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Sponsored by: EJ Dotts
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Membership Form
I would like to enter information for a spouse/partner
no
yes
Please check yes if you have a spouse/partner who would also like to be part of the Beth Tikvah family.
Please choose your preferred title
Mr.
Mrs.
Ms.
Miss
Dr.
Other
Other
*
First Name
*
Last Name
My preferred pronouns are...
He, Him
She, Her
They, Them
Other
Other
Please choose your spouse's/partner's preferred title
Mr.
Mrs.
Ms.
Miss
Dr.
Other
Other
*
Spouse/Partner First Name
*
Spouse/partner Last Name
Spouse/Partner Preferred Pronouns
He, Him
She, Her
They, Them
Other
Other
*
Email
*
Email (Spouse/Partner)
*
Primary Phone
Cell Phone
Spouse/Partner Cell Phone
*
Address
Address 2
*
City
*
State
--Select State--
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*
Zip
I am....
Jewish by Birth
Jewish by Choice
Not Jewish
My Spouse/Partner is ....
Jewish by Birth
Jewish by Choice
Not Jewish
Please Select One
Cohen
Levi
Israelite
Please Select One (Spouse/Partner)
Cohen
Levi
Israelite
Hebrew First Name
Hebrew First Name (Spouse/Partner)
Parent 1 Hebrew name
Parent 1 Hebrew name (Spouse/Partner)
Parent 2 (if applicable) Hebrew name
Parent 2 (if applicable) Hebrew name (Spouse/Partner)
Birth date
Birth Date (Spouse/Partner)
Anniversary
Job Title/Occupation
Job Title/Occupation (Spouse/Partner)
*
Building Fund (New Members)
I will pay $1,500 building fund fee this year
I will pay $2,000 building fund fee over time (years 2-5)
I have previously paid a building fund fee
Please contact me about the building fund requirement
New members who have not previously fulfilled a building fund obligation at another synagogue are expected to make their contribution to the Building Fund, but this can be spread over a number of years or deferred, if necessary.
Add Children Information if any
*
Child First Name
Child Last Name (if Different)
Hebrew Name
*
Birthdae
Sun, April 18 2021 6 Iyyar 5781