Online Membership

No charge for membership! All are welcome to join, regardless of background or affiliation!

Full Name

Prefix First Name Last Name Suffix

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Occupation

Birth Date

Month Day Year

Jewish By:

BirthConverted

Check One:

CohenLeviIsrael

E-mail

Phone Number

Area Code Phone Number

Full Name

Prefix First Name Last Name Suffix

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Occupation

Birth Date

Month Day Year

Jewish By:

BirthConverted

Check One

CohenLeviIsrael

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Marital Status

Anniversary Date

Month Day Year

If Divorced: Do you have a Jewish "Get"?

YesNo

Name Child 1

Birth Date Child 1

Month Day Year

Name Child 2

Birth Date Child 2

Month Day Year

Name Child 3

Birth Date Child 3

Month Day Year

Name Child 4

Birth Date Child 4

Month Day Year

Name Child 5

Birth Date Child 5

Month Day Year

Name Child 6

Birth Date Child 6

Month Day Year

Are any children adopted?

YesNo

If yes, give details, including conversion info:

Name 1 English/Hebrew/Father's Hebrew/Last

Date of Passing:

Month Day Year

Relationship

Name 2 English/Hebrew/Father's Hebrew/Last

Date of Passing:

Month Day Year

Relationship

Name 3 English/Hebrew/Father's Hebrew/Last

Date of Passing:

Month Day Year

Relationship

Name 4 English/Hebrew/Father's Hebrew/Last

Date of Passing:

Month Day Year

Relationship

Name 5 English/Hebrew/Father's Hebrew/Last

Date of Passing:

Month Day Year

Relationship

Name 6 English/Hebrew/Father's Hebrew/Last

Date of Passing:

Month Day Year

Relationship

Choose all that apply:

How did you find out about The Family Shul?

Did you belong to any Shul before this?

Are you affiliated with any other Jewish organization?

Notes:

No Charge for Membership: At the Family Shul we believe that you don't have to pay to pray, and therefore do not charge for membership. It is however, through your voluntary contributions that our doors remain open. We thank you for your support! If you can, please consider becoming a Chai Club Partner. May you see Hashems promise of your Tzedaka being repaid many times over.

The Family Shul Membership Form

SECTION I: YOUR INFO

SECTION II: SPOUSE'S INFO

SECTION III: PERSONAL INFORMATION

SECTION IV: CHILDREN

SECTION V: YAHRZEIT INFORMATION

SECTION VI: Please tell us which programs most interest you.

SECTION VII: GENERAL QUESTIONS