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Member Information
HOW MANY ADULTS ARE PART OF THIS MEMBERSHIP APPLICATION?
Please Select One
One
Two
PRIMARY MEMBER INFORMATION
Title
*
First Name
*
Last Name
Gender
N/A or Unknown
Male
Female
*
Date of Birth
*
Email Address
Mobile Phone
Primary Language
Secondary Language
Occupation
Business Name
Business Phone Number
*
Are you Jewish?
Please Select One
Yes
Yes, by Conversion
No
Conversion Date
(if applicable)
Conversion Location
(if applicable)
Hebrew Name
(if known)
Father's Hebrew Name
(if known)
Mother's Hebrew Name
(if known)
Tribe
Kohen
Levi
(check for yes)
SECONDARY MEMBER INFORMATION
Title
*
First Name
*
Last Name
Gender
N/A or Unknown
Male
Female
*
Date of Birth
Email Address
Mobile Phone
Primary Language
Primary Language
Occupation
Business Name
Business Phone Number
*
Are you Jewish?
Please Select One
Yes
Yes, by Conversion
No
Conversion Date
(if applicable)
Conversion Location
(if applicable)
Hebrew Name
(if known)
Father's Hebrew Name
(if known)
Mother's Hebrew Name
(if known)
Tribe
Kohen
Levi
(check for yes)
*
Marital/Relationship Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Anniversary
(if applicable)
Member Address Information
*
Home Address
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
Home Phone
Children Information
*
DO YOU HAVE CHILDREN TO ADD TO THIS MEMBERSHIP APPLICATION?
Please Select One
Yes
No
*
HOW MANY CHILDREN?
Please Select a Quantity
One
Two
Three
Four
CHILD ONE INFORMATION
*
Full Name
Hebrew Name
(if known)
*
Date of Birth
*
Does this child live at home?
Please Select One
Yes
No
*
Has this child had a Bar/Bat Mitzvah?
Please Select One
Yes
No
What was the date?
*
Name of School they are entering in the Fall
*
Grade they are entering in the Fall
CHILD TWO INFORMATION
*
Full Name
Hebrew Name
(if known)
*
Date of Birth
*
Does this child live at home?
Please Select One
Yes
No
*
Has this child had a Bar/Bat Mitzvah?
Please Select One
Yes
No
What was the date?
*
Name of School they are entering in the Fall
*
Grade they are entering in the Fall
CHILD THREE INFORMATION
*
Full Name
Hebrew Name
(if known)
*
Date of Birth
*
Does this child live at home?
Please Select One
Yes
No
*
Has this child had a Bar/Bat Mitzvah?
Please Select One
Yes
No
What was the date?
*
Name of School they are entering in the Fall
*
Grade they are entering in the Fall
CHILD FOUR INFORMATION
*
Full Name
Hebrew Name
(if known)
*
Date of Birth
*
Does this child live at home?
Please Select One
Yes
No
*
Has this child had a Bar/Bat Mitzvah?
Please Select One
Yes
No
What was the date?
*
Name of School they are entering in the Fall
*
Grade they are entering in the Fall
Member Interests
What do you hope to achieve through your membership at Beth Torah?
(Check all that apply)
A connection to your spirituality
A sense of community
A strong Jewish education for your child(ren)
Adult Education
The counsel of Rabbis of lifecycle events
Social Experiences
High Holy Days Worship
Other
Are you interested in Latin programs?
Yes
No
I am interested in High Holy Days Preferred Endowed Seating.
($3,600 per seat payable over 3 years or $3,000 per seat in one payment)
Yes
No
Did anyone refer you to Beth Torah?
Please Select One
Yes
No
*Who should we thank?
Please provide us with any additional information or requests that you feel are important:
Yahrzeit Information
*
DO YOU HAVE YAHRZEITS TO ADD TO THIS MEMBERSHIP APPLICATION?
Please Select One
Yes
No
*
HOW MANY YAHRZEITS?
Please Select a Quantity
One
Two
Three
Four
Five
Six
We want to help you observe the Yahrzeit of your loved ones. Please provide the information below for us to record your observance.
*
Name
*
Relationship
*
Mourner
Please Select One
Primary Member
Secondary Member
Both Members
*
English Date of Death
*
Time of Death
Please Select One
Before Sundown
After Sundown
*
Name
*
Relationship
*
Mourner
Please Select One
Primary Member
Secondary Member
Both Members
*
English Date of Death
*
Time of Death
Please Select One
Before Sundown
After Sundown
*
Name
*
Relationship
*
Mourner
Please Select One
Primary Member
Secondary Member
Both Members
*
English Date of Death
*
Time of Death
Please Select One
Before Sundown
After Sundown
*
Name
*
Relationship
*
Mourner
Please Select One
Primary Member
Secondary Member
Both Members
*
English Date of Death
*
Time of Death
Please Select One
Before Sundown
After Sundown
*
Name
*
Relationship
*
Mourner
Please Select One
Primary Member
Secondary Member
Both Members
*
English Date of Death
*
Time of Death
Please Select One
Before Sundown
After Sundown
*
Name
*
Relationship
*
Mourner
Please Select One
Primary Member
Secondary Member
Both Members
*
English Date of Death
*
Time of Death
Please Select One
Before Sundown
After Sundown
Disclosure & Agreement of Membership
We are an all-inclusive synagogue. Special financial arrangements may be made for anyone wishing to become part of our Beth Torah Family. If financial conditions proclude you from joining at any of the established categories please contact the Executive Director, so that your membership with the Beth Torah Family can be arranged in accordance with your financial circumstances.
Dues payment policy:
Each member shall have their account current in accordance with the Payment Plan. If at all possible, full payment will be very helpful and appreciated. All financial obligations must be met by the end of the fiscal year to remain in good standing.
By joining Beth Torah and signing below, I agree to abide by its Constitution and bylaws, and to be responsible for all financial obligations incurred through my membership.
I understand that all synagogue activities in which I and my family participate in may result in media coverage. I authorize BTBRC to use it in its promotional materials ad all photographic, audio and visual images of my family.
*
Signature
*
Date
Sat, May 4 2024 26 Nisan 5784
