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!
Are you currently a member of Har Shalom?
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Adult 1 - last name *
Adult 1 - first name *
Adult 1 - birth date
MM
/
DD
Adult 2 - last name
Adult 2 - first name
Adult 2 - birth date
MM
/
DD
Adult 3 - last name
Adult 3 - first name
Adult 3 - birth date
MM
/
DD
Child 1 - last name
Child 1 - first name
Child 1 - birth date
MM
/
DD
Child 2 - last name
Child 2 - first name
Child 2 - birth date
MM
/
DD
Child 3 - last name
Child 3 - first name
Child 3 - birth date
MM
/
DD
Additional children's names and birth dates
Mailing address - street *
City *
State
Zip code *
Home phone number
Please list at least one phone number on this information update form.
Cell phone number
Please list at least one phone number on this information update form.
Email 1 *
Email 2
Yartzeit 1 - name
Yartzeit 1 - relationship to HS member
Gregorian date for Yartzeit 1
MM
/
DD
/
YYYY
After sundown on Gregorian date for Yarzeit 1?
This helps us calculate the Hebrew date.
Clear selection
Yartzeit 2 - name
Yartzeit 2 - relationship to HS member
Gregorian date for Yartzeit 2
MM
/
DD
/
YYYY
After sundown on Gregorian date for Yarzeit 2?
This helps us calculate the Hebrew date.
Clear selection
Yartzeit 3 - name
Yartzeit 3 - relationship to HS member
Gregorian date for Yartzeit 3
MM
/
DD
/
YYYY
After sundown on Gregorian date for Yarzeit 3?
This helps us calculate the Hebrew date.
Clear selection
Please tell us anything else you would like us to know. Thank you!
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