Congregation Shalom Membership Application

CONTACT & DEMOGRAPHIC INFORMATION

Member 1 (adult)

First Name

Last Name

Hebrew Name (if applicable)

Pronouns

She, her, hersHe, him, hisThey, them, theirsother

Mobile Number

Birthday

Member 2 (adult)

First Name

Last Name

Hebrew Name (if applicable)

Pronouns

She, her, hersHe, him, hisThey, them, theirsother

Mobile Number

Birthday

Primary Address

City

State

Zip

If married, date:

COMMUNITY CONNECTIONS

Member 1

If you are related to any members at Congregation Shalom, please list name(s) and relationship(s).

Name of congregation where you were most recently affiliated.

Member 2

If you are related to any members at Congregation Shalom, please list name(s) and relationship(s).

Name of congregation where you were most recently affiliated.

TELL US ABOUT THE ADULTS IN YOUR HOUSEHOLD

Member 1

Do you read Hebrew?

YesNo

Do you chant Torah?

YesNo

Occupation/Profession

Special skills/talents you'd like to share

Special accommodations, if needed

NoneHearing assistance deviceVisual impairmentOther

If "other" please explain

Member 2

Do you read Hebrew?

YesNo

Do you chant Torah?

YesNo

Occupation/Profession

Special skills/talents you'd like to share

Special accommodations, if needed

NoneHearing assistance deviceVisual impairmentOther

If "other" please explain

TELL US ABOUT THE CHILDREN IN YOUR HOUSEHOLD (IF APPLICABLE)
Click on the plus sign to add each child

Child First Name

Child Last Name

Hebrew Name

Date of Birth

Gender Identity

FemaleMaleNon BinaryPrefer Not to Answer

School or College Name if in School

Grade/Year

Address (if not living with you)

CONGREGATION SHALOM INVOLVEMENT

We are always interested in involving our members in the life and activities of our Congregation. Please indicate any areas that are of interest to the adults in your household.

Member 1

Member 2

Is there any other information you would like to share with us?

Other information

Membership Application

Congregation Shalom Membership Application

Don't forget to also fill out and submit the Pledge Form. Your Membership Application will not be considered complete without it. Thank you!