New Member Application - Form - Congregation Shearith Israel

Adult 1 Information

* Gender

* Title Adult One

(Mr./Mrs./Ms./Dr./Other)

* Adult One First Name

M.I.

* Adult One Last Name

Informal First Name (if preferred)

Hebrew Name (in English)

Hebrew Name (in Hebrew)

* Birthday

* Cell Phone

* Email

Adult 2 Information

Gender

Title Adult Two

(Mr./Mrs./Ms./Dr./Other)

Adult Two First Name

M.I.

Adult Two Last Name

Informal First Name (if preferred)

Hebrew Name (in English)

Hebrew Name (in Hebrew)

Birthday

Cell Phone

General Information

* Marital Status

Wedding Date

* Street

Apartment/Suite

* City

* State

* Zip

Home Phone

Religious Background

Adult 1

* Previous Synagogue Affiliation

Synagogue name

* Are you...

* If you selected "Jewish by choice", please share conversion details (Synagogue, Rabbi, Date of Conversion, etc.)

Adult 2

Previous Synagogue Affiliation

Synagogue name

Are you...

If you selected "Jewish by choice", please share conversion details (Synagogue, Rabbi, Date of Conversion, etc.)

Occupation and Community involvement

Adult 1

* Occupation

* Employer

* Type of business

Work Phone

* Community Involvement (Activities, board affiliations, volunteer or related experiences)

Adult 2

Occupation

Employer

Type of business

Work Phone

Community Involvement (Activities, board affiliations, volunteer or related experiences)

Children

* Number of Children

Child One

* Child One First Name

Child One Last Name

Informal First Name (if preferred)

Hebrew Name

Gender

* Birthday (mm/dd/yyyy)

School Name

Grade

Camp

Child Two

Child Two First Name

Child Two Last Name

Informal First Name (if preferred)

Hebrew Name

Gender

Birthday (mm/dd/yyyy)

School Name

Grade

Camp

Child Three

Child Three First Name

Child Three Last Name

Informal First Name (if preferred)

Hebrew Name

Gender

Birthday (mm/dd/yyyy)

School Name

Grade

Camp

Child Four

Child Four First Name

Child Four Last Name

Informal First Name (if preferred)

Hebrew Name

Gender

Birthday (mm/dd/yyyy)

School Name

Grade

Camp

Child Five

Child Five First Name

Child Five Last Name

Informal First Name (if preferred)

Hebrew Name

Gender

Birthday (mm/dd/yyyy)

School Name

Grade

Camp

Friends and Family Affiliated with Shearith

Name (First and Last)

Relationship

Name (First and Last)

Relationship

Name (First and Last)

Relationship

Name (First and Last)

Relationship

Emergency Contact

Emergency Contact Name (First and Last)

Relationship

Phone Number

Address

Yahrtzeit Observance

Please provide the names and dates of death of loved ones for whom you would like to receive Yahrzeit notifications

* Number of Yahrtzeits

Yahrtzeit One

Name of Deceased

as it should appear in the listings

Hebrew Name

Relative Of

Relationship

Date of Death

Time of death after sundown

Yahrtzeit Two

Name of Deceased

as it should appear in the listings

Hebrew Name

Relative Of

Relationship

Date of Death

Time of death after sundown

Yahrtzeit Three

Name of Deceased

as it should appear in the listings

Hebrew Name

Relative Of

Relationship

Date of Death

Time of death after sundown

Yahrtzeit Four

Name of Deceased

as it should appear in the listings

Hebrew Name

Relative Of

Date of Death

Time of death after sundown

Yahrtzeit Five

Name of Deceased

as it should appear in the listings

Hebrew Name

Relative Of

Date of Death

Time of death after sundown

Interests and Involvement

At Shearith Israel there are many ways to get involved! Please indicate your interests in one or more of the following areas by clicking the check boxes.

* Our Klei Kodesh love to meet with new members to get to know them better. Would you like them to contact you to set up a meeting?

How can we help you feel at home at Shearith?

Congregation Shearith Israel Media Release

I hereby authorize Congregation Shearith Israel to use my photo and/or information for the use of publications, including electronic publications, audiovisual presentations, promotional literature, advertising, community presentations, and media and/or other similar ways.

I further acknowledge that neither I nor any other party who may share ownership of the property described above (whether in the past or future), will receive financial compensation of any type associated with the taking or publication of these photographs or participation in Congregation Shearith Israel publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever and that participation is voluntary.

I hereby release Congregation Shearith Israel, its contractors, its employees and any third parties involved in the creation or publication of marketing materials from liability for any claims by me or any third party in connection with my participation

Authorization:

* Adult Name One

Adult Name Two

Child Name One

Child Name Two

Child Name Three

Child Name Four

By clicking here, I am authorizing Congregation Shearith Israel to use the photos of the above individuals in promotional materials

By clicking here, I DO NOT authorize Congregation Shearith Israel to use my photos in any promotional materials

How did you hear about Congregation Shearith Israel?

If you selected other:

Please attach a picture here

Can be individual photos or of you and your family

Membership Contribution

Membership at Shearith is an investment in the vibrant, warm and diverse community that we are building together. From lower ticket prices for programs, to Rabbinic support for life cycle events, your membership not only supports programs, classes and initiatives, but also makes them accessible to our members. Your spiritual growth and connection to a community is important to us. Below are a list of membership levels available to all members of our community. please select the dues level for you or your family.

Please keep in mind that all dues include High Holiday seating for Rosh Hashanah and Yom Kippur, except Associate Membership.

* Please select a membership type:

If you selected Benefactor:

Please select a Benefactor level

* If you selected Individual

Please select an age bracket

* Please select a seating location

* If you selected Family

Please select an age bracket

* Please select a seating location

* If you selected Associate Membership:

Please write the name and location of the Synagogue with whom you have your other membership

* If you selected Choose Your Dues:

Please enter the amount you will be contributing to dues for the year

If you selected Kehillah, your application is NOT complete until you have submitted your Kehillah application to the membership department at the JCC.

PLEASE NOTE: Once you've submitted your form, a staff member from our team will be in touch with you.