Membership Application - Congregation Ohev Shalom

SECTION ONE: INFORMATION ABOUT YOU (Primary Account Holder)
Spouse fields will display when "Married" is selected in the "Marital Status" field, below.

* First Name:

Preferred Name:

* Last Name:

* Title (Dr., Mr., Mrs., Ms., etc.):

* Date of Birth (MM/DD/YYYY):

Hebrew Name:

Father's Hebrew Name:

Mother's Hebrew Name:

Home Phone:

Cell Phone:

* Email Address:

* Home Address:

* City:

* State:

* Zip Code:

* Are you Jewish by Birth?

Conversion Certificate

If You Have Converted Kindly Upload Your Conversion Certificate

* Tribe - I am a(n):

* Marital Status

Date Married

Occupation:

Company/Employer Name

INFORMATION ABOUT YOUR SPOUSE (Secondary Account Holder)

Spouse First Name:

Preferred Name:

Last Name:

Title (Dr., Mr., Mrs., Ms., etc.):

Date of Birth (MM/DD/YYYY):

Tribe - I am a(n):

Cell Phone:

Email Address:

Hebrew First Name:

Father's Hebrew Name:

Mother's Hebrew Name:

Occupation:

Company/Employer Name:

SECTION TWO: INFORMATION ABOUT YOUR CHILDREN
Click on the plus sign to add each child. Skip to Step 3 if not applicable.

Child's English Name:

Child's Hebrew Name:

Child's Preferred Name:

Child's Date of Birth:

Child's Gender:

SECTION THREE: PREVIOUS/CURRENT AFFILIATIONS

Previous congregational affiliations:

Current congregational affiliations:

Current memberships in other Jewish organizations:

SECTION FOUR: MEMBERSHIP AND SPONSORSHIP (Jan. 1st through Dec. 31st)

ADDITIONAL MONTHLY SPONSORSHIP:

Rabbi Rodin's Discretionary Fund $54/moRabbi Darrison's Discretionary Fund $54/mo

AGREEMENT

By submitting this form, I/We hereby apply for membership at Congregation Ohev Shalom. I/We agree to abide by Congregation Ohev Shalom’s Bylaws, policies and regulations. I/We acknowledge that dues, pledges, fees, and other financial obligations to Congregation Ohev Shalom are payable according to its policies. All applications are subject to approval per Congregation Ohev Shalom's Bylaws. In the event of resignation, I/We will be responsible for all obligations incurred prior to the resignation date.

Total:

** NOTE: For the submission to process, your account must be set up by adding a password when prompted.