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Membership Application
Please verify reCaptcha before submitting the form.
Please note that this membership application is for Temple Israel in West Bloomfield, Michigan.
YOUR INFORMATION
*
First Name
Middle Name
*
Last Name
Title
only if not Mr/Mrs
Nickname
Suffix
Note on gender selection
: Temple Israel is committed to inclusiveness and sensitive to gender identification. Our software limits the selections below on this form, but additional gender choices will be available after your account is created. Please don't hesitate to contact us at membership@temple-israel.org to let us know how the members of your family identify.
*
Gender
N/A or Unknown
Male
Female
Pronoun
*
Email
Hebrew name
don't include parents
Father Hebrew Name
don't include parents
Mother Hebrew Name
don't include parents
Maiden Name
if applicable
Birth Date
Cell Phone
Work Phone
(xxx) yyy-zzzz
Occupation
Employer
Work Email
Tribe/Religious Background
Please Select One
Kohen
Levi
Yisrael
Unknown
Jew by Choice
Not Jewish
Do you have a spouse/partner?
No
Yes
SPOUSE INFORMATION
*
First Name
Middle Name
*
Last Name
Title
only if not Mr/Mrs
Nickname
Suffix
Note on gender selection
: Temple Israel is committed to inclusiveness and sensitive to gender identification. Our software limits the selections below on this form, but additional gender choices will be available after your account is created. Please don't hesitate to contact us at membership@temple-israel.org to let us know how the members of your family identify.
*
Gender
N/A or Unknown
Male
Female
Pronoun
Email
Hebrew name
don't include parents
Father Hebrew Name
don't include parents
Mother Hebrew Name
don't include parents
Maiden Name
if applicable
Birth Date
Cell Phone
Work Phone
(xxx) yyy-zzzz
Occupation
Employer
Work Email
Tribe/Religious Background
Please Select One
Kohen
Levi
Yisrael
Unknown
Jew by Choice
Not Jewish
FAMILY INFO
Family Tribe
Cohen
Levi
Yisrael
None Set
if known
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Anniversary
Home Address Line 1
Home Address Line 2
City
State
--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
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Landline at Address
(xxx) yyy-zzzz
CHILDREN
Please select the number of children in your family, and complete the information for each child
0
1
2
3
4
5
6
7
8
9
10
Email
Title
only if not Mr/Mrs
*
First Name
Middle Name
*
Last Name
Maiden name
if applicable
Nickname
if applicable
Suffix
if applicable
Hebrew name
not including parents
Mother Hebrew name
not including parents
Father Hebrew name
not including parents
Gender
Please select one
Female
Male
Other/NA
Pronoun
Cell phone
please use (xxx) yyy-zzzz format
Birthday
Spouse/Partner's name
Spouse/Partner Gender
Please select one
Male
Female
N/A or Other
Spouse pronoun
Address
YAHRZEITS
Please select the number of yahrzeits observed in your family, and complete the information for each yahrzeit
0
1
2
3
4
5
6
7
8
9
10
*
Full English Name of Deceased
Full Hebrew Name of Deceased (if known)
Gender of deceased
Please select one
Female
Male
Other/NA
Preferred pronoun of deceased (e.g., her/his/their)
*
English date of death
After sunset?
Unknown
Yes
No
Hebrew date of death (if known)
Buried Date
Plaque location
Notes
*
Relationship to deceased
*
Mourner in family (one person)
Relationship of additional mourner
Additional mourner (if any)
Cemetery
Cemetery city/state
OTHER INFORMATION
Please provide any other information that you would like the Temple to be aware of
If you have never been an adult member at Temple Israel and our clergy officiated at your auf ruf, wedding or conversion, or if our clergy officiated at a funeral of your loved one in the last year, it is our pleasure to extend a complimentary year-long membership to you. Please enter the type (wedding, auf ruf, bereavement, conversion), date of ceremony and clergy's name below. Please include name of deceased if applicable.
Tue, May 30 2023 10 Sivan 5783