To download and print the Membership Covenant, click here. Step 1 of 3 33% MEMBER INFORMATIONDate Month Day Year Interviewer (if applicable) How did you learn about Temple Israel? ADULT 1Are you Jewish? Yes No Temple Israel Bylaws require that at least one member of the family be Jewish.Name Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First MI Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birthday Month Day Year Hebrew Name (if applicable) Home Phone #Cell Phone #Email Employer Occupation Relationship Single Widow(er) Partnered Married Other Anniversary Month Day Year If "Other," please explain below. Secondary/Vacation Address Ideal Contact Email Mail Phone Text Other If "Other," please explain below. ADULT 2Are you Jewish? Yes No Temple Israel Bylaws require that at least one member of the family be Jewish.Name Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First MI Last Birthday Month Day Year Hebrew Name (if applicable) Home Phone #Cell Phone #Email Employer Occupation Ideal Contact Email Mail Phone Text Other If "Other," please explain below. Prior Synagogue Affiliation (if any)Temple Name & Location If none, please check the box below. Previously unaffiliated Number of Years Type (Reform, Conservative, etc.) Special AccommodationsPlease Select One Visual Auditory Physical Mental Other If "Other," please explain below. Please indicate who needs the accommodations and how we can best serve him/her.Personal Skills or Talents You Are Willing to ShareUntitledInterests or Goals You Want to PursueUntitled Members' children under 18 enjoy all privileges of membership without the right to vote. Each dependent child 18+ is entitled to full membership with all privileges including the right to vote. Children of members between 18 and 25 are not asked to make a financial commitment until he or she becomes financially able to do so or until he or she reaches the age of 25, whichever comes first.CHILDREN YOUNGER THAN 25 (USE FIELD AT BOTTOM OF PAGE FOR MORE)Name First Last BirthdayMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address (if different from yours) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender M F PhoneEmail Is this child being raised Jewish? Y N Will he/she be attending the Religious School? Y N Relationship Single Partnered Married Widow(er) Other If "Other," please explain below. Name First Last Birthday MM slash DD slash YYYY Address (if different from yours) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender M F PhoneEmail Is this child being raised Jewish? Y N Will he/she be attending the Religious School? Y N Relationship Single Partnered Married Widow(er) Other If "Other," please explain below. Name First Last Birthday Month Day Year Address (if different from yours) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender M F PhoneEmail Is this child being raised Jewish? Y N Will he/she be attending the Religious School? Y N Relationship Single Partnered Married Widow(er) Other If "Other," please explain below. Use the field below if more than three children are being listed on this application.My Covenant with Temple IsraelConsent I/We choose to join Temple Israel pending approval of this application by the Board of Trustees. I/We accept the responsibility to contribute to the sustainability of Temple Israel by including the Financial Commitment and Payment Authorization Form.Member Signature I agree that my typed signature can serve as a substitute for my handwritten signature.Date Month Day Year FINANCIAL COMMITMENT AND PAYMENT AUTHORIZATIONTo be reviewed & resubmitted annually. Financial commitments can be paid in full or on an ongoing basis. Annual financial commitments will not run past July 1 each fiscal year. Religious School tuition and payments administered separately if appropriate.Name(s) Select appropriate membership category:REGULAR REGULAR - For Jewish participants. Includes all privileges of membership. $480 yearly (or $120 quarterly / $40 monthly installments)ASSOCIATE ASSOCIATE - Verifiable membership in another synagogue and in good standing. Includes attendance at High Holidays, classes, and programs for members only and facility rental discounts.$240 yearly (or $60 quarterly / $20 monthly installments)FRIEND FRIEND - For non-Jewish participants. Includes attendance at all services and participation in synagogue classes and programs.$300 yearly (or $75 quarterly / $25 monthly installments)Additional annual support (optional): Thank you for joining Temple Israel. Our day-to-day operations - from utility bills to spiritual leadership - are dependent on your contributions and generosity. We appreciate your best efforts to support Temple Israel and its dedication to providing Reform Judaism in our community.My total annual financial commitment to Temple Israel: Signature I agree that my typed signature can serve as a substitute for my handwritten signature.Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Δ
