BI Membership Form

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Please Note: In the case of a Single Membership, the applicant is
Jewish. In the case of a Family Membership, only one adult is
required to be Jewish.

Select Single Membership (one adult) or Family Membership (one or two adults, including children living at home)

Single MembershipFamily Membership

Adult 1 - First Name

Adult 1 - Last Name

Adult 1 - Date of Birth

Adult 1 - Gender

Adult 1 - Hebrew Name

Adult 1 - Fathers Hebrew Name

Adult 1 - Mothers Hebrew Name

Home Mailing Address

City

State

Zip Code

Home Phone

Cell Phone

Email Address

Marital Status

Occupation

Employer

Adult 2 - First Name

Adult 2 - Last Name

Adult 2 - Date of Birth

Adult 2 - Gender

Adult 2 - Hebrew Name

Adult 2 - Fathers Hebrew Name

Adult 2 - Mothers Hebrew Name

Cell Phone

Email Address

Marital Status

Occupation

Employer

Does Adult 2 live at the same address?

Adult 2 - Home Mailing Address

Adult 2 - City

Adult 2 - State

Adult 2 - Zip Code

Adult 2 - Home Phone

Name

Address

City & Postal Code

Contact Number

How many children live in the family home?

Child 1 - First Name

Child 1 - Last Name

Child 1 - Hebrew Name

Child 1 - Gender

Child 1 - Date of Birth

Child 1 - Secular School Name

Child 1 - Grade

Has Child 1 had a bar/bat mitzvah?

Child 1 - Bar/Bat Mitzvah Date

Child 2 - First Name

Child 2 - Last Name

Child 2 - Hebrew Name

Child 2 - Gender

Child 2 - Date of Birth

Child 2 - Secular School Name

Child 2 - Grade

Has Child 2 had a bar/bat mitzvah?

Child 2 - Bar/Bat Mitzvah Date

Child 3 - First Name

Child 3 - Last Name

Child 3 - Hebrew Name

Child 3 - Gender

Child 3 - Date of Birth

Child 3 - Secular School Name

Child 3 - Grade

Has Child 3 had a bar/bat mitzvah?

Child 3 - Bar/Bat Mitzvah Date

Child 4 - First Name

Child 4 - Last Name

Child 4 - Hebrew Name

Child 4 - Gender

Child 4 - Date of Birth

Child 4 - Secular School Name

Child 4 - Grade

Has Child 4 had a bar/bat mitzvah?

Child 4 - Bar/Bat Mitzvah Date

The Congregations Directory is going online! Would you like to be listed in the directory?

Once logged into their account, members will have the ability to set which personal information is available online. If you are applying as a One-Adult member, do you want your partner/spouse (if applicable) listed in the Directory? If yes, plese provide their name.

Name of partner/spouse

Please let us know how you learned about Beth Israel & your reason for joining:

The names of your deceased loved ones will be read in synagogue on the Shabbat before the Yahrzeit Date (anniversary of death). Unsure of the date? Choose a date on which to remember your loved one.

Deceased First Name

Deceased Last Name

Deceased Hebrew Name

Deceased Date of Death

Yahrzeit Observance

Relationship to the Deceased

Thu, 3 July 2025 7 Tammuz 5785