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Membership Application
We are delighted to have you join Kehillat Ma'arav. We wish to satisfy your needs as best we can, and have much to offer. We wish to also involve you as much as possible in our congregational activities. Feel free to print this document (using the printer-friendly button on the right) or you can pick up an application at the synagogue office. The information that you share with us remains absolutely confidential. With this information, we will be in a better position to understand and serve your needs. Thank you for your cooperation, and Baruch Haba -- welcome to Kehillat Ma'arav. I. MEMBER (Please Print) Last Name:_________________ First Name:___________________ Mr./Mrs./Ms./Dr.__ Date of Birth:__/__/__ Business Phone:(__)_____________Extension_______ Hebrew Name (if known):____________________ Wedding Anniversary____________________ Kohen___Levi___Israelite___ Occupation/Name of Firm__________________________________________ Business Address____________________________________ City__________________State_____Zip_______________ No. of Years in Area________ Prior Congregational Affiliation______________ Does Family Own Cemetery Plot?_____ If Yes, Where?____________________ Home Address_______________________________________ City_____________State_____Zip______________ Home Phone: (___)_________________ Email: _______________________________ II. MEMBER / SPOUSE Last Name:_________________ First Name:___________________ Mr./Mrs./Ms./Dr.__ Date of Birth:__/__/__ Business Phone:(__)_____________Extension_______ Hebrew Name (if known):______________________________ Wedding Anniversary_____________ Kohen___Levi___Israelite___ Occupation/Name of Firm__________________________________ Business Address_______________________________ City________________State_____Zip________________ Home Phone: (___)_________________ Email: _______________________________ III. CHILDREN WHO LIVE IN HOUSEHOLD 1. English Name________________________ Hebrew Name____________Date of Birth_______Sex____ 2. English Name________________________ Hebrew Name____________Date of Birth_______Sex____ 3. English Name________________________ Hebrew Name____________Date of Birth_______Sex____ 4. English Name________________________ Hebrew Name____________Date of Birth_______Sex____ 5. English Name________________________ Hebrew Name____________Date of Birth_______Sex____ IV. CHILDREN AWAY AT COLLEGE, MARRIED, OR LIVING INDEPENDENTLY 1. English Name____________________ Hebrew Name______________Date of Birth____________ Sex______College________________________ Jewish Education________________________________ 2. English Name____________________ Hebrew Name______________Date of Birth____________ Sex______College________________________ Jewish Education________________________________ 3. English Name____________________ Hebrew Name______________Date of Birth____________ Sex______College________________________ Jewish Education________________________________ V. YAHRZEIT RECORDS If there are yahrzeit dates observed in your family, please list them. We remind our congregants of their yahrzeit dates. 1. Full Name of Deceased___________________________ Relationship________ Hebrew Name (also include Hebrew name of father of deceased (for example: Isak Ben Moshe)_____________________________ English Date of Death__________________ Hebrew Date of Death________________ Before or After Sundown:_________________ 2. Full Name of Deceased___________________________ Relationship________ Hebrew Name (also include Hebrew name of father of deceased (for example: Isak Ben Moshe)_____________________________ English Date of Death__________________ Hebrew Date of Death________________ Before or After Sundown:_________________ 3. Full Name of Deceased___________________________ Relationship________ Hebrew Name (also include Hebrew name of father of deceased (for example: Isak Ben Moshe)_____________________________ English Date of Death__________________ Hebrew Date of Death________________ Before or After Sundown:_________________ 4. Full Name of Deceased___________________________ Relationship________ Hebrew Name (also include Hebrew name of father of deceased (for example: Isak Ben Moshe)_____________________________ English Date of Death__________________ Hebrew Date of Death________________ Before or After Sundown:_________________ 5. Full Name of Deceased___________________________ Relationship________ Hebrew Name (also include Hebrew name of father of deceased (for example: Isak Ben Moshe)_____________________________ English Date of Death__________________ Hebrew Date of Death________________ Before or After Sundown:_________________ VI. CONGREGATIONAL ACTIVITIES Your involvement in our congregational activities would serve our mutual interests. Below is a list of congregational areas of interest and activities. Please check items of interest to you.
Present or previous offices held in other organizations (list which spouse, if applicable)_________________________________________ Special interests, skills or hobbies (list which spouse, if applicable)___________________________________________ Please list names and phone numbers of anyone you know who may be interested in our congregation___________________________________________ ____________________________________________________ SUGGESTIONS OR COMMENTS? (use back if necessary)____________________________________________ ________________________________________________ PRIVACY PREFERENCE: Your name, address and phone number will be listed in the synagogue roster which is distributed to members only (check all that apply): __I do not want my address and/or phone number in the roster. __I do not want a copy of the synagogue roster. __I do not want my address released to the UJA/Federation. VII. I/We hereby apply for membership in Kehillat Ma'arav Synagogue. I/We agree to abide by the rules and regulations as specified in the by-laws. I/We further agree to assume all proper financial obligations for dues, tuitions, pledges and assessments, if any, as properly assessed by Kehillat Ma'arav Synagogue. My/Our membership remains valid unless I/we notify the Kehillat Ma'arav office in writing of our intention to terminate membership. Signature_______________________ Date__________ Witness________________________Date__________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ For Office Use Only: Approved by Administrator____ Accounting Completed____ Data in Rakefet____
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About Us Contact Info Facility Leadership » Membership 1715 21st Street Santa Monica, CA 90404 Phone: (310) 829-0566 Fax: (310) 453-8358 office @ km-synagogue . org |
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