Membership Application

Membership Application

Please fill in complete information if you are a new member. For renewed memberships please submit the information you would like updated.
Are you renewing your membership?
Membership (Dues includes High Holiday seats)

Family $1200Individual $800Sisterhood $36Men's Club $36
Name

First NameLast Name
Spouse Name

First NameLast Name
Child Name(s) - (Select "+" for additional lines)
Parent's Hebrew Name: Father

First NameLast Name
Mother

First NameLast Name
Spouse's Parent's Hebrew Name: Father

First NameLast Name
Mother

First NameLast Name
Primary Residence

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Primary Phone*

Area CodePhone Number
Local Address

Street Address

Street Address Line 2

CityState

Zip Code
Local Phone

Area CodePhone Number
Mailing Address if different from primary residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Affiliation:

KohanLeviYisrael
Yahrzeit Record (select "+" for additional lines)
Select Activities of Interest

Adult EducationLecturesSocial EventsServe on CommitteesOther
How did you find CTI?

Friend or relativeSocial MediaOur websiteZoom service or programNewspaper articleOther
Please list your skills or talents that could help our shul.
Questions / Comments
Calculation
Payment Type:

Online PaymentsMail in check
Please print (Ctrl P) to print this form and mail it to:

Congregation Tifereth Israel
Attention: Elaine Goldman
PO Box 659
Greenport, NY 11944

Check payable to: Congregation Tifereth Israel

Contact Elaine Goldman if you have any questions.

(631) 765-3504

epgoldy5@gmail.com
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