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Membership Application
Please verify reCaptcha before submitting the form.
*
Are you married or partnered?
Please Select One
Yes
No
HOUSEHOLD INFORMATION
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Street Address
*
City
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State
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*
Zip
Home Phone
Marital Status
Single
Married
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N/A
Partnered
Anniversary
MEMBER INFORMATION
Title (only if not Mr/Mrs/Ms)
Member 2 Title (only if not Mr/Mrs/Ms)
*
First name
Nickname
*
Member 2 First name
Member 2 nickname
Middle name
Member 2 middle name
*
Last name
Member 2 last name
*
Jewish heritage
Please Select One
Jew by birth
Jew by choice
Not Jewish
*
Member 2 Jewish heritage
Please Select One
Jew by birth
Jew by choice
Not Jewish
For Hebrew name fields, use English or Hebrew characters
Hebrew name (not including parents)
Member 2 Hebrew name (not including parents)
Father Hebrew name
Member 2 father Hebrew name
Mother Hebrew name
Member 2 mother Hebrew name
Tribe
Please Select One
Kohen
Levi
Yisrael
Member 2 Tribe
Please Select One
Kohen
Levi
Yisrael
*
Email
*
Member 2 email
Cell
Member 2 Cell
Birthdate
Member 2 birthdate
Company/business name
Member 2 company/business name
Occupation/title
Member 2 occupation/title
CHILDREN INFORMATION
Please select how many children you (and/or your partner) have and then complete the requested information
0
1
2
3
4
5
6
7
8
9
10
First Name
Middle Name
Last Name
Nickname
Hebrew Name
Tribe
Please Select One
Kohen
Levi
Yisrael
Parent 1 Hebrew Name
Parent 2 Hebrew Name
Birthday
Gender
Please Select One
Female
Male
Other/Non-Specified
Pronoun
Email (don't use parent email)
Cell (don't use parent cell)
YAHRZEIT INFORMATION
Please select how many yahrzeits your family observes and then complete the requested information for each yahrzeit
0
1
2
3
4
5
6
7
8
9
10
*
Full English Name of Deceased
Full Hebrew Name of Deceased
Pronoun of Deceased
*
Mourner in Family
*
Deceased is mourner's (relationship)
*
English Date of Death
Hebrew Date of Death (if known)
Cemetery (including city/state)
ADDITIONAL INFORMATION
Other or previous congregation affiliation (including location)
Interests
Adult bar/bat mitzvah
Adult social
Adult education
Yad chesed (caring committee)
Sisterhood
Brotherhood
Finance
Communication/marketing
Fundraising
Interfaith
Participate in service/read Torah/ritual
Social action
Youth programs
Holiday event planning
Membership
Technology
Music, Arts & Culture
Cooking/Kitchen
Book Club
Photograph release: I allow Congregation Or Atid to use photographs of me and my family in any member communications or in publicity efforts outside of the synagogue.
Yes
No
Please contact me to discuss
Do you or your family members have any physical restrictions we should be aware of?
Please Select One
No
Yes
Please describe:
Are you related to other members at Congregation Or Atid or do you have friends who belong?
Please Select One
No
Yes
Please list:
*
I/we hereby apply for membership in Congregation Or Atid and agree to support its religious, educational, and cultural activities.
I/we hereby apply for membership in Congregation Or Atid and agree to support its religious, educational, and cultural activities.
Wed, March 19 2025 19 Adar 5785