Temple Beth Abraham Application for Membership

Member 1 Information

Surname

First Name

Hebrew Name Phonetically

I am a

Gender

Date of Birth i.e. Feb. 22, 1965

I am Jewish because Please choose one

If you converted to Judaism, were your children also converted?

Occupation

Title

Work Phone

Work Email

Cell Phone

Member 2 Information

Surname

First Name

Hebrew Name Phonetically

I am a

Gender

Date of Birth i.e. Feb. 22, 1965

I am Jewish because Please choose one

If you converted to Judaism, were your children also converted?

Occupation

Title

Work Phone

Work Email

Cell Phone

Family Information

Home Address

City

Zip

Home Phone

Best Family Email

Marital Status

Married
Separated
Divorced
Widowed

If you are married, what is your anniversary date?

1st Child

Last Name if different

First Name

Date of Birth i.e. Feb. 22, 1965

Hebrew Name

If your child is in school please tell us what grade

If your child is in school please tell us what school

If your child is married please tell us their spouse's name

2nd Child

Last Name if different

First Name

Date of Birth i.e. Feb. 22, 1965

Hebrew Name

If your child is in school please tell us what grade

If your child is in school please tell us where

If your child is married please tell us their spouse's name

3rd Child

Last Name if different

First Name

Date of Birth i.e. Feb. 22, 1965

Hebrew Name

If your child is in school please tell us what grade

If your child is in school please tell us where

If your child is married please tell us their spouse's name

4th Child

Last Name if different

First Name

Date of Birth i.e. Feb. 22, 1965

Hebrew Name

If your child is in school please tell us what grade

If your child is in school please tell us where

If your child is married please tell us their spouse's name

Grandchildren

Please tell us the names of your grandchildren.

Yahrzeit Information

Name of Deceased 1st family member

Relationship

Date of Death English or Hebrew (if known)

Name of Deceased 2nd family member

Relationship

Date of Death English or Hebrew (if known)

Name of Deceased 3rd family member

Relationship

Date of Death English or Hebrew (if known)

Name of Deceased 4th family member

Relationship

Date of Death English or Hebrew (if known)

Participation Information

I am comfortable Please choose all that apply

I would like to learn how to Please choose all that apply

What other programs, activities or hobbies are you interested in? book club, singing, sports, etc.

What special skills/talents could you share to enhance life at TBA? music, art, website, dance, carpentry, etc.

How did you hear about Temple Beth Abraham?

So that we may better serve your needs, please tell us the reason(s) that you joined and what you hope to gain from your experience at TBA.

Please tell us any other information you feel is important.

Agreement

Please indicate below that you agree to the terms of membership of Temple Beth Abraham. Please note: In addition to dues there is a $100 Capital Improvement fund payment every year as well as a $100 building fund payment for the 1st 10 years. Once you have submitted your membership application, please send in a deposit of $100 to the temple office: Temple Beth Abraham 1301 Washington Street Canton, MA 02021. Or better yet, bring it in yourself and say, "Shalom!"

I (we) have received a copy of the fee schedule, and understand the terms there in. I (we) agree to meet my (our) financial obligations to Temple Beth Abraham. *

Yes
No