Form Test

Welcome! We are very pleased that you have chosen to become a member of Temple Rodef Shalom, a Kehilla Kedosha, a sacred community. Completing this application will help us get to know you and your household.

INDIVIDUAL INFORMATION – ADULT #1

Untitled

First name

Nickname (if applicable):

Last name

Birthdate:

Adult #1 Email

Adult #1 Cell Phone

Untitled

Jewish

Non-Jewish

Hebrew Name (if applicable)

Section Break

FAMILY INFORMATION – ADULT # 2

Untitled

First name

Nickname (if applicable):

Last name

Birthdate:

Adult #1 Email

Adult #1 Cell Phone

Untitled

Jewish

Non-Jewish

Hebrew Name (if applicable)

Section Break

FAMILY INFORMATION – ADULT # 2

RELATIONSHIPS

Anniversary Date

Wedding Date

Section Break

HOME INFORMATION

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

SEASONAL ADDRESS INFORMATION (Please send mail to this address (day/month)

from

Address

Street Address Address Line 2 City State ZIP Code

BUSINESS INFORMATION — ADULT # 1

Position/Title

Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

BUSINESS INFORMATION — ADULT # 2

Position/Title

Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Section Break

CHILDREN aged 25 and under (included in all member benefits)

Name, Birthdate, Gender, Grade, School, Hebrew Name, Email Address

CHILDREN aged 26 and older

Name, Birthdate, Gender, Grade, School, Hebrew Name, Email Address

RELATIVES (Please list relatives or friends who are affiliated with Temple Rodef Shalom)

Name

Relationship

Section Break

Please fill out the worksheet below:

Annual Membership Commitment

Annual Facility Maintenance Fund Contribution

$500 for two-adult households $200 for one-adult households

Annual Security Fee

$360 for two-adult households $180 for one-adult households

Total Annual Contribution

Form Test

Membership Application

INDIVIDUAL INFORMATION – ADULT #1

Section Break

FAMILY INFORMATION – ADULT # 2

Section Break

FAMILY INFORMATION – ADULT # 2

Section Break

HOME INFORMATION

Section Break

Section Break