Membership Application
Shomrei Torah - The Wayne Conservative Congregation

Name #1 __________________________________________ Birth Date _______________ Anniv Date ______________ Home Address ____________________________________ Home Telephone ___________________________________ Occupation _______________________________________ Employer _________________________________________ Business Address _________________________________ Business Telephone _______________________________ If Retired, Former Occupation/Employer: _______________________________________________ Cell Phone _____________ Fax _____________ E-mail Address _________________________ I am: Jewish by Birth ____ Jewish by Conversion ____ Not Jewish _____ My Hebrew Name* __________________________ Father's Hebrew Name* ______________________ Mother's Hebrew Name* _______________________ (*transliterated or in Hebrew) I last was a dues paying member at a synagogue which was: Conservative____Reform_____Orthodox_____ Reconstructionist_____ named _________________ located in _________________ I am a: Kohen/Bat Kohen______Levi/Bat Levi_____Yisrael_______ Judaic skills: Read Torah ______chant Haftarah______ lead a service______ Read Hebrew______ Speak: Hebrew______Yiddish______Ladino______ Teach______________________Other__________________ Other organizations in which I am active or hold positions: _______________________________________________ Skills/Hobbies _______________________________________	Name #2 __________________________________________ Birth Date _______________ Anniv Date ______________ Home Address ____________________________________ Home Telephone ___________________________________ Occupation _______________________________________ Employer _________________________________________ Business Address _________________________________ Business Telephone _______________________________ If Retired, Former Occupation/Employer: _______________________________________________ Cell Phone _____________ Fax _____________ E-mail Address _________________________ I am: Jewish by Birth ____ Jewish by Conversion ____ Not Jewish _____ My Hebrew Name* __________________________ Father's Hebrew Name* ______________________ Mother's Hebrew Name* _______________________ (*transliterated or in Hebrew) I last was a dues paying member at a synagogue which was: Conservative____Reform_____Orthodox_____ Reconstructionist_____ named _________________ located in _________________ I am a: Kohen/Bat Kohen______Levi/Bat Levi_____Yisrael_______ Judaic skills: Read Torah ______chant Haftarah______ lead a service______ Read Hebrew______ Speak: Hebrew______Yiddish______Ladino______ Teach______________________Other__________________ Other organizations in which I am active or hold positions: _______________________________________________ Skills/Hobbies ____________________________________________
Anything else we should know about you or your family? ______________________________________________________________________
CHILDREN LIVING AT HOME or in College: CHILDREN LIVING INDEPENDENTLY: English Name Sex Date of Birth Hebrew Name Name of school/college Grade/Year Email address 1. ___________________ _______ __________ _______________ ________________________ ___________ ________________ 2. ___________________ _______ __________ _______________ ________________________ ___________ ________________ 3. ___________________ _______ __________ _______________ ________________________ ___________ ________________ 4. ___________________ _______ __________ _______________ ________________________ ___________ ________________ English Name Sex Date of Birth Marital Status Children Email address 1. ___________________ _______ __________ _______________ ________________________ ________________ 2. ___________________ _______ __________ _______________ ________________________ ________________ 3. ___________________ _______ __________ _______________ ________________________ ________________ 4. ___________________ _______ __________ _______________ ________________________ ________________
YARZEIT RECORDS: Name Hebrew Name Relationship & to whom English date of death - Before or after sundown? Hebrew date of death? 1. _________________ _____________ _______________________ _______________________________________ ________________ 2. _________________ _____________ _______________________ _______________________________________ ________________ 3. _________________ _____________ _______________________ _______________________________________ ________________ 4. _________________ _____________ _______________________ _______________________________________ ________________
CONGREGATIONAL ACTIVITIES: Involvement in Congregational activities helps everyone. Check all those which might interest you:
Name #1 Name #2 Sisterhood _________ _________ Men's Club _________ _________ Parent Teacher Org _________ _________ Membership _________ _________ Education _________ _________ Hebrew High _________ _________ Junior Congregation _________ _________ Adult Education _________ _________ Koach (college outreach) _________ _________ Fundraising _________ _________ Long Range Planning _________ _________ Capital Campaign _________ _________ House Maintenance _________ _________ Landscaping/Fund _________ _________ Handicap Accessibility _________ _________ Library _________ _________ Minyan (morning) _________ _________ Minyan (evening) _________ _________ Shiva minyanim _________ _________ Programming _________ _________	Name #1 Name #2 Friday night dinners _________ _________ Mitzvah Corps _________ _________ Visiting the sick (Bikur Cholim) _________ _________ L'Chaim (monthly newsletter) _________ _________ Ads for L'Chaim _________ _________ Youth Activities _________ _________ Purim Schpiel (talent show) _________ _________ Singles _________ _________ Young Couples _________ _________ Jews by Choice/Mixed Marriages _________ _________ Shomrim (support group for those seeking to increase observance) _________ _________ Hazak (over 55) _________ _________ Ritual _________ _________ Ad Journal/Dinner Dance _________ _________ Wayne Interfaith Network _________ _________ Publicity _________ _________ President's Council (minimum $1,000 donation per family) _________ _________ Historian _________ _________ Other: _________ _________
Suggestions or Comments: ________________________________________________________ Dues Category____________________________________________________________________