Membership Application - Form - Congregation Beth Tefillah

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Membership Application

* Applicant Family Name

* First Name

* Hebrew Name

Tribe

Father's Hebrew Name

Mother's Hebrew Name

email address

Secondary Applicant Last Name (if different from applicant)

First Name

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Street Address

* City

* State

* ZIP code

If husband and wife are applying, is this your first marriage?

YesNo

If not, how was previous marriage terminated?

If divorced, who issued "Get"?

Child's First Name

Child's Hebrew Name

Birth date

Child's First Name

Child's Hebrew Name

Birth date

Child's First Name

Child's Hebrew Name

Birth date

Child's First Name

Child's Hebrew Name

Birth date

* Choose membership category

Please Select OneMember Family - $1300*Single or Senior Member - $650Associate Member** - $650Gold Patron - $7200Silver Patron - $3600*Discount of $100 if paid by December 31
**Must be a full member of another shul

Total Due

Thu, April 25 2024 17 Nisan 5784