Membership Application Membership Application Date Last Name(s) Home Street Address City, State, Zip Preferred Phone Number (home/cell/work – please circle) Email Address What brought you to Temple Israel Ner Tamid? ADULT #1 Name Nickname Hebrew Name Birthdate Work Name & Address Occupation Work # E-mail ADULT #2 Name Nickname Hebrew Name Birthdate Work Name & Address Occupation Work # E-mail Wedding Anniversary Date ADULT #1 Name ADULT #2 Name Educational Background Educational Background Community/Civic Activities Community/Civic Activities Hobbies/Special Interests Hobbies/Special Interests Do you read Hebrew? Do you read Hebrew? Year of Bar/Bat Mitzvah Year of Bar/Bat Mitzvah Year of Confirmation Year of Confirmation CHILD #1 Name Nickname Hebrew Name Birthdate Day (Secular) School Read/Speak Hebrew? Read/Chant Torah? Play Musical Instrument? CHILD #2 Name Nickname Hebrew Name Birthdate Day (Secular) School Read/Speak Hebrew? Read/Chant Torah? Play Musical Instrument? CHILD #3 Name Nickname Hebrew Name Birthdate Day (Secular) School Read/Speak Hebrew? Read/Chant Torah? Play Musical Instrument? 1. Name of Deceased English Date of Death Yahrzeit To Be Read on Which Date? English Hebrew Relationship to Congregant 2. Name of Deceased English Date of Death Yahrzeit To Be Read on Which Date? English Hebrew Relationship to Congregant 3. Name of Deceased English Date of Death Yahrzeit To Be Read on Which Date? English Hebrew Relationship to Congregant 4. Name of Deceased English Date of Death Yahrzeit To Be Read on Which Date? English Hebrew Relationship to Congregant Do you have time to spare? Make your own contribution to our congregation through volunteer activities. ADULT #1 ADULT #2 Yes, I’d like to help with: Greeting/Ushering at Services Office Help/Mailings Help During School Hours Suggestions? _________________________________ Yes, I would like to help with: Greeting/Ushering at Services Office Help/Mailings Help During School Hours Suggestions? _______________________________ Please check all activities in which you would like to participate. Adult Education Adult B’nai Mitzvah Cultural Programs Religious School Please check all activities in which you would like to participate. Adult Education Adult B’nai Mitzvah Cultural Programs Religious School ADULT #1 Name & Date ADULT #2 Name & Date Text Submit Start Over If you are human, leave this field blank.
