Membership Information 2019-2020

Personal Information

Member 1

Member 2

Title

Last Name

First Name

Date of Birth (m/d/y)

Marital Status

Email Address

Occupation/Title

Business Telephone

Mobile Phone

Special Needs

Last School Attended

Degree / Date

Date of Marriage (if applicable)

Address Information

For husband and wife memberships, mail will be addressed to "Mr. & Mrs. Sam G. Member" unless requested otherwise.

Please address our mail as follows (all mail will be sent to Residence unless requested otherwise):

Residence Street

Apartment #

City

State

Zip Code

Home Phone Number

Billing Address (if different)

Billing Street Address

Apartment #

City

State

Zip Code

Family Information

Children (please complete as it applies to each of your children residing with you)

1st Child

2nd Child

3rd Child

4th Child

Last Name

First Name

Birth Date

Age

Gender

School Grade 2018-2019

Secular School Name

Post HS - Living at home?

College Student?

College Name

Adult Children (18 years or older) Not Residing With You

1st Child

2nd Child

3rd Child

4th Child

Last Name

First Name

Birth Date

Age

Gender

College Student?

College Name

Other Adults in Your Household

1st Adult

2nd Adult

3rd Adult

Name

Age

Relationship

Yahrzeit Information

Please list the names of loved ones for whom you wish Yahrzeit notices sent

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

Name of Deceased

Hebrew Name

Relationship

Secular Date

Member 1 or 2?

Before or After Sundown?

Religious Background (Optional)

Member 1

Member 2

Current Religious Tradition / Affiliation

Hebrew Name (if applicable)

Bar / Bat Mitzvah?

Confirmation?

Hebrew Fluency

Miscellaneous Information

How did you hear about BSO?

Reason(s) for joining BSO?

Name of previous Congregation affiliation:

City / State

Year left:

Volunteer Opportunities

We always welcome our members to become involved in temple life and activities.

Please check any that interest you. We will be in touch!

Days of the week you are available

Member 1

Days of the week you are available

Member 2

I prefer to volunteer for short term opportunities

I would like to volunteer on a committee

Activities and Interests

What programs would you like more information about and/or interest you as a participant?

Member 1

Member 2

Tue, January 19 2021 6 Shevat 5781