Membership Application

PERSONAL INFORMATION

MEMBER 1

MEMBER 2

Title

Last Name

First Name

Date of Birth

Marital Status

Date of Marriage (if applicable)

Occupation/Title

Last School Attended

Degree

Email Address

Mobile Phone

Business Telephone

CONTACT INFORMATION

PRIMARY RESIDENCE

Street

Apartment #

City

State

Zip Code

Home Phone

BILLING ADDRESS (If different than Primary Residence)

Street

Apartment #

City

State

Zip Code

FAMILY INFORMATION

Please complete for each child (even adult children not living with you)

CHILD #1

CHILD #2

CHILD #3

CHILD #4

First Name

Last Name

Birth Date

Gender

School Name

School Grade

College Student?

Resides at home?

Please complete for other adults living with you

ADULT #1

ADULT #2

ADULT #3

First Name

Last Name

Birthdate

Relationship

YAHRZEIT INFORMATION

Please complete for the loved ones for whom you wish to receive Yahrzeit notices

YAHRZEIT #1

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

YAHRZEIT #2

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

YAHRZEIT #3

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

YAHRZEIT #4

Name of Deceased

Hebrew Name

Relationship

Relative of Member 1 or 2?

Secular Date

Before or After Sundown?

YAHRZEIT #5

Name of Deceased

Hebrew Name

Relationship

Member 1 or 2?

Secular Date

Before or After Sundown?

RELIGIOUS BACKGROUND
(This information is optional)

MEMBER 1

MEMBER 2

Hebrew Name (if applicable)

Current Religious Tradition / Affiliation

Bar / Bat Mitzvah?

Bar/Bat Mitvah Date (If known)

Confirmed?

Confirmation Date (If known)

Fluent in Hebrew?

MISCELLANEOUS INFORMATION

How did you hear about BSO?

Reason(s) for joining BSO?

Previous Congregation

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!

MEMBER 1

MEMBER 2

I prefer to volunteer for short term opportunities

I would like to volunteer on a committee

Days of the week you are available

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Days of the week you are available

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

ACTIVITIES & INTERESTS

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

MEMBER 1

MEMBER 2

Activities & Interests

Sat, September 14 2024 11 Elul 5784