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Adult 1
Title (Adult 1)
Dr.
Mr.
Mrs.
Ms.
Miss
Mx.
Title (Adult 2)
Dr.
Mr.
Mrs.
Ms.
Miss
Mx.
*
First Name (Adult 1)
First Name (Adult 2)
*
Last Name (Adult 1)
Last Name (Adult 2)
*
Gender (Adult 1)
N/A or Unknown
Male
Female
*
Gender (Adult 2)
N/A or Unknown
Male
Female
Tribe (Adult 1)
Cohen
Levi
Yisrael
None Set
Tribe (Adult 2)
Cohen
Levi
Yisrael
None Set
*
Marital Status (Adult 1)
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Marital Status (Adult 2 if different)
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
*
Primary Email Address (Adult 1)
Primary Email Address (Adult 2)
*
Birthday (Adult 1)
Birthday (Adult 2)
Wedding Anniversary (Adult 1)
Wedding Anniversary (Adult 2 if different)
*
Address Line 1 (Adult 1)
Address Line 1 (Adult 2 if different)
Address Line 2 (Adult 1)
Address Line 2 (Adult 2 if different)
*
City (Adult 1)
City (Adult 2 if different)
*
State (Adult 1)
--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
State (Adult 2 if different)
--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 (Adult 1)
Zip (Adult 2 if different)
*
Home Phone (Adult 1)
Home Phone (Adult 2 if different)
*
Cell Phone (Adult 1)
Cell Phone (Adult 2)
*
Billing Delivery Preference
No Preference
Email
Paper Mail
Job Title (Adult 1)
Job Title (Adult 2)
Business Name (Adult 1)
Business Name (Adult 2)
Business Phone (Adult 1)
Business Phone (Adult 2)
Out of Town Address (Adult 1)
Out of Town Address (Adult 2)
Approx. Out of Town Dates (Adult 1)
Approx. Out of Town Dates (Adult 2)
Bar/Bat Mitzvah (Adult 1)
Bar/Bat Mitzvah (Adult 2)
Parsha (Adult 1)
Bereshit
Noach
Lech Lecha
Vayera
Chayei Sara
Toldot
Vayetzei
Vayishlach
Vayeshev
Miketz
Vayigash
Vayechi
Shemot
Vaera
Bo
Beshalach
Yitro
Mishpatim
Terumah
Tetzaveh
Ki Tisa
Vayakhel
Pekudei
Vayikra
Tzav
Shmini
Tazria
Metzora
Achrei Mot
Kedoshim
Emor
Behar
Bechukotai
Bamidbar
Nasso
Beha'alotcha
Sh'lach
Korach
Chukat
Balak
Pinchas
Matot
Masei
Devarim
Vaetchanan
Eikev
Re'eh
Shoftim
Ki Teitzei
Ki Tavo
Nitzavim
Vayeilech
Ha'Azinu
Vayakhel-Pekudei
Tazria-Metzora
Achrei Mot-Kedoshim
Behar-Bechukotai
Chukat-Balak
Matot-Masei
Nitzavim-Vayeilech
Vezot Haberakhah
Select One
Parsha (Adult 2)
Bereshit
Noach
Lech Lecha
Vayera
Chayei Sara
Toldot
Vayetzei
Vayishlach
Vayeshev
Miketz
Vayigash
Vayechi
Shemot
Vaera
Bo
Beshalach
Yitro
Mishpatim
Terumah
Tetzaveh
Ki Tisa
Vayakhel
Pekudei
Vayikra
Tzav
Shmini
Tazria
Metzora
Achrei Mot
Kedoshim
Emor
Behar
Bechukotai
Bamidbar
Nasso
Beha'alotcha
Sh'lach
Korach
Chukat
Balak
Pinchas
Matot
Masei
Devarim
Vaetchanan
Eikev
Re'eh
Shoftim
Ki Teitzei
Ki Tavo
Nitzavim
Vayeilech
Ha'Azinu
Vayakhel-Pekudei
Tazria-Metzora
Achrei Mot-Kedoshim
Behar-Bechukotai
Chukat-Balak
Matot-Masei
Nitzavim-Vayeilech
Vezot Haberakhah
Select One
Languages (Adult 1)
English
Russian
Hebrew
Yiddish
Languages (Adult 2)
English
Russian
Hebrew
Yiddish
Other Languages (Adult 1)
Other Languages (Adult 2)
*
Do you read Hebrew? (Adult 1)
Please Select One
Not at All
Moderately
Very Well
Do you read Hebrew? (Adult 2)
Not at All
Moderately
Very Well
*
Would you like to chant Haftarah or read Torah? (Adult 1)
Please Select One
Yes
No
Would you like to chant Haftarah or read Torah? (Adult 2)
Yes
No
*
Would you like to learn to chant Haftarah or read Torah? (Adult 1)
Please Select One
Yes
No
Would you like to learn to chant Haftarah or read Torah? (Adult 2)
Yes
No
Hebrew First Name (Adult 1)
Hebrew First Name (Adult 2)
Hebrew Father's Name (Adult 1)
Hebrew Father's Name (Adult 2)
Hebrew Mother's Name (Adult 1)
Hebrew Mother's Name (Adult 2)
Do you own a cemetery plot? (Adult 1)
Yes
No
Do you own a cemetery plot? (Adult 2)
Yes
No
If yes, where? (Adult 1)
If yes, where? (Adult 2)
Yahrzeit Record
Name of Deceased
Member's Relationship to Deceased
English/Hebrew Date of Death
Hebrew Name of Deceased
Name of Deceased
Member's Relationship to Deceased
English/Hebrew Date of Death
Hebrew Name of Deceased
Name of Deceased
Member's Relationship to Deceased
English/Hebrew Date of Death
Hebrew Name of Deceased
Name of Deceased
Member's Relationship to Deceased
English/Hebrew Date of Death
Hebrew Name of Deceased
Dependent Children
Name
Date of Birth
Hebrew Name
Current Grade
Name
Date of Birth
Hebrew Name
Current Grade
Name
Date of Birth
Hebrew Name
Current Grade
Name
Date of Birth
Hebrew Name
Current Grade
Adult Children
Name
Date of Birth
Hebrew Name
Address
Name
Date of Birth
Hebrew Name
Address
Name
Date of Birth
Hebrew Name
Address
Name
Date of Birth
Hebrew Name
Address
Activities of the Congregation
Please check if interested
Interests (Adult 1)
Archives
Cemetery
Development
Education
Inclusion
LGBTQ
Membership
Men's Club
Minyan
Office Help
Sisterhood
Special Events
Tikkun Olam
Tot Shabbat
Ushers/Greeters
Youth
Interests (Adult 2)
Archives
Cemetery
Development
Education
Inclusion
LGBTQ
Membership
Men's Club
Minyan
Office Help
Sisterhood
Special Events
Tikkun Olam
Tot Shabbat
Ushers/Greeters
Youth
For dues and other financial information, please call the office at (585) 473-1770.
Additional notes:
Tue, June 24 2025 28 Sivan 5785
