application

CONGREGATION BETH ISRAEL MEMBERSHIP APPLICATION

Today’s Date:_____________________

Adult 1 Name:

_______________________________________________________________

Jewish Name*: __________________________________________________________________

Date of Birth: _______________ Is Adult 1 Jewish? (regardless of whether by birth or by conversion) Yes/No

Adult 2 Name: __________________________________________________________________

Jewish Name*: __________________________________________________________________

Date of Birth: _______________

Is Adult 2 Jewish? (regardless of whether by birth or by conversion) Yes/No

Address: ______________________________________________________________________

City/State/Zip: _________________________________________________________________

Home Telephone: _______________________________________________________________

Other Telephone(s): ____________________________________________________________

E-mail(s): _____________________________________________________________________

Fax(es): ______________________________________________________________________

Previous or current synagogue memberships (synagogue name, city, state, dates of membership):

______________________________________________________________________

* “Jewish Names” are most often in Hebrew or Yiddish. If you have a Jewish name, please give your name and the first names of both parents, if known. For example, “Yosef ben Dan v’Chaya” or “Sara bat Avram v’Naomi.” Write in Hebrew or English transliteration.

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Date of wedding anniversary (if applicable): __________________________________

Children and additional household members:

Name/Jewish Name Relationship Date of Birth Is this person Jewish?

(either by birth or conversion)*

_______________________________________________________________________Yes/No

Yahrtzeits (anniversaries of the deaths of loved ones)

Name Relationship Date (Hebrew & English)**

______________________________________________________________________________

Do you have cemetery plots? Yes/No. If “yes,” where?

______________________________________________________________________________

I (we) will abide by the By-Laws, rules and regulations of Congregation Beth Israel.

____________________________________ ___________________________________

Signature Signature

* Congregation Beth Israel follows the Reform movement’s standard of “Patrilineal descent.” In addition to children with two Jewish parents, we regard as a Jew any child with one Jewish parent who has established his or her Jewish identity “through appropriate and timely public and formal acts of identification with the Jewish faith and people.” We ask you, please, to address any question or concerns about this policy to the Congregation’s rabbi.

** If you are uncertain about a Hebrew date, please provide the English date with the year of death and we will calculate the Hebrew date.