TSE Membership Application

Personal Information

Member 1

Member 2

Title

Last Name

First Name

Date of Birth (m/d/y)

Click on month, date, year to type in change; or click on arrow at right of box to select from calendar.

Date of Birth (m/d/y)

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Marital Status

Email Address

Occupation/Title

Business Telephone

Mobile Phone

Special Needs

Last School Attended

Degree / Date

Date of Marriage (if applicable)

Address Information

Residence Street

Apartment #

City

State

Zip Code

Home Phone Number

Billing Address (if different)

Billing Street Address

Apartment #

City

State

Zip Code

Family Information

Children (please complete as it applies to each of your children residing with you)

1st Child

2nd Child

3rd Child

4th Child

Last Name

First Name

Birth Date

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Birth Date

Gender

School Grade Fall 2023

Secular School/College Name

Adult Children (25 years or older) Not Residing With You

1st Child

2nd Child

3rd Child

4th Child

Last Name

First Name

Hebrew Name

Birth Date

Age

Gender

College Student?

College Name

Other Adults in Your Household

1st Adult

2nd Adult

3rd Adult

Name

Age

Relationship

Yahrzeit Information

Please list the names of loved ones for whom you wish Yahrzeit notices sent

Name of Deceased

Relationship

Member 1 or 2?

Secular Date

Click on month, date, year to type in change; or click on arrow at right of box to select from calendar.

Name of Deceased

Relationship

Member 1 or 2?

Secular Date

Name of Deceased

Relationship

Member 1 or 2?

Secular Date

Name of Deceased

Relationship

Member 1 or 2?

Secular Date

Name of Deceased

Relationship

Member 1 or 2?

Secular Date

Religious Background (Optional)

Member 1

Member 2

Religious tradition in which you were raised

If not raised in the Jewish tradition, are you

Hebrew Name (if applicable)

Bar / Bat Mitzvah?

Confirmation?

Hebrew Fluency

Miscellaneous Information

How did you hear about Temple Shaari Emeth?

Reason(s) for joining a synagogue:

Reason(s) for joining Temple Shaari Emeth?

Name of previous Congregation affiliation:

City / State

Year left:

Agreement

The undersigned hereby apply for membership in Temple Shaari Emeth and agree to comply with the rules and regulations of the Temple, and to pay and be responsible for the dues and full building assessments as established by the Board of Trustees. It is understood that the full unpaid building fund assessment is due upon resignation, and resignations must be submitted in writing. B'nai Mitzvah dates are assigned and confirmed at the completion of 4th grade. It is further understood that any child attending our Religious School shall continue attending after Bar/Bat Mitzvah through Confirmation, which occurs at the end of 10th grade.

Is there anything that we should be aware of?

Member 1

Writing your name here is the equivalent of your signature. You are agreeing to the above as conditions of membership.

Member 2

Writing your name here is the equivalent of your signature. You are agreeing to the above as conditions of membership.

Sat, April 20 2024 12 Nisan 5784