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Har Shalom contact information update
Please help us to keep our contact information current, so that we can all keep in touch. This will just take a minute of your time. Thank you!
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* Indicates required question
Are you currently a member of Har Shalom?
Yes
No
Not sure
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Adult 1 - last name
*
Your answer
Adult 1 - first name
*
Your answer
Adult 1 - birth date
MM
/
DD
Adult 2 - last name
Your answer
Adult 2 - first name
Your answer
Adult 2 - birth date
MM
/
DD
Adult 3 - last name
Your answer
Adult 3 - first name
Your answer
Adult 3 - birth date
MM
/
DD
Child 1 - last name
Your answer
Child 1 - first name
Your answer
Child 1 - birth date
MM
/
DD
Child 2 - last name
Your answer
Child 2 - first name
Your answer
Child 2 - birth date
MM
/
DD
Child 3 - last name
Your answer
Child 3 - first name
Your answer
Child 3 - birth date
MM
/
DD
Additional children's names and birth dates
Your answer
Mailing address - street
*
Your answer
City
*
Your answer
State
Your answer
Zip code
*
Your answer
Home phone number
Please list at least one phone number on this information update form.
Your answer
Cell phone number
Please list at least one phone number on this information update form.
Your answer
Email 1
*
Your answer
Email 2
Your answer
Yartzeit 1 - name
Your answer
Yartzeit 1 - relationship to HS member
Your answer
Gregorian date for Yartzeit 1
MM
/
DD
/
YYYY
After sundown on Gregorian date for Yarzeit 1?
This helps us calculate the Hebrew date.
yes, after sundown
no, not after sundown
do not have this information
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Yartzeit 2 - name
Your answer
Yartzeit 2 - relationship to HS member
Your answer
Gregorian date for Yartzeit 2
MM
/
DD
/
YYYY
After sundown on Gregorian date for Yarzeit 2?
This helps us calculate the Hebrew date.
yes, after sundown
no, not after sundown
do not have this information
Clear selection
Yartzeit 3 - name
Your answer
Yartzeit 3 - relationship to HS member
Your answer
Gregorian date for Yartzeit 3
MM
/
DD
/
YYYY
After sundown on Gregorian date for Yarzeit 3?
This helps us calculate the Hebrew date.
yes, after sundown
no, not after sundown
do not have this information
Clear selection
Please tell us anything else you would like us to know. Thank you!
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