Membership Application

APPLICATION FOR MEMBERSHIP

TEMPLE ISRAEL - 432 – 30th Street NW - CANTON, OHIO 44709
I/we hereby make application for membership in Temple Israel in accordance with the by-laws of the congregation.
Member #1 Name

PrefixFirst NameLast Name
Member #1 Hebrew Name
Member #1 Date of Birth

MonthDayYear
Date
Member #1 is

Other
Member #1 is

Other
Member #1 Email Address
example@example.com
Member #1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Member # 1 Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Member #1 Occupation & Employer

Spouse/Partner (Member #2) Name

PrefixFirst NameLast Name
Member #2 Hebrew Name
Member #2 Date of Birth

MonthDayYear
Date
Member #2 is

Other
Member #2 is

Other
Member #2 Email Address
example@example.com
Member #2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Member #2 Occupation & Employer

Children's Information

Preferred Formal Name(s)
e.g., Abraham and Sarah Cohen, Mr. and Mrs. Abraham and Sarah Cohen, The Cohens, etc.
Preferred Informal Name(s)
e.g., Abe and Sarah, Sarah and Abraham, etc.
Previous Congregational Affiliation & City
Relatives who are Members of Temple Israel

Yahrzeit (Memorial Anniversary) Information

Rows	Name of Deceased	Relationship to Member	English or Hebrew Date of Death	Before Sundown or After Sundown?	Observance Date (Hebrew or English)
1
2
3
4
5
6
7
8

APPLICATION FOR MEMBERSHIP