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CKA Cemetery – Gan HaDorot
When a Loved One Dies
Notify Office of a Passing
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Community
Show sub menu
Affinity Groups
Considering Converting to Judaism?
Fundraising
People of the Book
Sisterhood
Stop the Bleed Kits
Tikkun Olam
Youth Groups
Education
Show sub menu
Religious School
Religious School Registration 2024-25
2024-25 Religious School Calendar (Printable)
Adult Education
Show sub menu
Adult Hebrew Class
Introduction to Judaism
Reference Materials
Teach the Shoah
Jewish Feeds
Weekly Blast Archive
Worship
From the Rabbi
Show sub menu
A Cup of Kabbalah
DIY Judaism
Heartfelt Haftarah
Rabbi’s Eats
Rabbi’s Links
Rabbi’s Words
Soulful Psalms
Taste of Torah
Donations/Payments
Show sub menu
Friends of CKA
Fundraising
General Donations
Membership Dues – Single Payment
Membership Dues – Recurring Payment
Mitzvah Magic
Order Siddur Kol Ami
Purchase Signed “The Last Rose of Shanghai”
Member & Youth Group Application Forms
Show sub menu
Online Membership Application
Junior Youth Group Registration Form (Middle School)
NoTTY Online Registration (High School)
Printable Forms
Member Tools
Show sub menu
Notify Office of a Passing
Add a Yahrzeit
Correct a Yahrzeit
Mi Shebeirach List
Host an Oneg
Website/Newletter Submission
Request Gift Shop Item
Request Access to CKA Member Portal
Login to Member Portal
Building Access Request
Stay in Touch
Show sub menu
General Question or Comment
Submit an Item for the Website/Newletter/Calendar
Weekly Blast Subscription
About Us
Show sub menu
About Congregation Kol Ami
About Rabbi Dennis
Our Leadership
CKA Board Meeting Minutes
Hours and Contact Info
Directions
Privacy Policy
Online Membership Application
Please use this form to request membership. If you have any questions or issues, please contact the CKA office at 972-539-1938.
Please enable JavaScript in your browser to complete this form.
-
Step
1
of 8
Member Information
Please enter in the information for the primary adult member(s).
Adult 1
*
First
Middle
Last
Title (Optional)
Preferred Name
Gender
*
Male
Female
Home Address
*
Address Line 1
Address Line 2
City
--- 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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Next
Phone
*
Phone Type
*
Home
Cell
Work
Please indicate the type of phone for the number above.
Add another phone number?
*
Yes
No
2nd Phone
2nd Phone Type
Home
Cell
Work
Add a 3rd phone number?
Yes
No
3rd Phone
3rd Phone Type
Home
Cell
Work
Email
*
Occupation
*
Date of Birth
*
MM
1
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DD
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YYYY
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Marital Status
*
Single
Married
Divorced
Widowed
Date of Marriage
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
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YYYY
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2025
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2023
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2020
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2015
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2012
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1981
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1979
1978
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1972
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1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Are you Jewish?
*
Yes
No
Hebrew Name
Name of Last Temple Affiliated with and Location
Jewish Background
Read Hebrew
Speak Hebrew
Read Torah
Please check all that apply.
Religion
*
If you are not Jewish, please indicate your religion.
Next
Add another adult?
Yes
No
Adult 2
*
First
Middle
Last
Does this adult have a different address?
*
Yes
No
Title (Optional)
Preferred Name
Gender
*
Male
Female
Secondary Address
*
Address Line 1
Address Line 2
City
--- 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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
2nd Adult's Phone
*
2nd Adult's Phone Type
*
Home
Cell
Work
Please indicate the type of phone for the number above.
Add another phone number? (Adult 2)
*
Yes
No
2nd Phone (2nd Adult)
2nd Phone Type (2nd Adult)
Home
Cell
Work
Add a 3rd Phone number? (2nd Adult)
Yes
No
3rd Phone (2nd Adult)
3rd Phone Type (2nd Adult)
Cell
Home
Work
Email
*
Date of Birth
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
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22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Occupation
*
Marital Status
*
Single
Married
Divorced
Are you Jewish?
*
Yes
No
Hebrew Name
Jewish Background
Read Hebrew
Speak Hebrew
Read Torah
Please check all that apply.
Religion
*
If you are not Jewish, please indicate your religion.
Next
Emergency Contact
Please specify the contact in case of emergency.
Emergency Contact Name
*
First
Last
Relationship
*
Address
Address Line 1
Address Line 2
City
--- 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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Please provide the best number for your emergency contact.
Next
Additional Adults Living in the Household
This form only supports the addition of up to 2 more adult family members living in the house. If you need to add more than that, please contact the office to have those adults added manually.
Are there any additional adults living in the house that should be included in the membership?
*
Yes
No
Name
*
First
Middle
Last
Date of Birth
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
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28
29
30
31
YYYY
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2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Relationship
*
Are they Jewish?
*
Yes
No
Hebrew Name
Jewish Background
Read Hebrew
Speak Hebrew
Read Torah
Please check all that apply.
Religion
*
If you are not Jewish, please indicate your religion.
Is there a 4th adult living in the house?
*
Yes
No
Name
*
First
Middle
Last
Date of Birth
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Relationship
*
Are they Jewish?
*
Yes
No
Hebrew Name
Jewish Background
Read Hebrew
Speak Hebrew
Read Torah
Religion
*
If you are not Jewish, please indicate your religion.
Next
Children
This form supports up to 3 children. If you need to add additional children, please complete the form and then contact the office. They will assist you in adding them.
Do you have any children to add to the membership?
*
Yes
No
1st Child's Name
*
First
Middle
Last
1st Child's Hebrew Name
1st Child's Birthdate
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Will they attend Religious School?
*
Yes
No
Planning a B'nai Mitzvah?
*
Yes
No
Does the child reside in the same household?
*
Yes
No
1st Child's Address
*
Address Line 1
Address Line 2
City
--- 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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you have a 2nd child to add to the membership?
*
Yes
No
2nd Child's Name
*
First
Middle
Last
2nd Child's Hebrew Name
2nd Child's Birthdate
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Will they attend Religious School?
*
Yes
No
Planning a B'nai Mitzvah?
*
Yes
No
Does the child reside in the same household?
*
Yes
No
2nd Child's Address
*
Address Line 1
Address Line 2
City
--- 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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you have a 3rd child to add to the membership?
*
Yes
No
3rd Child's Name
*
First
Middle
Last
3rd Child's Hebrew Name
3rd Child's Birthdate
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Will they attend Religious School?
*
Yes
No
Planning a B'nai Mitzvah?
*
Yes
No
Does the child reside in the same household?
*
Yes
No
3rd Child's Address
*
Address Line 1
Address Line 2
City
--- 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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Next
Yahrzeits
This form supports up to 7 yahrzeits added online. If after completing the form you have additional yahrzeits to be added, please contact the CKA office. They will assist you in adding them.
Would you like to add any yahrzeits?
*
Yes
No
Please specify which type of date you prefer to observe for your yahrzeit(s)?
*
Gregorian
Hebrew
Name
*
First
Last
Relationship
*
Be sure to include to whom in the family the relationship is connected.
Gregorian Date
*
MM
1
2
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9
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12
DD
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14
15
16
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
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Hebrew Date
If you don't know this, you can leave it blank. We will retrieve it for you.
Would you like to add another yahrzeit?
*
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Name
*
First
Last
Relationship
*
Be sure to include to whom in the family the relationship is connected.
Gregorian Date
*
MM
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1925
1924
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1921
1920
Hebrew Date
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Would you like to add 3rd yahrzeit?
*
Yes
No
Name
*
First
Last
Relationship
*
Be sure to include to whom in the family the relationship is connected.
Gregorian Date
*
MM
1
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12
DD
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YYYY
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1935
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1931
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1928
1927
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1925
1924
1923
1922
1921
1920
Hebrew Date
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No
Name
*
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Last
Relationship
*
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Gregorian Date
*
MM
1
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DD
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YYYY
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2019
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2015
2014
2013
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1935
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1931
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Hebrew Date
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Would you like to add 5th yahrzeit?
*
Yes
No
Name
*
First
Last
Relationship
*
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Gregorian Date
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
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30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
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1997
1996
1995
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1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
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1966
1965
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1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Hebrew Date
If you don't know this, you can leave it blank. We will retrieve it for you.
Would you like to add 6th yahrzeit?
*
Yes
No
Name
*
First
Last
Relationship
*
Be sure to include to whom in the family the relationship is connected.
Gregorian Date
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
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29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
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1974
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1972
1971
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1969
1968
1967
1966
1965
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1963
1962
1961
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1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Hebrew Date
If you don't know this, you can leave it blank. We will retrieve it for you.
Would you like to add 7th yahrzeit?
*
Yes
No
Name
*
First
Last
Relationship
*
Be sure to include to whom in the family the relationship is connected.
Gregorian Date
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
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13
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25
26
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28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
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1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
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1975
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1972
1971
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1951
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1941
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Hebrew Date
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Next
Interests and Activities
Please check all below that apply to any member of the family.
We are interested in the following:
Sisterhood
Jr. Youth Group (Grades 6-8)
Sr. Youth Group (Grades 9-12)
Youth Group Advisor
Education Committee
Religious School Teaching
Hebrew Teaching
Choir
Communication Committee
Ritual Committee
Tikkun Olam Committee
Building Committee
New Members Committee
Membership Support Committee
Budget & Finance Committee
Fundraising Committee
Cemetery Committee
Other Areas:
Please indicate any other areas that are special interest to you that are not listed above.
Special Talents
Please tell us about any special talents you would like to share with the congregation.
Where did you hear about us?
*
Search Engine (Google, Bing, etc.)
Social Media (Facebook, Twitter, Instagram)
Current congregant or community member
Mailing I Received
Other
Since you indicated 'Other', please tell us where.
*
Comments/Questions
If you have any additional information we need or have any questions we can answer for you, please enter them here.
Message
Submit Application
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