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Membership Application

Kindly contact our Administrator, Jay Hirschhorn if you have any questions about filling out this form.  This includes requiring more fields for certain information.                     Admin@ShomreiTorahWCC.org  or  973.696.2500 x12.

Contact  Information

Member 1

Member 2

FAMILY BACKGROUND INFORMATION

Member  # 1

Member  # 2

Hebrew names can be entered using English transliteration or in Hebrew using the Hebrew keyboard.  (Click on icon at right of each field.)


Judaic Skills

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FAMILY INFORMATION

CHILDREN AT HOME (or in College):

CHILD # 1

CHILD # 2

CHILD # 3


CHILDREN LIVING INDEPENDENTLY:

INDEPENDENT CHILD # 1

INDEPENDENT CHILD # 2

INDEPENDENT CHILD # 3

INDEPENDENT CHILD # 4


OTHER ADULTS IN YOUR HOUSEHOLD


YAHRZEIT RECORDS

DECEASED  # 1

DECEASED  # 2

DECEASED  # 3

DECEASED  # 4

DECEASED  # 5


CONGREGATIONAL ACTIVITIES & INVOLVEMENT

What programs would you like more information about and/or interest you as a participant?

Check all those which might interest you and your family.

 

Member # 1

Member # 2

Sun, December 10 2017 22 Kislev 5778