Membership Application - Form - Ramat Shalom Beth Israel

Membership Application

MEMBER FAMILY INFORMATION

How many adults are on your account?

Adult 1 Information

* Adult 1 First Name:

* Adult 1 Last Name:

* Adult 1 Date of Birth:

* Adult 1 Hebrew Name:

* Adult 1 Email Address:

* Adult 1 Cell Phone:

Adult 1 Emergency Contact Name

Adult 1 Emergency Contact Phone

* Adult 1 Occupation:

* Adult 1 Business Name:

* Adult 1 Business Phone:

* Adult 1 Business Address:

* Adult 1 Marital Status:

Anniversary

if applicable

Please list any skills, experiences, or areas of interest that you may want to share with our synagogue.

Adult 2 Information

* Adult 2 First Name:

* Adult 2 Last Name:

* Adult 2 Hebrew Name:

* Adult 2 Date of Birth:

* Adult 2 Email Address:

* Adult 2 Cell Phone:

Adult 2 Emergency Contact Name

Adult 2 Emergency Contact Phone

* Adult 2 Occupation:

* Adult 2 Business Name:

* Adult 2 Business Address:

* Adult 2 Business Phone:

Please list any skills, experiences, or areas of interest that you may want to share with our synagogue.

Home and Address Information

* Home Address:

* City:

* State:

* Zip Code:

Additional Information

* Does Ramat Shalom Beth Israel have permission to share your contact information with the congregation?

Please Select OneYesNo

If there any additional information you would like to share with us?

CHILDREN INFORMATION

* How many children up to the age of 26 live in the family home?

* Child 1 - Name

Child 1 - Hebrew Name

* Child 1 - Birthdate

Child 1 - Date of Bar/Bat Mitzvah

Child 1 - School Name

Child 1 - Grade

Child 1 - Email Address, if applicable

DO NOT enter Adult email address here.

* Child 2 - Name

* Child 2 - Hebrew Name

Child 2 - Birthdate

Child 2 - Date of Bar/Bat Mitzvah

Child 2 - School Name

Child 2 - Grade

Child 2 - Email Address, if applicable

DO NOT enter Adult email address here.

* Child 3 - Name

* Child 3 - Hebrew Name

Child 3 - Birthdate

Child 3 - Date of Bar/Bat Mitzvah

Child 3 - School Name

Child 3 - Grade

Child 3 - Email Address, if applicable

DO NOT enter Adult email address here.

* Child 4 - Name

* Child 4 - Hebrew Name

Child 4 - Birthdate

Child 4 - Date of Bar/Bat Mitzvah

Child 4 - School Name

Child 4 - Grade

Child 4 - Email Address, if applicable

DO NOT enter Adult email address here.

* Child 5 - Name

* Child 5 - Hebrew Name

Child 5 - Birthdate

Child 5 - Date of Bar/Bat Mitzvah

Child 5 - School Name

Child 5 - Grade

Child 5 - Email Address, if applicable

DO NOT enter Adult email address here.

YAHRZEIT INFORMATION

How many yahrzeits are you observing?

Deceased 1 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 2 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 3 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 4 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 5 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 6 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 7 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 8 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 9 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

Deceased 10 Name

Hebrew Name

Name of Mourner

Relationship to Mourner

Date of Death

Before SunsetAfter Sunset

English ObservanceHebrew Observance

CONGREGATIONAL FEE INFORMATION

Please choose your Membership Category below. For detailed description of categories, please click here.

Please select the plan that applies to you:

Please select the plan that applies to you:

Security Fee

An additional $400 Security fee will be added per household.

$400 Security Fee

* The congregational year for Ramat Shalom begins June 1st, 2024. I understand that membership dues are payable annually and are not transferable or refundable. In the event that I am unable to meet any of these payments or require a change in my payment arrangement, it is my obligation and responsibility to notify the Director of Administration to avoid losing my membership-in-good-standing and the attendant rights.

The congregational year for Ramat Shalom begins June 1st, 2024. I understand that membership dues are payable annually and are not transferable or refundable. In the event that I am unable to meet any of these payments or require a change in my payment arrangement, it is my obligation and responsibility to notify the Director of Administration to avoid losing my membership-in-good-standing and the attendant rights.

Total 2023-24 Congregational Commitment

Please click on the submit button below. You will be taken to a payment page. You can make a payment at that time, or select "bill to my account" if you prefer to send in a check.