Tri-Valley Cultural Jews Enrollment Form
Questions?
If you would like to be contacted to discuss your questions before becoming a member, please click here:
https://goo.gl/forms/IKeVOhZoWrxhzzFA3
Personal Information
Adult #1 Name *
Adult #1 Nickname
Adult #1 Birthdate (mm/dd)
Adult #1 Email Address *
Adult #2 Name
Adult #2 Nickname
Adult #2 Birthdate (mm/dd)
Adult #2 Email Address
Home Address
City, State, Zip
Home Phone
Other Phone
Which activities in the organization would you like to participate in?
Is your home available for events?
Clear selection
How did you hear about our organization?
Yortseits you'd like us to remember (name, date and relationship to you):
Would you like to enroll your children in the Jewish Culture School at this time?
Clear selection
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