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Welcome to Kehillat Beth Israel. Your privacy is important to us. The information you provide will enrich your experience as a member of Kehillat Beth Israel and is for office use only. Please complete this application form by July 31st along with your annual dues payment information. Thank you for becoming a part of our community. We look forward to growing and learning with you and your family.
ADULT 1
*
First Name
*
Last Name
Hebrew Name
e.g. Yaakov ben Yitzhak v'Rikva
Date of Birth
I prefer email for:
Yahrzeit Reminders
Billing Notifications
Please check all that apply.
Are you Jewish?
Yes (born Jewish)
Yes (by conversion)
No (or not currently)
Tribe
Click here
Kohen
Levi
Yisrael
Unknown
Not Jewish
Gender
N/A or Unknown
Male
Female
Bar/Bat Mitzvah Date
Bar/Bat Mitzvah Location
If converted, name of Rabbi, date, and place:
*
Mobile Phone
*
Email Address
Occupation/Title
Employer Name
If previously married, was marriage terminated by a get?
Yes
No
If previous marriage was not terminated by a get, please explain:
Are you affiliated with another synagogue?
Yes
No
If yes, please provide name/city/province of synagogue:
*
Please choose your dues category:
Choose below
I-am-41-or-over---1100
I-am-36-to-40---836
I-am-31-to-35---430
I-am-22-to-30---218
I am under 21 - $0
I will speak to the Executive Director about a Dues reduction
Would you like to join
MERCAZ
and/or
MASORTI
?
I would like to join MERCAZ - $18
I would like to join MASORTI - $18
Please check all that apply:
I would like to volunteer
I would like to receive the weekly newsletter
Total Due
PARENTS OF ADULT 1
Parent 1 First Name
Parent 1 Last Name
Parent 1 Hebrew Name
Parent 1 Gender
Parent 2 First Name
Parent 2 Last Name
Parent 2 Hebrew Name
Parent 2 Gender
ADULT 2
First Name
Last Name
Hebrew Name
e.g. Dinah bat Yaakov v'Leah
Date of Birth
I prefer email for:
Yahrzeit Reminders
Billing Notifications
Please check all that apply.
Are you Jewish?
Yes (born Jewish)
Yes (by conversion)
No (or not currently)
Tribe
Click here
Kohen
Levi
Yisrael
Unknown
Not Jewish
Gender
N/A or Unknown
Male
Female
Bar/Bat Mitzvah Date
Bar/Bat Mitzvah Location
If converted, name of Rabbi, date, and place:
Mobile Phone
Email Address
Occupation/Title
Employer Name
If previously married, was marriage terminated by a get?
Yes
No
If previous marriage was not terminated by a get, please explain:
Are you affiliated with another synagogue?
Yes
No
If yes, please provide name/city/province of synagogue:
Please choose your dues category:
Choose below
I-am-41-or-over---1100
I-am-36-to-40---836
I-am-31-to-35---430
I-am-22-to-30---218
I am under 21 - $0
I will speak to the Executive Director about a Dues reduction
Would you like to join
MERCAZ
and/or
MASORTI
?
I would like to join MERCAZ - $18
I would like to join MASORTI - $18
Please check all that apply:
I would like to volunteer
I would like to receive the weekly newsletter
Total Due
PARENTS OF ADULT 2
Parent 1 First Name
Parent 1 Last Name
Parent 1 Hebrew Name
Parent 1 Gender
Parent 2 First Name
Parent 2 Last Name
Parent 2 Hebrew Name
Parent 2 Gender
YAHRZEIT REMINDERS
Yahrzeit Reminders for Member 1
Please provide Yahrzeit information below:
i.e. English Name, Hebrew Name, Date of Death, Time of Death (if known), Relationship.
Yahrzeit Reminders for Member 2
Please provide Yahrzeit information below:
i.e. English Name, Hebrew Name, Date of Death, Time of Death (if known), Relationship.
ADDRESS & HOME PHONE
*
Address Line 1
Address Line 2
*
City
*
Province
*
Postal Code
Phone Number
EMERGENCY CONTACT INFORMATION
Name of emergency contact
Phone number of emergency contact
Relationship to family
MARITAL STATUS
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Date of Marriage
If applicable.
CHILD 1
First Name
Last Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Date
2019/2020 Grade
Allergies
Gender
N/A
Male
Female
Other
Child's Email
optional
Child's Mobile Phone
optional
CHILD 2
First Name
Last Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Date
2019/2020 Grade
Allergies
Gender
N/A
Male
Female
Other
Child's Email
optional
Child's Mobile Phone
optional
CHILD 3
First Name
Last Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Date
2019/2020 Grade
Allergies
Gender
N/A
Male
Female
Other
Child's Email
optional
Child's Mobile Phone
optional
CHILD 4
First Name
Last Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Date
2019/2020 Grade
Allergies
Gender
N/A
Male
Female
Other
Child's Email
optional
Child's Mobile Phone
optional
CHILD 5
First Name
Last Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Date
2019/2020 Grade
Allergies
Gender
N/A
Male
Female
Other
Child's Email
optional
Child's Mobile Phone
optional
OTHER INFORMATION (IF APPLICABLE)
Were all male children circumcised by a Mohel?
Yes
No
Were all adopted children converted?
Yes
No
OPTIONAL DONATION
In you are able, please consider making a contribution in excess of your dues to help underwrite our inevitably increased need for dues subsidies this year.
Please choose an amount:
Choose below
$72
$118
$180
$250
$360
$540
$1000
$1800
Please enter other amount:
MEMBERSHIP AGREEMENT
I/we promise to abide by all the rules and regulations of the Congregation as stated in the By-Laws.
I/we understand that the Fiscal Year for payment of all Kehillat Beth Israel accounts is July 1, 2020 to June 30, 2021.
I/we understand that all requests for Dues reductions can only be considered after consultation with the Executive Director.
I/we agree with all of the above statements.
YOUR TOTAL AMOUNT DUE
Total Due
Mon, 18 October 2021
12 Cheshvan 5782
Friday Night
Teddy Bear Shabbat
: 5:30pm
Candle Lighting
: 5:48pm
Shabbat Day
Shacharit
: 9:30am
Havdalah
: 6:46pm
Upcoming Programs & Events
Oct
22
Teddy Bear Shabbat
Friday, Oct 22 5:30pm
This week's Torah portion is
Parshat Vayera
Shabbat, Oct 23
Candle Lighting
Friday, Oct 22, 5:48pm
Havdalah
Motzei Shabbat, Oct 23, 6:46pm
Shabbat Mevarchim
Shabbat, Oct 30
View Calendar
Mon, 18 October 2021 12 Cheshvan 5782
