Congregation Beth Israel Membership Application

Congregation Beth Israel Membership Application
First Adult*

First NameLast Name
Hebrew Name
Preferred Pronouns
Are you Jewish?*

YesNo
E-Mail*
Birthdate*
Occupation*
(If full-time student or active duty military, please indicate)
Phone Number*
If Jewish by choice, please indicate date and place of conversion and Rabbi who officiated at your conversion
Please describe your Jewish background (prior congregations, education, etc.)*
Please tell us your goals and interests in joining Beth Israel*
May we contact you by e-mail? (address will not be shared)*

YesNo

Second Adult
First NameLast Name
Hebrew Name
Preferred Pronouns
Are you Jewish?

YesNo
E-Mail
Birthdate
Occupation
(If full-time student or active duty military, please indicate)
Phone Number
If Jewish by choice, please indicate date and place of conversion and Rabbi who officiated at your conversion
Please describe your Jewish background (prior congregations, education, etc.)
Please tell us your goals and interests in joining Beth Israel
May we contact you by e-mail? (address will not be shared)

YesNo

Household Information
Street Address*
City & State*
Zipcode*
Wedding Anniversary
(if applicable) Month, Day, Year
How would you like your names(s) to appear on our membership list? *
(e.g. Ms. Sara Gold, Mr. Jon Cohen, Mr. & Mrs. Jon Cohen, Sarah & Jon Cohen, Sara Gold & Jon Cohen, Dr. Sara Gold, etc.)
Children in Household

Yahrzeits (Remembrances of Loved Ones)
Please list the name and date of death for loved ones whose yahrzeits you wish to be remembered at the Shabbat service preceding the anniversary date. Yahrzeit observances follow the Hebrew calendar, but you may request the secular date if preferred. Our database will calculate the Hebrew date from the secular date provided the year of death is included.
Select to observe on a secular or Hebrew date

SecularHebrew
Yahrzeit 1
Name (Hebrew name also if known)
Relationship
Date
Secular Date and Time of Day (AM or PM) or Hebrew Date (if known)
Yahrzeit 2
Name (Hebrew name also if known)
Relationship
Date
Secular Date and Time of Day (AM or PM) or Hebrew Date (if known)
Yahrzeit 3
Name (Hebrew name also if known)
Relationship
Date
Secular Date and Time of Day (AM or PM) or Hebrew Date (if known)
Yahrzeit 4
Name (Hebrew name also if known)
Relationship
Date
Secular Date and Time of Day (AM or PM) or Hebrew Date (if known)
Yahrzeit 5
Name (Hebrew name also if known)
Relationship
Date
Secular Date and Time of Day (AM or PM) or Hebrew Date (if known)
Yahrzeit 6
Name (Hebrew name also if known)
Date
Secular Date and Time of Day (AM or PM) or Hebrew Date (if known)
Date
Secular Date and Time of Day (AM or PM) or Hebrew Date (if known)
Relationship

Personal Interest
We rely heavily on volunteers at CBI to support programs and the building. Please check areas of interest for volunteering. (Check all that apply)

High Holy DaysHolidays (Purim, Chanukah, Passover)GardeningAdministrative tasksKesher (Religious School)Audio Visual
Do any of your family members need special accommodations? If yes, please explain: *
Consent to use photographs of Congregation Beth Israel members taken at synagogue-related events on the synagogue's website and other published congregational materials will be assumed unless the synagogue office is notified. Notification to opt out of this policy must be made in writing.
Our bylaws provide that any Jewish person eighteen years of age or older is eligible to become a member upon approval of his or her application by the board of directors. The bylaws also provide that both individual and family memberships are each considered one unit of membership in the congregation. By applying to membership at CBI you agree to our Code of Conduct as part of our Member in Good Standing Policy. See section 2.2 of bylaws.

Please find our bylaws below.
Signature*

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Second Adult Signature

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