Join Us! - Temple Shalom Emeth

Membership Application

Please fill out this form to become a member of our congregation!

Member Information

Name(Required)

First Last

Pronouns(Required)

Date of Birth(Required)

Religion

(if not Jewish, please note if practicing or non-practicing)

Spouse/Partner Information

Name

First Last

Pronouns

Date of Birth

Religion

(if not Jewish, please note if practicing or non-practicing)

Wedding Anniversary

(if applicable)

Contact Information

Address(Required)

Street Address Address Line 2 City State ZIP Code

Member Email Address(Required)

Spouse/Partner Email Address

Home Phone

Member Cell Phone

Spouse/Partner Cell Phone

Children

Child Name

First Last

Date of Birth

Grade In School

Current year (or upcoming year, if summer)

Child Name

First Last

Date of Birth

Grade In School

Current year (or upcoming year, if summer)

Child Name

First Last

Date of Birth

Grade In School

Current year (or upcoming year, if summer)

Child Name

First Last

Date of Birth

Grade In School

Current year (or upcoming year, if summer)

Yahrzeits

Please let us know of any immediate family members whose yahrzeits you would like us to recognize.

Name

First Last

Relationship

Secular Date of Death

Jewish Date of Death

(if known)

Name

First Last

Relationship

Secular Date of Death

Jewish Date of Death

(if known)

Name

First Last

Relationship

Secular Date of Death

Jewish Date of Death

(if known)

Name

First Last

Relationship

Secular Date of Death

Jewish Date of Death

(if known)

Additional Questions

Reasons for choosing Temple Shalom Emeth

How did you hear about the Temple?

Name and city of previous temple affiliation