Membership Application

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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

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

Do you have a spouse/partner?

SPOUSE INFORMATION

* First Name

Middle Name

* Last Name

Title

only if not Mr/Mrs

Nickname

Suffix

* Gender

Pronoun

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

FAMILY INFO

Family Tribe

if known

Marital Status

Anniversary

Home Address Line 1

Home Address Line 2

City

State

Zip

Landline at Address

(xxx) yyy-zzzz

CHILDREN

Please select the number of children in your family, and complete the information for each child

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

Pronoun

Cell phone

please use (xxx) yyy-zzzz format

Birthday

Spouse/Partner's name

Spouse/Partner Gender

Spouse pronoun

Address

YAHRZEITS

Please select the number of yahrzeits observed in your family, and complete the information for each yahrzeit

* Full English Name of Deceased

Full Hebrew Name of Deceased (if known)

Gender of deceased

Preferred pronoun of deceased (e.g., her/his/their)

* English date of death

After sunset?

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