NOTE: Before completing the Membership Application Form below, PLEASE set-up a log in account by clicking "New user: Register now" at the top right corner of this page.
ADULT A
Title Please Select One Mr. Mrs. Ms. Dr. Rabbi Other
* Gender Identity Please Select One Female Male Non-Binary Prefer not to say
* State--Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* TribePlease Select One Kohen (Priest) Levite Israelite Not-sure
* Marital StatusPlease Select One Single Married Engaged Divorced Widowed Partnered
* How Did You Hear About Shearith Israel?
ADULT B
Title Please Select One Mr. Mrs. Ms. Dr. Rabbi Other
Gender Please Select One Female Male Non-Binary Prefer not to say
State --Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Tribe Please Select One Kohen (Priest) Levite Israelite Not sure
CHILD #1 (if applicable)
Gender Please Select One Female Male Non-Binary Prefer not to say
State --Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Are you interested in enrolling your child in our Machaneh Shai Religious School? Please Select One Yes No
CHILD #2 (if applicable)
Gender Please Select One Female Male Non-Binary Prefer not to say
State --Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Are you interested in enrolling your child in our Machaneh Shai Religious School? Please Select One Yes No
CHILD #3 (if applicable)
Gender Please Select One Female Male Non-Binary Prefer not to say
State --Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code --Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Are you interested in enrolling your child in our Machaneh Shai Religious School? Please Select One Yes No
Please list any additional children's name, DOB & current grade
DUES
* Choose Your Membership PlanPlease Select One FAMILY 70+ FAMILY 50-69 FAMILY 40s FAMILY 30s FAMILY 20s INDIVIDUAL 70+ INDIVIDUAL 50-69 INDIVIDUAL 40s INDIVIDUAL 30s INDIVIDUAL 20s ASSOCIATE
YAHRZEIT INFORMATION It is the custom of the congregation to read the names of loved ones who are no longer with us on the anniversary of their passing. You will be notified via mail from the Rabbinic Offices in advance of the date your loved one’s name will be read and the appropriate date to light a remembrance candle. You will be notified on the Hebrew date of passing.
Did your loved one pass before sundown on that date? Please Select One Yes No
Did your loved one pass before sundown on that date? Please Select One Yes No
Did your loved one pass before sundown on that date? Please Select One Yes No
Did your loved one pass before sundown on that date? Please Select One Yes No
Did your loved one pass before sundown on that date? Please Select One Yes No
GENERAL QUESTIONS In order to serve you better, please take a few moments to answer the following questions. Also, please feel free to include any additional information that you feel may be beneficial to us.
What skills, hobbies or interests do you or members of your household have that could potentially be shared with the congregation both with programs/activities as well as with worship (i.e. musical talents, public relations experience, party planning, etc…)? Please specify by individual.
Are you related to other Shearith Israel members (i.e. parents, grandchildren, cousins, etc…)? Please specify each individual and their relationship to you.
Do you have any suggestions or recommendations that you wish to forward to us regarding the Synagogue (i.e. activities, new services, etc…)?
By clicking the "Submit" button, below, I/we herewith apply for membership at Congregation Shearith Israel, and when accepted, I/we promise to abide by the rules and regulations of the Synagogue. I/we agree to pay annual dues as fixed by the Congregation Shearith Israel Board of Trustees, in accordance with the By-Laws of the Synagogue. First 1/2 dues must be paid prior to High Holy Days in order to obtain tickets. Furthermore, I/we agree to pay any dues obligation needs in full by each December 31st. I/we understand that an obligation of membership includes a Building Fund pledge in the amount of $3,600 which is billed over the first 5 years of membership. Resignations must be in writing, and by the below referenced signatures, it is understood and agreed that I/we am/are responsible for the entire year’s dues and fees, should the resignation be submitted during any given fiscal year. This application must be accompanied by $200.00 which is a deposit towards the annual dues for the first year.
If you have any questions, please call the synagogue at (404) 873-1743. To discuss payment plans or other options for financial assistance, please contact Jacinta Cox, our Office Manager, at bookkeeper@shearithisrael.com or 404-503-9909.
