Membership Application Form

First Name (Primary)

Last Name (Primary)

Hebrew Name:

Jewish By:

If converted, conversion date:

First Name (Secondary)

Last Name (Secondary)

Hebrew Name:

Jewish By:

BirthConversionNotJewish

If converted, conversion date:

Tribe (Primary)

Tribe (Secondary)

Birthday: (Primary)

If joining under an age category, you must submit your birthday year. PLUS, we want to send you Happy Birthday Emails

Birthday: (Secondary)

If joining under an age category, you must submit your birthday year. PLUS, we want to send you Happy Birthday Emails

Street:

City

State

Zip Code

Home Phone:

Cell Phone 1:

Cell Phone 2:

E-Mail Address: (Primary)

E-Mail Address: (Secondary)

Marital Status:

If married, anniversary date:

* Are you interested in receiving updates on future Congregation Adat Reyim community events?

Photo Consent

The Synagogue occasionally photograph adults and children during special activities for use in press releases in local Jewish or secular newspapers, or for use in the synagogue newsletter, brochure or website, facebook etc. These photos are often on a spur-of-the-moment basis, which makes it difficult to obtain immediate consent. Consent is requested for you and/or your child(ren) to be photographed at Adat Reyim or during any of their activities.