Names(s)______________________________________________________________________________
(Please print name(s) exactly as you wish to be listed)
Home Address___________________________________Email___________________________________
City____________________________ State_____ Zip: _________Phone____________________________
Marital Status: Married Single Divorced Separated Widowed Date of Marriage_________________
Hebrew Name___________________________________________________________________________
Father's Hebrew Name_____________________________________________________________________
Mother's Hebrew Name____________________________________________________________________
Kohen/Levi/Yisrael_______________________________________________________________________
Date of Birth____________________________________________________________________________
Occupation______________________________________________________________________________
Specialization____________________________________________________________________________
Business Name___________________________________________________________________________
Address________________________________________________________________________________
City, State, Zip___________________________________________________________________________
Business Telephone/Fax___________________________________________________________________
| Jewish Background: | Conservative | Conservative |
| Reform | Reform | |
| Orthodox | Orthodox | |
| Reconstructionist | Reconstructionist | |
| Other_________ | Other_________ | |
| Jew By ChoiceConversion Date_____ | Jew By Choice Conversion Date___ | |
| Synagogue Skills | Torah Reading | Torah Reading |
| Haftorah Chanting | Haftorah Chanting | |
| Leading Service | Leading Service | |
| Shofar Blowing | Shofar Blowing | |
| Other___________ | Other________ |
Name_________________________________ Hebrew Name _______________Date of Birth__________________ Name_________________________________ Hebrew Name _______________Date of Birth__________________ Name_________________________________ Hebrew Name _______________Date of Birth_________________
OTHER PERSON(S) IN HOUSEHOLD
Name______________________________________Relationship__________________________________________ Name______________________________________Relationship__________________________________________
Are you related to other Beth Israel Members? Who?__________________________________________________
YAHRZEIT RECORD:
| Name: | Relationship: | English Date | Hebrew Date If Hebrew Date is not Known please indicate if before or after sunset on English date. |
REMARKS
Please indicate special talents, skills, interest, willingness to serve on particular committees, etc.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Name/Community of previous Congregation__________________________________________________________
Does family have a cemetery plot? Yes No Location_____________________________________________