Membership Application

Your Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Do you have an out-of-town address?

Yes
No

Out-of-Town Address

Street Address Address Line 2 City State ZIP Code

Marital Status*

Anniversary Date

Type of Membership*

Member Information

Adult 1 - Name*

Adult 2 - Name

Adult 1 - Hebrew Name

Adult 2 - Hebrew Name

Adult 1 - Email*

Adult 2 - Email

Adult 1 - Cell Phone*

Adult 2 - Cell Phone

Adult 1 - Date of Birth*

Adult 2 - Date of Birth

Adult 1 - Occupation

Adult 2 - Occupation

Adult 1 - Retired?

Yes
No

Adult 2 - Retired?

Yes
No

Adult 1 - Business Name

Adult 2 - Business Name

Adult 1 - Business Address

Adult 2 - Business Address

Adult 1 - Business Phone

Adult 2 - Business Phone

Background / Jewish Skills / Interests

Adult 1 - Were you born Jewish?*

Yes
No

Adult 2 - Were you born Jewish?

Yes
No

Adult 1 - Conversion Location & Date (if applicable)

Adult 2 - Conversion Location & Date (if applicable)

Adult 1 - Kohen or Levi?*

Kohen
Levi
Neither

Adult 2 - Kohen or Levi?

Kohen
Levi
Neither

Adult 1 - Do you have any family affiliated with Adath Israel?

If so, please list.

Adult 2 - Do you have any family affiliated with Adath Israel?

If so, please list.

Adult 1 - Speak or Read Hebrew?*

Speak
Read
Both
Neither

Adult 2 - Speak or Read Hebrew?

Speak
Read
Both
Neither

Adult 1 - Years of Religious School

Adult 2 - Years of Religious School

Adult 1 - Lead Services?

Yes
No

Adult 2 - Lead Services?

Yes
No

Adult 1 - Chant Torah/Haftarah?

Yes
No

Adult 2 - Chant Torah/Haftarah?

Yes
No

Adult 1 - Chant Kiddush?

Yes
No

Adult 2 - Chant Kiddush?

Yes
No

Adult 1 - Bless Shabbat Candles?

Yes
No

Adult 2 - Bless Shabbat Candles?

Yes
No

Yahrzeits

Yahrzeit #1

Please list English & Hebrew Names, Relationship, Date & time of death

Yahrzeit #2

Please list English & Hebrew Names, Relationship, Date & time of death

Yahrzeit #3

Please list English & Hebrew Names, Relationship, Date & time of death

Yahrzeit #4

Please list English & Hebrew Names, Relationship, Date & time of death

Religious & Cultural Data

Adult 1 - Current Synagogue Affiliation & Location

Adult 2 - Current Synagogue Affiliation & Location

Adult 1 - Are you affiliated with any Jewish organizations?

Yes
No

Adult 2 - Are you affiliated with any Jewish organizations?

Yes
No

Adult 1 - Jewish Organizational Affiliation

Adult 2 - Jewish Organizational Affiliation

Adult 1 - Have you participated in community projects or services?

If so, please list.

Adult 2 - Have you participated in community projects or services?

If so, please list.

Children (if applicable)

Child 1 - Full Name

Child 2 - Full Name

Child 3 - Full Name

Child 1 - Hebrew Name

Child 2 - Hebrew Name

Child 3 - Hebrew Name

Child 1 - Date of Birth

Child 2 - Date of Birth

Child 3 - Date of Birth

Child 1 - Previous Religious School

Child 2 - Previous Religious School

Child 3 - Previous Religious School

Child 1 - Bar/Bat Mitzvah Date

Child 2 - Bar/Bat Mitzvah Date

Child 3 - Bar/Bat Mitzvah Date

Congregational Participation

Adult 1 - Areas of interest where you may want to volunteer

Ritual
Fundraising
Religious School
Teaching
Youth Activities
Adult Education
House & Grounds
Programs

Adult 2 - Areas of interest where you may want to volunteer

Ritual
Fundraising
Religious School
Teaching
Youth Activities
Adult Education
House & Grounds
Programs

Agreement

I/We hereby make application for membership in Congregation Adath Israel, and agree to adhere to its By-Laws. I/We agree to fulfill all financial obligations.

Adult 1 - Signature*

Adult 2 - Signature

Synagogue dues invoices and statements are sent electronically to the email address(es) you have submitted in this form.

Upon submission, please print the notification email you will receive and mail it with a $250 check, which will be applied to your membership dues, to: Congregation Adath Israel, P.O. Box 623, Newtown, CT 06470.

Membership Application

Membership Application

Member Information

Background / Jewish Skills / Interests

Yahrzeits

Religious & Cultural Data

Children (if applicable)

Congregational Participation

Agreement

About Us