Temple B'nai Israel Membership Information Form
Please complete the form below in order to become a full, trial, or student member of Temple B'nai Israel. All information will be treated confidentially. Thank you!
Date *
MM
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DD
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YYYY
Name of Member(s): *
Address: *
City: *
State: *
Zip Code: *
Type of membership: *
Required
For full members: I understand that in addition to annual dues, there is also a building fund commitment (paid over 5 years): *
Required
Name of Member #1: *
Hebrew Name:
Birthday:
MM
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DD
/
YYYY
Preferred Pronouns: *
Home phone:
Mobile phone:
Work phone:
E-mail address: *
Name of Member 2:
Hebrew name:
Birthday:
MM
/
DD
/
YYYY
Preferred Pronouns:
Clear selection
Home phone:
Mobile phone:
Work phone:
E-mail address:
Wedding anniversary date:
MM
/
DD
/
YYYY
Emergency Contact Name(someone not living in your household): *
Emergency Contact Phone Number: *
Emergency Contact Relationship to Member: *
Yahrtzeit Name #1:
Relationship to member:
Date of passing:
MM
/
DD
/
YYYY
Yahrzeit Name #2:
Relationship to member:
Date of passing:
MM
/
DD
/
YYYY
Name of child #1:
Hebrew name:
Birthday:
MM
/
DD
/
YYYY
Age:
Preferred Pronouns:
Clear selection
Name of child #2:
Hebrew name:
Birthday:
MM
/
DD
/
YYYY
Age:
Preferred Pronouns:
Clear selection
Name of child #3:
Hebrew name:
Birthday:
MM
/
DD
/
YYYY
Age:
Preferred Pronouns:
Clear selection
Name of child #4:
Hebrew name:
Birthday:
MM
/
DD
/
YYYY
Age:
Gender:
Clear selection
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