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Application for Membership
Please verify reCaptcha before submitting the form.
*
Adult 1 - First Name
Adult 1 - Middle Name
*
Adult 1 - Last Name
*
Adult 1 - Date of Birth
Adult 1 - Hebrew Name (type in English or Hebrew)
*
Adult 1 - Are you Cohen, Levi or Yisrael?
Cohen
Levi
Yisrael
None Set
*
Adult 1 - Email
Adult 1 - Mobile Phone
Adult 1 - Father's Hebrew Name (type in English or Hebrew)
Adult 1 - Mother's Hebrew Name (type in English or Hebrew)
*
Adult 1 - Address
*
Adult 1 - City
*
Adult 1 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Adult 1 - Zip Code
*
Adult 1 - Occupation
Adult 1 - Employer
Adult 1 - Work Phone
*
Adult 1 - If not raised in the Jewish tradition are you:
Please Select One
Jew by Choice
Non-Jewish
Other Denomination
Adult 1 - Did your Jewish education include a Bar/Bat Mitzvah?
Please Select One
Yes
No
Adult 1 - Previous (or current) member of the following Synagogue(s)
Volunteers are the life & breath of the congregation & the reason our congregation survives. Participation in Synagogue activities enriches the Synagogue membership experience for everyone. Even a small amount of time on a single project is .....
Chesed (Caring) Committee
College Outreach Committee
Education Committee
Fundraising Committee
Shorashim Nursery School Committee
House Committee
Israel Action Committee
Marketing & Communications Committee
Membership Committee
Programming Committee
Ritual Advisory Committee
Social Action Committee
Is there anything else you would like to share with us? Any interests that you have that we have not listed? Any programs or services that you would like to see that are not currently being offered?
*
Adult 1 - Is there a second adult applying for Membership?
Please Select One
Yes
No
*
Adult 2 - First Name
Adult 2 - Middle Name
*
Adult 2 - Last Name
*
Adult 2 - Date of Birth
Adult 2 - Hebrew Name
*
Adult 2 - Are you Cohen, Levi or Yisrael?
Cohen
Levi
Yisrael
None Set
*
Adult 2 - Email
Adult 2 - Mobile Phone
Adult 2 - Father's Hebrew Name (type in English or Hebrew)
Adult 2 - Mother's Hebrew Name (type in English or Hebrew)
*
Adult 2 - Does Adult 2 live at the same address as Adult 1?
Please Select One
Yes
No
*
Adult 2 - Address
*
Adult 2 - City
*
Adult 2 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Adult 2 - Zip Code
*
Adult 2 - Occupation
Adult 2 - Employer
Adult 2 - Work Phone
*
Adult 2 - If not raised in the Jewish tradition are you:
Please Select One
Jew by Choice
Non-Jewish
Other Denomination
Adult 2 - Did your Jewish education include a Bar/Bat Mitzvah?
Please Select One
Yes
No
Adult 2 - Previous (or current) member of the following Synagogue(s):
Volunteers are the life & breath of the congregation & the reason our congregation survives. Participation in Synagogue activities enriches the Synagogue membership experience for everyone. Even a small amount of time on a single project is .....
Caring Committee
College Outreach Committee
Education Committee
Fundraising Committee
Shorashim Nursery School Committee
House Committee
Israel Action Committee
Marketing & Communications Committee
Membership Committee
Programming Committee
Ritual Advisory Committee
Social Action Committee
Is there anything else you would like to share with us? Any interests that you have that we have not listed? Any programs or services that you would like to see that are not currently being offered?
*
How many children under the age of 26 live in the family home?
Please Select One
One child
Two children
Three children
Four children
Five children
None
*
Child 1 - First Name
*
Child 1 - Last Name
*
Child 1 - Gender
N/A or Unknown
Male
Female
*
Child 1 - Date of Birth
*
Child 1 - Hebrew Name (type in English or Hebrew)
*
Child 1 - Grade in Secular School
*
Child 1 - Name of School
Child 1 - Will attend:
Shorashim Preschool Academy
Religious School
Teen Programs
*
Child 2 - First Name
*
Child 2 - Last Name
*
Child 2 - Gender
N/A or Unknown
Male
Female
*
Child 2 - Date of Birth
*
Child 2 - Hebrew Name (type in English or Hebrew)
*
Child 2 - Grade in Secular School
*
Child 2 - Name of School
Child 2 - Will attend:
Shorashim Preschool Academy
Religious School
Teen Programs
*
Child 3 - First Name
*
Child 3 - Last Name
*
Child 3 - Gender
N/A or Unknown
Male
Female
*
Child 3 - Date of Birth
*
Child 3 - Hebrew Name (type in English or Hebrew)
*
Child 3 - Grade in Secular School
*
Child 3 - Name of School
Child 3 - Will attend:
Shorashim Preschool Academy
Religious School
Teen Programs
*
Child 4 - First Name
*
Child 4 - Last Name
*
Child 4 - Gender
N/A or Unknown
Male
Female
*
Child 4 - Date of Birth
*
Child 4 - Hebrew Name (type in English or Hebrew)
*
Child 4 - Grade in Secular School
*
Child 4 - Name of School
Child 4 - Will attend:
Shorashim Preschool Academy
Religious School
Teen Programs
*
Child 5 - First Name
*
Child 5 - Last Name
*
Child 5 - Gender
N/A or Unknown
Male
Female
*
Child 5 - Date of Birth
*
Child 5 - Hebrew Name (type in English or Hebrew)
*
Child 5 - Grade in Secular School
*
Child 5 - Name of School
Child 5 - Will attend:
Shorashim Preschool Academy
Religious School
Teen Programs
Please list any adult children or grandchildren that are members of your family.
Please chose your Annual Membership Support Level
Please Select One
Family Membership
Single Membership
Senior Family Membership
Senior Single Membership
Shorashim Membership
Associate Family membership (member of another synagogue)
Associate Single Membership (member of another synagogue)
Out of Town Membership
I will discuss my Annual Membership Support with the Executive Director
Please choose any Optional Levels of Support:
Sisterhood Membership ($36)
Mens Club Membership $18
Mortgage Satisfaction Fund (help pay off the building mortgage)
United Synagogue Dues (help to cover the cost of membership dues to United Synagogue of Conservative Judaism
JTS (help support the Jewish Theological Seminary - the seminary of the Conservative Movement)
Is there anything else you would like to share with us? Any interests that you have that we have not listed? Any programs or services that you would like to see that are not currently being offered?
Total Membership Support
Sun, April 28 2024 20 Nisan 5784
