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Temple Concord Membership Application
Please verify reCaptcha before submitting the form.
Thank you for your interest in joining Temple Concord
Being a member of Temple Concord means you have a spiritual home.
You will find here a welcoming, inclusive congregational family and we are excited about the prospect of getting to know you. We are a vibrant, growing congregation with a long history of over 180 years.
ADULT 1 INFORMATION
Title
Please only include if other than Mr/Mrs/Ms
*
First Name
Nickname
Middle Name
*
Last Name
*
Email Address
*
Cell
Birthdate
Maiden Name
Hebrew Name
Tribe at Birth
Please Select One
Kohen
Levi
Yisrael
Jew by Choice
Father Hebrew Name
Mother Hebrew Name
Conversion Date (if applicable)
Business Name
Occupation
Business Phone
Special Skills or Areas of Expertise
ADULT 2 INFORMATION (IF NEEDED)
Title
Please only include if other than Mr/Mrs/Ms
First Name
Nickname
Middle Name
Last Name
Email Address
Cell
Birthdate
Maiden Name
Hebrew Name
Tribe at Birth
Please Select One
Kohen
Levi
Yisrael
Jew by Choice
Father Hebrew Name
Mother Hebrew Name
Conversion Date (if applicable)
Business Name
Occupation
Business Phone
Special Skills or Areas of Expertise
HOUSEHOLD INFORMATION
*
Home Street Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
Home Phone Number
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Anniversary
CHILDREN
How many children do you have?
0
1
2
3
4
5
6
Child 1
First Name
Middle Name
Nickname
Last Name
Hebrew Name
Gender
N/A or Unknown
Male
Female
Birthdate
Mobile (if applicable)
Email (if applicable)
Bris / Baby Naming / Conversion Date
School Name (if applicable)
School Grade (if applicable)
Child 2
First Name
Middle Name
Nickname
Last Name
Gender
N/A or Unknown
Male
Female
Birthdate
Mobile (if applicable)
Email (if applicable)
Bris / Baby Naming / Conversion Date
School Name (if applicable)
School Grade (if applicable)
Child 3
First Name
Middle Name
Nickname
Last Name
Gender
N/A or Unknown
Male
Female
Birthdate
Mobile (if applicable)
Email (if applicable)
Bris / Baby Naming / Conversion Date
School Name (if applicable)
School Grade (if applicable)
Child 4
First Name
Middle Name
Nickname
Last Name
Gender
N/A or Unknown
Male
Female
Birthdate
Mobile (if applicable)
Email (if applicable)
Bris / Baby Naming / Conversion Date
School Name (if applicable)
INTERESTS AND ACTIVITIES
Adult 1: Please check off the boxes to let us know which committees might interest you-
Brotherhood
Caring: Supporting members in need
Choir
Finance & Budgeting
Greeters: For services
Library
Adult Education - Helps create classes and learning opportunities for adults
Membership
Religious School
Ritual
Sisterhood
Social Action
Youth Groups
Blood Drive - Help run our annual blood drive
Building and Grounds - Help with landscaping
Publicity - Help with marketing
Fund Raising
Social and Cultural Events - Help plan and coordinate events
Adult 2: Please check off the boxes to let us know which committees might interest you-
Brotherhood
Caring: Supporting members in need
Choir
Finance & Budgeting
Greeters: For services
Library
Adult Education - Helps create classes and learning opportunities for adults
Membership
Religious School
Ritual
Sisterhood
Social Action
Youth Groups
Blood Drive - Help run our annual blood drive
Building and Grounds - Help with landscaping
Publicity - Help with marketing
Fund Raising
Social and Cultural Events - Help plan and coordinate events
Any additional information you would like to share with us, including current and/or past family members at Temple Concord
In case of emergency, please contact:
Thank you for taking the time to share your information.
Please expect a call from Diane Sacks once this information has been reviewed.
We look forward to sharing many years of spiritual experiences together.
Feel free to be in touch by emailing
diane@templeconcord.org
or (315) 475-9952.
Thu, February 6 2025 8 Sh'vat 5785