Membership Form

Date

Family Name

Adult 1 - Home Telephone

* Home Address

* City

* State

* Zip Code

* Do you have a secondary/vacation address?

* Secondary/Vacation Address

* City

* State

* Zip Code

* Start Date at this Address

* End Date at this Address

* Adult 1 - Marital Status

Anniversary Date

* Adult 1 - Title

* Adult 1 - First Name

* Adult 1 -Middle Name

* Adult 1 -Last Name

* Adult 1 - Tribe

* Adult 1 - Hebrew Name

* Adult 1 - Your Father's Hebrew Name

* Adult 1 - Your Mother's Hebrew Name

* Adult 1 - Birthdate

* Adult 1 - Mobile Phone

* Adult 1 - Email Address

Adult 1 - Employer

Adult 1 - Occupation

Adult 1 - Business Phone

Adult 1 - Special Skills or Interests

Adult 1 - Membership in Community Organizations

* Is there a second adult applying for membership?

* Adult 2 - Title

* Adult 2 - First Name

* Adult 2 -Middle Name

* Adult 2 -Last Name

* Adult 2 - Tribe

* Adult 2 - Hebrew Name

* Adult 2 - Your Father's Hebrew Name

* Adult 2 - Your Mother's Hebrew Name

* Adult 2 - Birthdate

* Adult 2 - Mobile Phone

* Adult 2 - Email Address

Adult 2 - Employer

Adult 2 - Occupation

Adult 2 - Work Phone

Adult 2 - Special Skills or Interests

Adult 2 - Membership in Community Organizations

* How many Children do you have?

* Child 1 - Name

* Child 1 - Birthdate

* Child 1 - Hebrew Name

* Child 1 - Hebrew School Attending

Child 1 - Email Address

Child 1 - Cell Phone

* Child 1 - Lives:

Child 1 - School Name

Child 1 - School Address

Child 1 - Is Child 1 adopted?

Child 1 - Please note any pertinent information of which you feel we should be aware:

(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)

Child 1 - If yes, has this child, where necessary, been converted according to Jewish law?

Child 1 - If yes, what year and where?

* Child 2 - Name

* Child 2 - Birthdate

* Child 2 - Hebrew Name

* Child 2 - Hebrew School Attending

Child 2 - Email Address

Child 2 - Cell Phone

* Child 2 - Lives:

Child 2 - School Name

Child 2 - School Address

Child 2 - Is Child 2 adopted?

Child 2 - Please note any pertinent information of which you feel we should be aware:

(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)

Child 2 - If yes, has this child, where necessary, been converted according to Jewish law?

Child 2 - If yes, what year and where?

* Child 3 - Name

* Child 3 - Birthdate

* Child 3 - Hebrew Name

* Child 3 - Hebrew School Attending

Child 3 - Email Address

Child 3 - Cell Phone

* Child 3 - Lives:

Child 3 - School Name

Child 3 - School Address

Child 3 - Is Child 3 adopted?

Child 3 - Please note any pertinent information of which you feel we should be aware:

(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)

Child 3 - If yes, has this child, where necessary, been converted according to Jewish law?

Child 3 - If yes, what year and where?

* Child 4 - Name

* Child 4 - Birthdate

* Child 4 - Hebrew Name

* Child 4 - Hebrew School Attending

Child 4 - Email Address

Child 4 - Cell Phone

* Child 4 - Lives:

Child 4 - School Name

if applicable

Child 4 - School Address

Child 4 - Is Child 4 adopted?

Child 4 - Please note any pertinent information of which you feel we should be aware:

(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)

Child 4 - If yes, has this child, where necessary, been converted according to Jewish law?

Child 4 - If yes, what year and where?

How many yahrzeits would you like to observe?

* English Name

* Hebrew Name

* Relationship

To whom?

Date of Death

* Before or After Sunset?

Observance (select one)

* English Name

* Hebrew Name

* Relationship

* To whom?

Date of Death

* Before or After Sunset?

Observance (select one)

* English Name

* Hebrew Name

* Relationship

* To whom?

Date of Death

* Before or After Sunset?

Observance (select one)

* English Name

* Hebrew Name

* Relationship

* To whom?

Date of Death

* Before or After Sunset?

Observance (select one)

* How did you hear about CSZ?

Are you related to a current CSZ member? If so, whom?

Are you currently affiliated with another congregation? If so, which one

Mon, October 28 2024 26 Tishrei 5785

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