Membership Form - Temple B'nai Shalom

* First Name, Member 1

Last Name

Middle Name

Title

Nickname

First Name--Member 2

Last Name

Middle Name

Title

Nickname

Address 1

Suite #/Apt. #

City

State

Zip Code

Home Phone #1

* Cell Phone #1:

Work Phone :#1

Email #1 (Where we may send Temple information)

Home Phone #2

Cell Phone #2

Work Phone #2:

Email #2 (Where we may send Temple information)

* Birthday #1

Birthday #2:

Gender/Pronoun #1 (Optional)

Gender/Pronoun #2 (Optional)

Employer and Type of Business or Profession #1 (Optional)

Employer and Type of Business or Profession #2 (Optional)

* I am #1:

JewishNon-Jewish

Hebrew Name #1 If Known:

If Non-Jewish #1, are you practicing another religion?

YesNo

Which faith?

I am #2

JewishNon-Jewish

Hebrew Name (if known)

If Non-Jewish #1, are you practicing another religion?

YesNo

Which faith

Mother's Full Name #1: (English)

Mother's Hebrew Name #1: (if applicable)

Father's Full Name #1: (English)

Father's Hebrew Name #1: (if applicable)

Mother's Full Name #2: (English)

Mother's Hebrew Name #2: (if applicable)

Father's Full Name #2: (English)

Father's Hebrew Name #2: (if applicable)

If Married, please list Anniversary Date

*For Jewish members only: In order to be accepted for membership, you must exclusively practice Judaism. Jewish members may not practice other religions.

Child #1 Full Name:

Child #1 Gender/Pronoun (Optional)

Child #1 Birthday

Child #1 School Name

Child #1 Grade

Will Child # 1 Attend Religious School?

YesNo

Child # 1 Hebrew Name (if any)

Child #2 Full Name:

Child #2 Gender/Pronoun (Optional)

Child #2 Birthday

Child #2 School Name

Child #2 Grade

Will Child # 2 Attend Religious School?

YesNo

Child # 2 Hebrew Name (if any)

Child #3 Full Name:

Child #3 Gender/Pronoun (Optional)

Child #3 Birthday

Child #3 School Name

Child #3 Grade

Will Child # 3 Attend Religious School?

YesNo

Child # 3 Hebrew Name (if any)

Child #4 Full Name:

Child #4 Gender/Pronoun (Optional)

Child #4 Birthday

Child #4 School Name

Will Child # 4 Attend Religious School?

YesNo

Will Child # 4 Attend Religious School?

YesNo

Child # 4 Hebrew Name (if any)

Are all children exclusively practicing Judaism?

YesNo

If not, please indicate the child's name and religious affiliation:

*Children are eligible for our religious school only if they are being raised exclusively as Jews.

Yahrzeit #1 Full Name of Deceased

Yahrzeit #1 Relationship to Family (e.g. father of wife, mother of husband, etc.)

Yahrzeit #1 English Date of Death

Observe Hebrew or English Date?

HebrewEnglish

Yahrzeit #2 Full Name of Deceased

Yahrzeit #2 Relationship to Family (e.g. father of wife, mother of husband, etc.)

Yahrzeit #2 English Date of Death

Observe Hebrew or English Date?

HebrewEnglish

Yahrzeit #3 Full Name of Deceased

Yahrzeit #3 Relationship to Family (e.g. father of wife, mother of husband, etc.)

Yahrzeit #3 English Date of Death

Observe Hebrew or English Date?

HebrewEnglish

Yahrzeit #4 Full Name of Deceased

Yahrzeit #4 Relationship to Family (e.g. father of wife, mother of husband, etc.)

Yahrzeit #4 English Date of Death

Observe Hebrew or English Date?

HebrewEnglish

Membership Categories (Select One)

Note regarding limited memberships
Please be advised that limited membership do not include life cycle events or rabbinic services

Note regarding membership dues
Your dues are the financial foundation of the temple, its activities and services. Your application is your commitment to investing a full year of dues in the community that will be your home (or the prorated amount beginning in the quarter in which you joined TBS). We are who and what we are only with your support and involvement.

If you were previously a member at a different congregation, what was the name of your previous congregation? (include the city and state

Billing (Please select how you wish to be billed for membership dues)

MonthlyQuarterly (Jul. 1, Oct. 1, Jan. 1, Apr. 1)Bi-Annual (Jul. 1 Jan. 1)Annually (Jul. 1)

We send dues billing statements via email. To which email should we send your dues statement?

BothHead of Household #1Head of Household #2

Please note that you will have the abilility with ShulCloud, our billing database, to easily pay via secure link from the emailed statement, and also to set up a billing schedule.

We have a variety of groups and committees that help our building running and members engaged. These groups are a great weay to meet new people and better connect with TBS. Check any that you want to participate in or contribute to:

Other Skills, hobbies, talents, experience you bring to the community

Method of Communication

What is your preferred method of communication regarding upcoming events?

Membership From

Membership Application