Temple Judea 4311 Hood Road

Palm Beach Gardens, FL 33410 Voice: 561-624-4633

Fax: 561-624-4076 gotj.org

MEMBERSHIP APPLICATION

GENERAL INFORMATION

This form is editable on your computer – Please type in each box. You can then save this document and email it to the temple administrator, or you can print out this form and hand-write the membership application.

Family Name (Last Name):

Current Address:

Subdivision:

City:

State:

Zip Code:

Out of Town Address (If Applicable):

Subdivision:

City:

State:

Zip Code:

Telephone Number:

Family Status: (check one): Married Date: ____________ Single Widowed Partnership

Previous Synagogue (If Applicable):

We love to include pictures of you in many projects for Temple Judea. These may include mailers, website, videos, etc. If you do not wish to have your photo used in any promotional material, please check the box to the right. Thank you. Adult Member # 1 : Name:

E-mail:

Cellular Phone:

Home Phone:

Date of Birth:

Occupation:

Business Name:

Work Phone:

Facebook User Name:

Interests/Hobbies:

Adult Member #2

Name:

E-mail:

Cellular Phone:

Home Phone:

Date of Birth:

Occupation:

Business Name:

Work Phone:

Facebook User Name:

Interests/Hobbies:

Temple Judea 4311 Hood Road

Palm Beach Gardens, FL 33410 Voice: 561-624-4633

Fax: 561-624-4076 gotj.org

Children Information (College Age and Under)

Child #1 Name: Hebrew Name (if known):

Date of Birth:

If a Student – Name of School Grade: Male Female

Child #2 Name: Hebrew Name (if known):

Date of Birth: If a Student – Name of School Grade: Male Female

Child #3 Name: Hebrew Name (if known):

Date of Birth: If a Student – Name of School Grade: Male Female

Child #4 Name: Hebrew Name (if known):

Date of Birth: If a Student – Name of School Grade: Male Female

Yahrzeit Information

Please indicate if you would like the Yahrzeits read on the English or Hebrew date? English Hebrew Deceased Name Relative of:

Relationship: English Date of Death (mm/dd/yyyy):

Deceased Name

Relative of:

Relationship: English Date of Death (mm/dd/yyyy):

Deceased Name Relative of:

Relationship: English Date of Death (mm/dd/yyyy):

Deceased Name Relative of:

Relationship: English Date of Death (mm/dd/yyyy):

Emergency Contact Name: Phone #: Relationship:

Temple Judea 4311 Hood Road

Palm Beach Gardens, FL 33410 Voice: 561-624-4633

Fax: 561-624-4076 gotj.org

GET INVOLVED! We invite you to become an active member of your congregation

Name:

Please check the areas you are interested in becoming more involved

Adult Education Book Club Chorus Fundraising Kabbalah Membership Men’s Club

Office Volunteer Religious School Sisterhood Social Action Special Events Young Adults Youth Group

List additional areas:

Name:

Please check the areas you are interested in becoming more involved

Adult Education Book Club Chorus Fundraising Kabbalah Membership Men’s Club

Office Volunteer Religious School Sisterhood Social Action Special Events Young Adults Youth Group

List additional Areas:

I heard about Temple Judea from: Newspaper Friends/Family Advertising Location Mailings Other Reason for joining Temple Judea?

Did you get referred to our Temple? By whom?

Financial Information Fiscal Year: June 1st – May 31st

My Annual Commitment to Temple Judea ___________ First Year Introductory ___________ Chai Society (Optional) -“I believe in our mission of never turning anyone away” ___________ Golden Chai Society (Optional) – “I want to continue our vision of education, spirituality & creativity” ___________ ARZA: The Reform Israel Fund (Voluntary Contribution) – Linking the reform movement in Israel and United States ___________ High Holiday Books ($36 Each) ___________ Total ___________ Charge my (Check One): Visa MasterCard American Express Card Number: __________________________________________Expiration Date: ______ / ________ CVV Code: _____________ Enclosed is my check for:

(Please call the temple to review this section)

Temple Judea 4311 Hood Road

Palm Beach Gardens, FL 33410 Voice: 561-624-4633

Fax: 561-624-4076 gotj.org

Thank you for becoming a member of Temple Judea.

We welcome you to our family .

Rev: 01/2013

Please use this space to add additional information: