CEH Membership Registration Form

Whom can we thank for referring you to CEH?

How did you hear about us?

I am applying for the following membership option. (All memberships except for associate include High Holy Day tickets for all family members living full-time in residence.)

Financial means should never be a barrier to membership. For confidential financial assistance, please contact director@etzhayim.net or treasurer@etzhayim.net.

Please list full name of each adult in household.

Adult 1

First NameLast Name

Salutation

Relationship Status

E-mail

Home Phone Number:

Area CodePhone Number

Mobile Phone Number:

Area CodePhone Number

Work Phone Number:

Area CodePhone Number

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Occupation

Birth Date:

MonthDayYear

T-shirt Size

ADULT 1 - Select one option

Other

*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.

Hebrew Name (optional)

Date of Bar/Bat Mitzvah and Torah Portion (optional)

Hobbies/Interests

Adult 2

First NameLast Name

Salutation

Relationship Status

E-mail

Home Phone Number:

Area CodePhone Number

Mobile Phone Number:

Area CodePhone Number

Work Phone Number:

Area CodePhone Number

Occupation

Birth Date:

MonthDayYear

T-shirt Size

ADULT 2 - Select one option

Other

*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.

Hebrew Name (optional)

Date of Bar/Bat Mitzvah and Torah Portion (optional)

Hobbies/Interests

Please list full name of each child in household.

Child 1

First NameLast Name

Birth Date:

MonthDayYear

Child 1 - Select one option

Other

*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.

T-shirt Size

Name of School & Grade

Hebrew Name (optional)

Date of Bar/Bat Mitzvah and Torah Portion (optional)

Hobbies/Interests

Child 2

First NameLast Name

Birth Date:

MonthDayYear

Child 2 - Select one option

Other

*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.

T-shirt Size

Name of School & Grade

Hebrew Name (optional)

Date of Bar/Bat Mitzvah and Torah Portion (optional)

Hobbies/Interests

Child 3

First NameLast Name

Birth Date:

MonthDayYear

Child 3 - Select one option

Other

*Born to Jewish Mother or converted under the auspices of a Beit Din with mikvah and (if relevant) circumcision.

T-shirt Size

Name of School & Grade

Hebrew Name (optional)

Date of Bar/Bat Mitzvah and Torah Portion (optional)

Hobbies/Interests

Child 4

First NameLast Name

Birth Date:

MonthDayYear

Child 4 - Select one option

Other

T-shirt Size

Name of School & Grade

Hebrew Name (optional)

Date of Bar/Bat Mitzvah and Torah Portion (optional)

Hobbies/Interests

Member Directory Permissions

Please indicate which information is okay to publish in our Member Directory. This directory is shared only with members and staff of Congregation Etz Hayim.

Adult 1 - Directory preferences

Adult 2 - Directory preferences

Do you have a skill/talent that you would like to contribute to our congregation? If yes, please describe.

ADULT 1 - Would you like to contribute to/participate in any of the following activities? Please mark all that apply.

ADULT 2 - Would you like to contribute to/participate in any of the following activities? Please mark all that apply.

List activities you would like to organize at our synagogue that are not outlined above.

Anything else we should know about you/your family?

How would you like for us to contact you?

Congregation Etz Hayim Membership Application

Activities & Ways to Get Involved