Temple Beth Shalom Membership Form - Form

* Home Mailing Address

* City

* State

* Zip Code

Landline Phone

Leave blank if you have no landline phone number.

Community/Sub-Division:

Adult 1 -Title

* Adult 1 - First Name

Adult 1 - Nickname

Adult 1 - Middle Name

* Adult 1 - Last Name

* Adult 1 - Date of Birth

Adult 1 - Mobile Phone

Adult 1 - Work Phone

* Adult 1 - Email

* Adult 1 - Occupation

* Adult 1 - Jewish?

Adult 1 - Hebrew Name

Adult 1 - Fathers English Name

If living, otherwise leave blank.

Adult 1 - Fathers Hebrew Name

Adult 1 - Fathers Address

Adult 1 - Fathers Phone

Adult 1 - Mothers English Name

If living, otherwise leave blank.

Adult 1 - Mothers Hebrew Name

Adult 1 - Mothers Address

Adult 1 - Mothers Phone

Listed below are areas of congregational activities in which you may be interested. Check the committee(s) and program(s) in which you would like to be active or to which you can lend particular experience and skills.

* Is there a second adult applying for Membership?

Marital Status

Adult 2 - First Name

Adult 2 - Nickname

Adult 2 - Middle Name

Adult 2 - Last Name

Wedding Date:

Adult 2 - Date of Birth

Adult 2 - Mobile

Adult 2 - Work Phone

Adult 2 - Email

MUST BE DIFFERENT THAN ADULT ONE or LEAVE BLANK.

Adult 2 - Occupation

Adult 2 - Jewish?

Adult 2 - Hebrew Name

Adult 2 - Fathers English Name

If living, otherwise leave blank.

Adult 2 - Fathers Hebrew Name

Adult 2 - Fathers Address

Adult 2 - Fathers Phone

Adult 2 - Mothers English Name

If living, otherwise leave blank.

Adult 2 - Mothers Hebrew Name

Adult 2 - Mothers Address

Adult 2 - Mothers Phone

* How many children live in the family home?

Child 1 - First Name

Child 1 - Middle Name

Child 1 - Last Name

Child 1 - Date of Birth

Child 1 - Hebrew Name

if known

Child 1 - Is this child Jewish?

Child 1 - Does this child live at home?

Child 1 - Bar/Bat Mitzvah Date

if applicable

Child 1 - Confirmation Date

if applicable

Child 2 - First Name

Child 2 - Middle Name

Child 2 - Last Name

Child 2 - Date of Birth

Child 2 - Hebrew Name

if known

Child 2 - Is this child Jewish?

Child 2 - Does this child live at home?

Child 2 - Bar/Bat Mitzvah Date

if applicable

Child 2 - Confirmation Date

if applicable

Child 3 - First Name

Child 3 -Middle Name

Child 3 - Last Name

Child 3 - Date of Birth

Child 3 - Hebrew Name

if known

Child 3 - Is this child Jewish?

Child 3 - Does this child live at home?

Child 3 - Bar/Bat Mitzvah Date

if applicable

Child 3 - Confirmation Date

if applicable

Child 4 - First Name

Child 4 -Middle Name

Child 4 - Last Name

Child 4 - Date of Birth

Child 4 - Hebrew Name

if known

Child 4 - Is this child Jewish?

Child 4 - Does this child live at home?

Child 4 - Bar/Bat Mitzvah Date

if applicable

Child 4 - Confirmation Date

if applicable

The names of your deceased loved ones will be read in synagogue the Friday evening before the Yahrzeit Date (anniversary of death). Unsure of the date? Choose a date on which to remember your loved one. Please include Hebrew names if applicable

* How many names would you like to add to our Yahrzeit list?

Deceased English Name

Deceased Hebrew Name

Related to:

Relationship of Deceased to Adult

Secular Date of Death

Hebrew Date of Death

if known

Before/After Sundown

Do you want the name read according to Hebrew or secular date?

Deceased English Name

Deceased Hebrew Name

Related to:

Relationship of Deceased to Adult

Secular Date of Death

Hebrew Date of Death

Before/After Sundown

Do you want the name read according to Hebrew or secular date?

Deceased English Name

Deceased Hebrew Name

Related to:

Relationship of Deceased to Adult

Secular Date of Death

Do you want the name read according to Hebrew or secular date?

Before/After Sundown

Do you want the name read according to Hebrew or secular date?

Deceased English Name

Deceased Hebrew Name

Related to:

Relationship of Deceased to Adult

Secular Date of Death

Hebrew Date of Death

Before/After Sundown

Do you want the name read according to Hebrew or secular date?

We are thrilled for you to be part of the Temple Beth Shalom family!

All members are truly part of this community. We have a variety of ways you can contribute. We never want finances to be a barrier, and we will be glad to make it work financially for you. If you need assistance, please reach out to the temple office at info@annapolistemple.org.

* I have read and understand the financial policies of Temple Beth Shalom

I have read and understand the financial policies of Temple Beth Shalom Please click here to see a copy of the temple's financial policies including the information on the New Member Assessment. If you have questions regarding these policies please email info@annapolistemple.org.

* Please choose a Membership Category:

* I agree to a Security Fee of $150

I would like to make an additonal donation to the Security Fund of:

* I would like to join the Men's Club:

* I would like to join the Sisterhood:

Additonal comments?

Total Membership Commitment