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 *
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Name of Member(s): *
Your answer
Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
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: *
Your answer
Hebrew Name:
Your answer
Birthday:
MM
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DD
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YYYY
Preferred Pronouns: *
Home phone:
Your answer
Mobile phone:
Your answer
Work phone:
Your answer
E-mail address: *
Your answer
Name of Member 2:
Your answer
Hebrew name:
Your answer
Birthday:
MM
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DD
/
YYYY
Preferred Pronouns:
Home phone:
Your answer
Mobile phone:
Your answer
Work phone:
Your answer
E-mail address:
Your answer
Wedding anniversary date:
MM
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DD
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YYYY
Emergency Contact Name(someone not living in your household): *
Your answer
Emergency Contact Phone Number: *
Your answer
Emergency Contact Relationship to Member: *
Your answer
Yahrtzeit Name #1:
Your answer
Relationship to member:
Your answer
Date of passing:
MM
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DD
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YYYY
Yahrzeit Name #2:
Your answer
Relationship to member:
Your answer
Date of passing:
MM
/
DD
/
YYYY
Name of child #1:
Your answer
Hebrew name:
Your answer
Birthday:
MM
/
DD
/
YYYY
Age:
Your answer
Preferred Pronouns:
Name of child #2:
Your answer
Hebrew name:
Your answer
Birthday:
MM
/
DD
/
YYYY
Age:
Your answer
Preferred Pronouns:
Name of child #3:
Your answer
Hebrew name:
Your answer
Birthday:
MM
/
DD
/
YYYY
Age:
Your answer
Preferred Pronouns:
Name of child #4:
Your answer
Hebrew name:
Your answer
Birthday:
MM
/
DD
/
YYYY
Age:
Your answer
Gender:
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