Membership Form

TEMPLE DOMINION MEMBERSHIP FORM

Thank you for your interest in becoming a member of our synagogue community. Membership is a covenantal relationship rooted in worship, learning, service, and community.
MEMBER INFORMATION
Full Legal Name
Hebrew Name if applicable
Date of Birth

MonthDayYear
Date
What are your pronouns?

Other
Marital Status
SpousePartner Name if applicable
CONTACT INFORMATION
Home Address
City
State
Zip
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Perferred Method of Contact:
HOUSEHOLD INFORMATION (if applicable)
Names of Children/Dependents
Ages
Jewish Status (check all that apply):
Conversion Details (if applicable)
Rabbi Beit Din
Date

MonthDayYear
Date
PARTICIPATION & INTERESTS
Please check areas you are interested in:
MEMBERSHIP COMMITMENT

Membership supports the spiritual, educational, and operational life of the synagogue.
Membership Type:
Annual Membership Contribution: $
Type a question
COMMUNITY COVENANT
By signing below, I affirm my desire to be part of this synagogue community and to uphold its values of respect, learning, worship, and ethical conduct.
Signature
Printed Name
Date Received

MonthDayYear
Date
OFFICE USE ONLY

BELOW
Date Received

MonthDayYear
Date
Membership Approved:

Yes No
Approved By
Notes
Should be Empty:

TEMPLE DOMINION MEMBERSHIP FORM