Membership Application - Form

New Member Application

Welcome! By filling in this form as fully as possible, you will help us serve your needs to the best of our ability. If you have any questions, please email info@templeshalom.net or call (301) 587-2273. Thank you!

* Date of Application

FAMILY INFORMATION

* Family Address

* City

* State

* Zip Code

* Preferred Email Address

* Preferred daytime phone number for any questions

* Name & location of previous synagogue:

How long?

ADULT MEMBER 1 INFORMATION

Adult 1 - Title

* Adult 1 - First Name

Adult 1 - Middle Name

* Adult 1 - Last Name

Adult 1 - Nickname, if preferred

Adult 1 - Maiden Name

if applicable

Adult 1 - Hebrew Name

Adult 1 - Parent's Hebrew Name

* Adult 1 - Occupation

* Adult 1 - Birthdate

* Adult 1 - Commitment Status

Adult 1 - Commitment/Anniversary Date

if applicable

* Adult 1 - Email

* Adult 1 - Mobile Phone

Adult 1 - Employer

Adult 1 - Occupation

Adult 1 - Work Phone

Adult 1 - Work Email

Adult 1 - Employer Address

Adult 1 - Employer City

Adult 1 - Employer State

Adult 1 - Employer Zip Code

* Adult 1 - Religious Identification:

* Adult 1 - Were you active in synagogue life?

Adult 1 - If so, in what capacity?

Adult 1 - Please list any community activities, board affiliations, volunteer work or related experiences:

Adult 1 - College/University

Adult 1 - Degree

Adult 1 - Graduation Date:

Adult 1 - Graduate School

Adult 1 - Degree

Adult 1 - Graduation Date:

ADDITONAL ADULT

* Is there a second adult applying for membership?

ADULT MEMBER 2 INFORMATION

Adult 2 - Title

* Adult 2 - First Name

Adult 2 - Middle Name

* Adult 2 - Last Name

Adult 2 - Nickname, if preferred

Adult 2 - Maiden Name

if applicable

Adult 2 - Hebrew Name

Adult 2 - Parent's Hebrew Name

* Adult 2 - Occupation

* Adult 2 - Birthdate

* Adult 2 - Commitment Status

Adult 2 - Commitment/Anniversary Date

if applicable

* Adult 2 - Email

* Adult Member 2 - Mobile Phone

Adult 2 - Employer

Adult 2 - Occupation

Adult 2 - Work Phone

Adult 2 - Work Email

Adult 2 - Employer Address

Adult 2 - Employer City

Adult 2 - Employer State

Adult 2 - Employer Zip Code

* Adult 2 - Religious Identification:

* Adult 2 - Were you active in synagogue life?

* Adult 2 - If so, in what capacity?

Adult 2 - Please list any community activities, board affiliations, volunteer work or related experiences:

Adult 2 - College/University

Adult 2 - Degree

Adult 2 - Graduation Date:

Adult 2 - Graduate School

Adult 2 - Degree

Adult 2 - Graduation Date:

CHILD INFORMATION

* How many school aged children live in the family home?

CHILD 1 INFORMATION

* Child 1 - Enrolling this year in Temple Shalom Religious School? (Infant/Toddler w/Parent – 12th grade classes available)

YesNo

* Child 1 - First Name and Middle Initial

* Child 1 - Last Name

* Child 1 - Birthdate (mm/dd/yyyy)

Child 1 - Bar/Bat Mitzvah Date (mm/dd/yy)

if applicable

Child 1 - Hebrew Name

if applicable

Child 1 - Email Address

if applicable

Child 1 - Mobile Phone

if applicable

* Child 1 - Current School/College

* Child 1 - Grade/College Year

Child 1 - Address (if in college)

if applicable

Child 1 - Please indicate below any special needs. If you prefer we will be happy to speak with you; 301-587-2273 ext. 111.

CHILD 2 INFORMATION

* Child 2 - Enrolling this year in Temple Shalom Religious School? (Infant/Toddler w/Parent – 12th grade classes available)

YesNo

* Child 2 - First Name and Middle Initial

* Child 2 - Last Name

* Child 2 - Birthdate (mm/dd/yyyy)

Child 2 - Bar/Bat Mitzvah Date (mm/dd/yy)

if applicable

Child 2 - Hebrew Name

if applicable

Child 2 - Email Address

if applicable

Child 2 - Mobile Phone

if applicable

* Child 2 - Current School/College

* Child 2 - Grade/College Year

Child 2 - Address (if in college)

if applicable

Child 2 - Please indicate below any special needs. If you prefer we will be happy to speak with you; 301-587-2273 ext. 111.

CHILD 3 INFORMATION

* Child 3 - Enrolling this year in Temple Shalom Religious School? (Infant/Toddler w/Parent – 12th grade classes available)

YesNo

* Child 3 - First Name and Middle Initial

* Child 3 - Last Name

* Child 3 - Birthdate (mm/dd/yyyy)

Child 3 - Bar/Bat Mitzvah Date (mm/dd/yy)

if applicable

Child 3 - Hebrew Name

if applicable

Child 3 - Email Address

if applicable

Child 3 - Mobile Phone

if applicable

* Child 3 - Current School/College

* Child 3 - Grade/College Year

Child 3 - Address (if in college)

if applicable

Child 3 - Please indicate below any special needs. If you prefer we will be happy to speak with you; 301-587-2273 ext. 111.

CHILD 4 INFORMATION

* Child 4 - Enrolling this year in Temple Shalom Religious School? (Infant/Toddler w/Parent – 12th grade classes available)

YesNo

* Child 4 - First Name and Middle Initial

* Child 4 - Last Name

* Child 4 - Birthdate (mm/dd/yyyy)

Child 4- Bar/Bat Mitzvah Date (mm/dd/yy)

if applicable

Child 4 - Hebrew Name

if applicable

Child 4 - Email Address

if applicable

Child 4 - Mobile Phone

if applicable

* Child 4 - Current School/College

* Child 4 - Grade/College Year

Child 4 - Address (if in college)

if applicable

Child 4 - Please indicate below any special needs. If you prefer we will be happy to speak with you; 301-587-2273 ext. 111.

YAHRZEIT INFORMATION

Should you desire to be notified of the anniversary of the death of a loved one, please indicate whether you prefer to observe the English or Hebrew calendar date. If you do not recall the Hebrew date, please check “Hebrew date of death” and give the full English date and time.

* How many yahrzeits would you like to observe?

* Deceased’s Name

* Related to:

* Relationship

* I/We wish to observe: