Membership Application

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We are delighted that you have chosen to join Congregation Brothers of Israel!

To ensure that we can efficiently communicate with you please fill in the information below

* Adult 1 - First Name

* Adult 1 - Middle Name

* Adult 1 - Last Name

Adult 1 - Maiden Name

if applicable

* Adult 1 - Preferred Name

* Adult 1 - Date of Birth

* Adult 1 - Place of Birth/Country

Adult 1 - Marital Status

Adult 1 - Hebrew Name

* Adult 1 - Email Address

* Adult 1 - Mobile Phone

Adult 1 - Home Phone

* Adult 1 - Home Address

Adult 1 - Address 2

* Adult 1 - City

* Adult 1 - State

* Adult 1 - Zip Code

* Adult 1 - Occupation/Profession

* Adult 1 - Business/Employer Name

* Adult 1 - Business Phone

* Adult 1 - Secular Education

Adult 1 - Photograph

Please attach a photo of Adult 1 above:

* Is there a second adult applying for membership?

* Adult 2 - First Name

* Adult 2 - Middle Name

* Adult 2 - Last Name

Adult 2 - Maiden Name

if applicable

* Adult 2 - Preferred Name

* Adult 2 - Date of Birth

* Adult 2 - Place of Birth/Country

Adult 2 - Marital Status

Adult 2 - Hebrew Name

* Adult 2 - Email Address

* Adult 2 - Mobile Phone

Adult 2 - Home Phone

* Adult 2 - Occupation/Profession

* Adult 2 - Business/Employer Name

* Adult 2 - Business Phone

* Adult 2 - Secular Education

Adult 2 - Photograph

Please attach a photo of Adult 2 here above

* Adult 2 - Does Adult 2 live at the same address as Adult 1?

* Adult 2 - Home Address

* Adult 2 - Address 2

* Adult 2 - City

* Adult 2 - State

* Adult 2 - Zip Code

How many Yahrzeits would you like to observe?

English Name

Observed by:

Relationship:

Date of Death

Before/After Sunset

English Name

Observed by:

Relationship:

Date of Death

Before/After Sunset

English Name

Observed by:

Relationship:

Date of Death

Before/After Sunset

English Name

Observed by:

Relationship:

Date of Death

Before/After Sunset

List all children in your household that are included in your family membership. If you have more than four children, contact the office.

* How many children live in the family home?

* Child 1 - First Name

Child 1 - Middle Name

* Child 1 - Last Name

Child 1 - Preferred Name

* Child 1 - Birth Date

* Child 1 - Name of Current School

* Child 1 - Current Grade

Child 1 - Address if not living with you

* Child 1 - Is this child being raised in the Jewish faith?

Child 1 - Bar/Bat Mitzvah: Date, Congregation, City

Child 1 - Confirmation: Date, Congregation, City

Child 1 - Photograph

Please attach a photo of Child 1 above.

* Child 2 - First Name

Child 2 - Middle Name

* Child 2 - Last Name

Child 2 - Preferred Name

* Child 2 - Birth Date

* Child 2 - Name of Current School

* Child 2 - Current Grade

Child 2 - Address if not living with you

* Child 2 - Is this child being raised in the Jewish faith?

Child 2 - Bar/Bat Mitzvah: Date, Congregation, City

Child 2 - Confirmation: Date, Congregation, City

Child 2 - Photograph

Please attach a photo of Child 2 above.

* Child 3 - First Name

Child 3 - Middle Name

* Child 3 - Last Name

Child 3 - Preferred Name

* Child 3 - Birth Date

* Child 3 - Name of Current School

* Child 3 - Current Grade

Child 3 - Address if not living with you

* Child 3 - Is this child being raised in the Jewish faith?

Child 3 - Bar/Bat Mitzvah: Date, Congregation, City

Child 3 - Confirmation: Date, Congregation, City

Child 3 - Photograph

Please attach a photo of Child 3 above.

* Child 4 - First Name

Child 4 - Middle Name

* Child 4 - Last Name

Child 4 - Preferred Name

* Child 4 - Birth Date

* Child 4 - Name of Current School

* Child 4 - Current Grade

Child 4 - Address if not living with you

* Child 4 - Is this child being raised in the Jewish faith?

Child 4 - Bar/Bat Mitzvah: Date, Congregation, City

Child 4 - Confirmation: Date, Congregation, City

Child 4 - Photograph

Please attach a photo of Child 4 above.

Congregation Brothers of Israel offers Membership at 2 different locations. Park Avenue and Ocean Avenue. Both locations offer a Full time and Summer membership opportunities. No one will ever be turned away from our congregation for inability to contribute. We ask that you support our congregation in a way that is significant and meaningful, with the intent of enabling our community to thrive.

Please choose a Membership giving level:

* I will primarily daven at:

Please choose your Park Avenue Membership:

Please choose your Ocean Avenue Membership:

* I/We wish to pay our Membership via credit card online now. We acknowledge we are able to pay in full or split our payments at said time.

Total Membership Commitment

Tue, December 6 2022 12 Kislev 5783

Membership Application

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