OFFICE USE ONLY

ADULT 1

ADULT 2

Last Name__________________________________

Last Name _______________________________

First Name__________________________________

First Name _______________________________

Address____________________________________

Cell Phone: (

_____________________________ Apt # _________

Office Phone: (

City_______________Postal Code_______________

E-Mail ____________________________________

Home Phone: ( Cell Phone: (

)_________________________ )___________________________

Date of Birth

) _________________________ ) _______________________

d________ m__________ yr_______

 Male  Female

CHILDREN (if more than 3 please attach extra sheet)

YAHRZEIT INFORMATION

1) Last Name_______________________________

_________________________________________

First Name_______________________________ Birth Date

d_________ m_________ yr_________

Lives at Home  Y  N

1) Person observing Yahrzeit Observing Yahrzeit for Last Name_______________________________

 Male  Female

First Name_______________________________

Hebrew Name____________________________

Relationship to the deceased __________________________________________

School/Occupation ________________________ Status  Single  Married  Divorced  Widow

Date

Address (if different from parents)

English d______ m________ yr_________ Hebrew d___________ m_____________

) ________________________

Occupation _______________________________

_________________________________________

Hebrew Name_____________________________

E-Mail_____________________________________

d________ m_________ yr________

City _________________Postal Code _________

Hebrew Name ____________________________

ben/bat __________________________________

Email: ___________________________________

Office Phone: (

Date of Birth

d_________ m_________ yr________

Status:  Single  Married  Divorced  Widow

 Male  Female Occupation ________________________________ Date Married

Date Married

d________ m_________ yr_________

Hebrew Name ______________________________ Status:  Single  Married  Divorced  Widow Tribe:  Kohen

 Levi

 Israel

Religious Status:

 Born

 Converted

Tribe:

 Kohen

Religious Status:

 Levi  Born

 Israel  Converted

Father’s Hebrew Name ________________________________________ Mother’s Hebrew Name ________________________________________

2) Last Name_______________________________ First Name_______________________________ Birth Date d_______m___________yr__________ Lives at Home  Y  N

 Male  Female

Hebrew Name____________________________ School/Occupation ________________________ Status  Single  Married  Divorce  Widow

2) Person observing Yahrzeit _________________________________________ Observing Yahrzeit for Last Name________________________________ First Name________________________________ Relationship to the deceased __________________________________________ Date

English d_______ m________ yr________

Father’s Hebrew Name _______________________

Address (if different from parents) ________________________________________

Mother’s Hebrew Name ______________________

City __________________Postal Code________

Hebrew Name_____________________________

Email: ___________________________________

ben/bat __________________________________

Information Regarding Cemetery Plots: Each Member has the following rights: To a cemetery plot for the Member and for each unmarried dependent child of the Jewish faith, in accordance with Bylaw #3 (Cemetery Bylaw). Any Member paying a Promotional Fee shall not be entitled to a cemetery plot as provided for in Section 2.2(g). In the event that a member requires a cemetery plot while paying a Promotional Fee, an assessment shall be charged covering the difference between the Promotional Fees paid and the full membership fee for each year in which a Promotional Fee was paid. The foregoing shall not apply to a Member paying a Reduced Fee.

3) Last Name_______________________________ First Name_______________________________ Birth Date

d_______m__________yr___________

Lives at Home  Y  N

 Male  Female

Hebrew d__________ m______________

3) Person observing Yahrzeit __________________________________________ Observing Yahrzeit for Last Name_________________________________

Hebrew Name___________________________

First Name ________________________________

School/Occupation _______________________ Status  Single  Married  Divorce  Widow

Relationship to the deceased __________________________________________

Address (if different from parents)

Date

________________________________________ City _________________Postal Code__________

Hebrew Name _____________________________

Email: __________________________________

ben/bat ___________________________________

English d_______ m________ yr________ Hebrew d__________ m______________

Tell Us More About Yourself! How did you hear about Beth David?

______________________________________ ______________________________________ What about membership most interests you? (Socializing, family programming, adult education, children’s education, services etc.?

______________________________________ ______________________________________

New Member Application

What are your hobbies?

______________________________________ Do you have special skills or interests that you would like to volunteer?________________________________ Which of the following committees would you like to join? Adult Adult #1 #2 #1 #2 [ ] [ ] Adult Education [ ] [ ] Fund Raising [ ] [ ] Brotherhood [ ] [ ] Israel [ ] [ ] Budget & Finance [ ] [ ] Membership [ ] [ ] Catering [ ] [ ] Personnel [ ] [ ] Cemetery [ ] [ ] House and Property [ ] [ ] Communications [ ] [ ] Sisterhood [ ] [ ] Families & Youth

Email Newsletters and Information: I would like to subscribe to the following email newsletter list: General______ Youth & Families______ Sad News______

Welcome and thank you for choosing Beth David B’nai Israel Beth Am as your synagogue. You will soon discover what makes Beth David the ideal place for you and your family to Participate, Learn & Grow! To help us get to know you better, please take a moment to answer the following questions.