Online New Membership Application

Membership Category	Fees
Family (includes 2 High Holiday Seats)	$1400
Single (includes 1 High Holiday Seat)	$1000
Associate	$500
Married student (Full time College) 2 High Holiday Seats	$380
Single student (Full time College) 1 High Holiday Seat	$200
Active Military or Law Enforcement	FREE

Please fill out application below:

Applicant

* Choose Membership Category

If student, name of school and field of study

* English Name (First and Last)

* Hebrew Name

* Birthplace

* Birthdate

* Tribe

* Father's Hebrew Name

* Mother's Hebrew Name

* Home Phone

* Cell Phone

* Email Address

* Address 1

Address 2

* City

* State

* Zip Code

* Occupation

Place of Employment

* Previous Synagogue Affiliation

* Name of Previous Synagogue

* Describe your Jewish Education

Spouse

English Name

Hebrew Name

Birthplace

Birthdate

Tribe

Father's Hebrew Name

Mother's Hebrew Name

Home Phone

Cell Phone

Address 1

Address 2

City

State

Zip Code

Occupation

Place of Employment

Previous Synagogue Affiliation

Name of Previous Synagogue

Describe your Jewish Education

Volunteering

Please list areas of interest for volunteering (ex. Kiddush, Shopping, Shalosh Seudos, Chessed, etc.)

Applicant's Marital Status

Wedding Date (if married)

Place of Marriage

Previously Divorced?

ApplicantSpouse

Name of Rabbi(s) who wrote Get

Where and When was Get Written?

Conversion to Judaism

ApplicantSpouse

Name of Rabbi who performed conversion

Location/Date of Conversion

Children

Children (English and Hebrew names; English date of birth). Start each on a blank line.

Yartzheits

English Name, Hebrew Name, Hebrew date of passing, Relationship to applicant or spouse

E-Signature

* First/Last Name(s) for application signature

I am/We are interested in membership at Beth Jacob Congregation and hereby submit this application. I/We agree to abide by the rules, regulations and by-laws of Beth Jacob Congregation.

Rabbi's Signature

President's Signature

Thu, January 2 2025 2 Teves 5785

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