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Type of Membership
Single Membership, Family Membership, or Donor Membership
English (full name)
Hebrew Name
Born Jewish or Jewish by choice?
Date of Birth
Home Address
City/State
Zip Code
Email
Phone Number
Employer
Occupation
Yearly Income
Spouse - English (full name)
Hebrew Name
Born Jewish or Jewish by choice?
Date of Birth
Email
Phone Number
Spouse's Employer
Occupation
Yearly Income
Previous Congregation Affiliation
Are husband and wife both Jewish?
Date of Marriage
Children - English Name
Hebrew Name
Date of Birth
Children - English Name
Hebrew Name
Date of Birth
Children - English Name
Hebrew Name
Date of Birth
In Case of Emergency Notify
Relation
Yahrzeit Record - Father English Name
Hebrew Name
Hebrew Date of Death
Date of Death
Mother English Name
Hebrew Name
Hebrew Date of Death
Date of Death
Relative English Name
Hebrew Name
Hebrew Date of Death
Date of Death
Fri, April 19 2024
11 Nisan 5784
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Fri, April 19 2024 11 Nisan 5784
