Congregation Beth Am Membership Application - Congregation Beth Am

Congregation Beth Am Membership Application

Congregation Beth Am believes that the contribution we make to the synagogue is an investment in future generations. Our membership is active and engaged in worship services, social activities, and educational programs. We strive to make our membership attractive and affordable to everyone.

Once you join Beth Am you will find within its doors a spiritual home and an opportunity to add meaning to your life and to those of others. You will meet members who cherish this community and look to it as a source of friendship, Jewish learning of the highest quality and variety, and social action engagement

Beth Am Membership Form
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First Name of person filling out form:
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Primary Email
Alternate Email
Home Phone
Cell Phone
FAMILY INFORMATION
Heads of Household Information
ADULT ONE
Adult One: First Name
Middle Name
Last Name
Preferred Salutation
If you picked other, please type your preferred salutation here:
Adult One: Informal Name
Adult One: Email
Adult One: Home Phone
Adult One: Cell Phone
Adult One: Birth Month
Adult One: Birth Day
Adult One: Birth Year
Adult One: Your Hebrew Name - Written in Hebrew
Adult One: Your Hebrew Name - Written in English
Adult One: Anniversary Date
Adult One: Anniversary Day
Adult One: Anniversary Year

Adult One: Father's Hebrew Name - Written in Hebrew
Adult One: Father's Hebrew Name - Written in English
Adult One: Mother's Hebrew Name - Written in Hebrew
Adult One: Mother's Hebrew Name - Written in English
Adult One: Religion
Adult one: Previous Synagogue affiliation
Adult One: Years With Previous Synagogue

Adult One: Occupation
Adult One: Specialization
Adult One: Business Phone
ADULT 2
Adult 2: First Name
Middle Name
Last Name
Adult 2: Preferred Salutation
Adult 2: If you picked other, please type your preferred salutation here:
Adult 2: Informal Name
Adult 2: Email
Adult 2: Home Phone
Adult 2: Cell Phone
Adult 2: Birth Month
Adult 2: Birth Day
Adult 2: Birth Year
Adult 2: Your Hebrew Name - Written in Hebrew
Adult 2: Your Hebrew Name - Written in English
Adult 2: Anniversary Date
Adult 2: Anniversary Day
Adult 2: Anniversary Year

Adult 2: Father's Hebrew Name - Written in Hebrew
Adult 2: Father's Hebrew Name - Written in English
Adult 2: Mother's Hebrew Name - Written in Hebrew
Adult 2: Mother's Hebrew Name - Written in English
Adult 2: Religion
Adult 2: Previous Synagogue affiliation
Adult 2: Years With Previous Synagogue

Adult 2: Occupation
Adult 2: Specialization
Adult 2: Business Phone

YOUR DEPENDENTS
Please fill in the information about your dependent children
CHILD 1
Child 1 Name
Child 1 Informal Name
Child 1 Phone
Child 1 Email
Child 1 Hebrew Name in Hebrew
Child 1 Hebrew Name in English
Child 1 Birthdate (MM/DD/YYYY)
Child 1 - School Grade
Child 1 - Years at Religious School?
Child 1 - Bar/Bat Mitzvah Date (MM/DD/YYYY)
CHILD 2
Child 2 Name
Child 2 Informal Name
Child 2 Phone
Child 2 Email
Child 2 Hebrew Name in Hebrew
Child 2 Hebrew Name in English
Child 2 Birthdate (MM/DD/YYYY)
Child 2 - School Grade
Child 2 - Years at Religious School?
Child 2 - Bar/Bat Mitzvah Date (MM/DD/YYYY)

CHILD 3
Child 3 Name
Child 3 Informal Name
Child 3 Phone
Child 3 Email
Child 3 Hebrew Name in Hebrew
Child 3 Hebrew Name in English
Child 3 Birthdate (MM/DD/YYYY)
Child 3 - School Grade
Child 3 - Years at Religious School?
Child 3 - Bar/Bat Mitzvah Date (MM/DD/YYYY)
CHILD 4
Child 4 Name
Child 4 Informal Name
Child 4 Phone
Child 4 Email
Child 4 Hebrew Name in Hebrew
Child 4 Hebrew Name in English
Child 4 Birthdate (MM/DD/YYYY)
Child 4 - School Grade
Child 4 - Years at Religious School?
Child 4 - Bar/Bat Mitzvah Date (MM/DD/YYYY)

Yahrtzeits
Please provide us with the following information so we may send you timely yahrzeit reminders. The complete date is necessary so each year we can determine the correct date on the Jewish calendar.
NAME
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
Yahrtzeits - Name
RELATIONSHIP
Relationship
Relationship
Relationship
Relationship
Relationship
Relationship
Relationship
Relationship
Relationship
Relationship
Relationship
RELATED TO...
Related to...
Related to...
Related to...
Related to...
Related to...
Related to...
Related to...
Related to...
Related to...
Related to...
Related to...
DATE OF DEATH
DOD
DOD
DOD
DOD
DOD
DOD
DOD
DOD
DOD
DOD
DOD
AFTER SUNSET?
After Sunset
After Sunset
After Sunset
After Sunset
After Sunset
After Sunset
After Sunset
After Sunset
After Sunset
Do we have permission to email you about events, programming, services, and relevant Congregation Beth Am information?
Yes
No
Do you we have permission to text you? Text charges may apply from mobile phone provider.
Yes
No

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