Membership Application

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TBSMB
Membership
Membership Form

Membership Application
4144 Chase Avenue @ Miami Beach, FL 33140
305.538.7231 @ www.tbsmb.org
W E L C O M E
(Please enter name(s) as you wish it to be listed on Temple roster, i.e. Jane and Jon Cohen.)

Member Information

Name *

Home Address *

City *

State *

Zip Code *

Primary Phone *

Type of Membership Single Family

Billing Info.

Is billing address the same: Yes No *

If no, write billing address

Address (City, State & Zip)

Phone

Marital Status:

Single Partnered Divorced Separated Widowed Married Anniversary Date

Adult 1

Full Name (include maiden name) *

Hebrew Name

Nickname

Date of Birth

Gender

Occupation/Profession

Specialization or Expertise

E-Mail Address *

Cellular Phone (if none enter primary #) *

Home Fax Number

Business Name

Business Address

Business City, State, Zip

Business Phone & ext. no.

Business Fax Number

Vacation Address

Birthplace

Religious Tradition in which you were raised.

Are you related to a TBS member? Yes No

If so, list member name.

How are you related?

Current or previous Temple affiliation.

Reason for joining Temple Beth Sholom

Referred by

Adult 2

Full Name (include maiden name)

Hebrew Name

Nickname

Date of Birth

Gender

Occupation/Profession

Specialization or Expertise

E-Mail Address

Cellular Phone (if none enter primary #)

Home Fax Number

Business Name

Business Address

Business City, State, Zip

Business Phone & ext. no.

Business Fax Number

Vacation Address

Birthplace

Religious Tradition in which you were raised.

Are you related to a TBS member? Yes No

If so, list member name.

How are you related?

Current or previous Temple affiliation.

Reason for joining Temple Beth Sholom

Referred by

If applicable, please fill in the following information as it applies to each of your children.

Child #1

First Name

Middle Name

Surname if different

Hebrew Name

Birthdate

Gender Male Female

Name of school

Current grade

Are your child(ren) attending Temple Beth Sholom Foundation School SLJ Religious School

Child's email address, if applicable

Bar/Bat Mitzvah Date

Confirmation Date

If College Student, school name

Expected date of graduation

If adult, occupation

Address if not living with you (specify address)

Is this a college address? Yes No

Child #2

First Name

Middle Name

Surname if different

Hebrew Name

Birthdate

Gender Male Female

Name of school

Current grade

Are your child(ren) attending Temple Beth Sholom Foundation School SLJ Religious School

Child's email address, if applicable

Bar/Bat Mitzvah Date

Confirmation Date

If College Student, school name

Expected date of graduation

If adult, occupation

Address if not living with you (specify address)

Is this a college address? Yes No

Child #3

First Name

Middle Name

Surname if different

Hebrew Name

Birthdate

Gender Male Female

Name of school

Current grade

Are your child(ren) attending Temple Beth Sholom Foundation School SLJ Religious School

Child's email address, if applicable

Bar/Bat Mitzvah Date

Confirmation Date

If College Student, school name

Expected date of graduation

If adult, occupation

Address if not living with you (specify address)

Is this a college address? Yes No

Child #4

First Name

Middle Name

Surname if different

Hebrew Name

Birthdate

Gender Male Female

Name of school

Current grade

Are your child(ren) attending Temple Beth Sholom Foundation School SLJ Religious School

Child's email address, if applicable

Bar/Bat Mitzvah Date

Confirmation Date

If College Student, school name

Expected date of graduation

If adult, occupation

Address if not living with you (specify address)

Is this a college address? Yes No

Child #5

First Name

Middle Name

Surname if different

Hebrew Name

Birthdate

Gender Male Female

Name of school

Current grade

Are your child(ren) attending Temple Beth Sholom Foundation School SLJ Religious School

Child's email address, if applicable

Bar/Bat Mitzvah Date

Confirmation Date

If College Student, school name

Expected date of graduation

If adult, occupation

Address if not living with you (specify address)

Is this a college address? Yes No

Child #6

First Name

Middle Name

Surname if different

Hebrew Name

Birthdate

Gender Male Female

Name of school

Current grade

Are your child(ren) attending Temple Beth Sholom Foundation School SLJ Religious School

Child's email address, if applicable

Bar/Bat Mitzvah Date

Confirmation Date

If College Student, school name

Expected date of graduation

If adult, occupation

Address if not living with you (specify address)

Is this a college address? Yes No

Additional Information

If applicable, please list present affiliations in Miami civic & cultural clubs, Jewish & community organizations:

Are you and/or your spouse a survivor of the Holocaust or children of survivors? Yes No

Can you and/or your spouse read or speak Hebrew? Yes No

Would you like to have a personal meeting with one of our rabbis? Yes No

Person to contact in case of emergency

Name

Phone

Relationship

Yahrzeit

Please list names and dates of those for whom you wish Yahrzeit (anniversary of death) notices sent.

Please make sure to include the English date of death AND year.

Yahrzeit Family Member

Name of deceased

English date of death

Before or After Sundown Before After

Relationship to Which Member

Would you like to observe Hebrew date or English date? Hebrew English

Yahrzeit Family Member

Name of deceased

English date of death

Before or After Sundown Before After

Relationship to Which Member

Would you like to observe Hebrew date or English date? Hebrew English

Yahrzeit Family Member

Name of deceased

English date of death

Before or After Sundown Before After

Relationship to Which Member

Would you like to observe Hebrew date or English date? Hebrew English

Yahrzeit Family Member

Name of deceased

English date of death

Before or After Sundown Before After

Relationship to Which Member

Would you like to observe Hebrew date or English date? Hebrew English

Yahrzeit Family Member

Name of deceased

English date of death

Before or After Sundown Before After

Relationship to Which Member

Would you like to observe Hebrew date or English date? Hebrew English

Yahrzeit Family Member

Name of deceased

English date of death

Before or After Sundown Before After

Relationship to Which Member

Would you like to observe Hebrew date or English date? Hebrew English

Please enter the letters & numbers below.

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