Non-Member Access Request Application

Non-Member Access Request Application

Beth Sholom Congregation reserves the right to restrict admission to our building. All non-members must request access by submitting this form to the synagogue office. Please complete a separate form for each person who resides at a different address. Please include the names of the family members (at the same address) who will be joining you. *****All fields are required unless marked otherwise.*****
Email
example@example.com
First Name
Last Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Telephone number where you can be reached (with area code)
Please enter a valid phone number.Format: (000) 000-0000.
Please let us know the reason for your visit to Beth Sholom.
Service you are requesting to attend
If Other, please specify
First requested date of your visit

MonthDayYear
Date
If you need additional dates, please enter the number of days you wish to visit
Are you a member of another synagogue?
Name and contact information for your rabbi or synagogue:
Do you know any Beth Sholom Congregation members?
Names of Beth Sholom members you know:
If you do not know any Beth Sholom members, please list two local references:
Local reference 1
Local reference 2
Should be Empty: