah buddy program?
Please Select One
Yes
No
Our membership committee will connect you with a member buddy to welcome you to our community.
Using what criteria?
Please Select One
Similar ages to adults
Similar ages to children
Interfaith
Home address
Religious Upbringing
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
Please Select One
Female
Male
Other
None
Pronoun of Adult 1
Other Gender of Adult 1
Gender of Adult 2
Please Select One
Female
Male
Other
None
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
Please Select One
Cohen
Levi
Yisrael
Unknown
Is Father of Adult 1 Account Living?
Living
Deceased
Mother's Hebrew name of Adult 1 (no parent name)
Mother's Tribe of Adult 1
Please Select One
Cohen
Levi
Yisrael
Unknown
Is Mother of Adult 1
Living
Deceased
Hebrew name of Adult 2 (no parent name)
Father's Hebrew name of Adult 2 (no parent name)
Father's Tribe of Adult 2
Please Select One
Cohen
Levi
Yisrael
Is Father of Adult 2 Living?
Living
Deceased
*
Mother's Hebrew name of Adult 2 (no parent name)
*
Mother's Tribe of Adult 2
Please Select One
Cohen
Levi
Yisrael
Unknown
Is Mother of Adult 2 living?
Living
Deceased
*
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?
Please Select One
Conservative Jewish
Reform Jewish
Orthodox Jewish
Secular/unaffiliated Jewish
Not Jewish
Is Adult 1 a Jew by choice?
Please Select One
Yes
No
Month/Year of conversion
Synagogue Affiliation Adult 1
List any previous synagogue affiliations.
In what religious tradition was the Adult 2 raised?
Please Select One
Conservative Jewish
Reform Jewish
Orthodox Jewish
Secular/unaffiliated Jewish
Not Jewish
Is the Adult 2 a Jew by choice?
Please Select One
Yes
No
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 Mitzvah
Religious/Hebrew School
Jewish day school
Did the Jewish upbringing and education of Adult 2 include: (please check all that apply)
B'nei Mitzvah
Religious/Hebrew School
Jewish day school
Does Adult 1 own a cemetery plot?
Please Select One
Yes
No
Where is the plot located?
Does the Adult 2 own a cemetery plot?
Please Select One
Yes
No
Where is the plot located?
CHILDREN'S 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 Adult 1:
ReadingTorah
Leading Tefilah
Giving a D'var Torah
Leading a Lunch and Learn
Social Action/Tikkun Olam
Adult Jewish Education (attending a class)
Adult Jewish Education (leading a class)
Social Event Planning
Softball Team
Website/Communications/Social Media
Please check the activities that might interest Adult 2:
Reading Torah
Leading Tefila
Giving a D'var Torah
Leading a Lunch and Learn
Social Action/Tikkun Olam
Adult Jewish Education (attending a class)
Adult Jewish Education (leading a class)
Social Event Planning
Softball Team
Website/Communications/Social Media
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!
Fri, June 2 2023 13 Sivan 5783