Membership Form

I would like to enter information for a spouse/partner

noyesPlease check yes if you have a spouse/partner who would also like to be part of the Beth Tikvah family.

Other

* First Name

* Last Name

My preferred pronouns are...

He, HimShe, HerThey, ThemOther

Other

* Spouse/Partner First Name

* Spouse/partner Last Name

Spouse/Partner Preferred Pronouns

He, HimShe, HerThey, ThemOther

Other

* Email

* Email (Spouse/Partner)

* Primary Phone

Cell Phone

Spouse/Partner Cell Phone

* Address

Address 2

* City

* State

* Zip

I am....

Jewish by BirthJewish by ChoiceNot Jewish

My Spouse/Partner is ....

Jewish by BirthJewish by ChoiceNot Jewish

Please Select One

CohenLeviIsraelite

Please Select One (Spouse/Partner)

CohenLeviIsraelite

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 yearI will pay $2,000 building fund fee over time (years 2-5)I have previously paid a building fund feePlease contact me about the building fund requirementNew 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

Sponsored by: EJ Dotts

Sponsored by: EJ Dotts

EJ Dotts