Application for Membership

PERSONAL INFORMATION

Adult 1 Name *

Adult 2 Name

Adult 1 Hebrew Name

Adult 2 Hebrew Name

Adult 1 Birthdate

Adult 2 Birthdate

CONTACT INFORMATION

Name (for printed mailings)

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Adult 1 Phone *

Adult 2 Phone

Adult 1 E-mail *

Adult 2 E-mail

RELIGIOUS BACKGROUND

Other

Adult 1 Please list any relatives who are members of Temple Emanu-El

Adult 2 Please list any relatives who are members of Temple Emanu-El

CHILDREN

Child 1 First Name

Child 2 First Name

Child 3 First Name

Child 4 First Name

Child 1 Last Name

Child 2 Last Name

Child 3 Last Name

Child 4 Last Name

Child 1 Hebrew Name

Child 2 Hebrew Name

Child 3 Hebrew Name

Child 4 Hebrew Name

Child 1 Birthday

Child 2 Birthday

Child 3 Birthday

Child 4 Birthday

Would you like to receive information about our Religious School?

COMMUNICATION

Adult 1 Receive Temple communications via e-mail.

YesNo

Adult 2 Receive Temple communications via e-mail.

YesNo

Adult 1 Receive Temple communications via postal mail.

YesNoThere is a nominal annual fee to receive communications via postal mail.

Adult 2 Receive Temple communications via postal mail.

YesNoThere is a nominal annual fee to receive communications via postal mail.

ACKNOWLEDGMENT

I (Adult 1), *, am applying to become a member of Temple Emanu-El.

I (Adult 2),, am applying to become a member of Temple Emanu-El.

Membership TypeFull MembershipAssociate Membership: 1) former members who have moved out of the Wiregrass and wish to remain connected to our community, or; 2) new friends who reside at a distance too great to fully participate in Temple Emanu-El activities but choose to be spiritually connected to our congregation.

Date *

Date