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Friday, August 4, 7:45 PM
Traditional Sabbath Service
Led by Rabbi Stan Levin
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Hevrat Shalom Congregation - Membership

We are pleased that you have chosen to continue your membership or join Hevrat Shalom for 2016/2017 and hope that you will be an active participant. Please provide the following information so we can maximize our services to you and your family.

Name:

Address:

City: State: Zip:

Phone: Email:

Date of Birth: (mm/dd/yy)

Occupation:

Employer:

Business Address:

Business Phone:

Hebrew Names: (______ben______)

Hebrew Names: (______bat______)

Status: Wedding Anniversary: (mm/dd/yy)


Can you read Hebrew? No: A Little: Moderately Well:

Unmarried Children (Please include information on all children including those living with another parent or away at school):

Name, Hebrew Name, M/F, Birthdate, School Grade           


Yahrzeits Observed (English Date):
Name, Relationship (To Whom), Date You Observe (mm/dd/yy)


Previous Synagogue Affiliation:


Please indicate, even if you have done so before, areas you might be interested in:
Adult Learning
Financial
Fundraising
Interfaith
Membership
Newsletter/Publicity
Office Help
Oneg Preparation
Outreach
Rabbi's Study Group
Social Activities
Social Action
Temple Board
Youth Programs
Religious School



By affixing my/our signature(s) to this application, I/we hereby agree to abide by the Constitution and By-Laws of the congregation, and to maintain my/our membership in good standing.

Signature: Date: (mm/dd/yy)









   

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