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Membership Application

Our membership form is below. If you do not know something in Hebrew, just leave it blank and it can be filled in later at the office.  The office will be contacting you to set up an appointment with Rabbi Pitkowsky as part of starting to build our relationship together.   Alternatively, if you like, Rabbi Pitkowsky and our staff would be delighted to meet with you prior to filling in an application.  If that is the case, please call the office at 201-833-2343 to set up an appointment.  

 

Is there a second adult in household?

Enter Adult B last name

Enter home phone

Enter how you would prefer your mail be addressed.
For example: Rabbi Joe Doe and Ms. Elaine Stit

Enter street address

Enter apartment number

Enter city name

Enter street address

Enter apartment number

Enter city name

Enter street address

Enter apartment number

Enter city name


For further information on membership types/dues, click here.
 


Mr., Mrs., Ms., Rabbi, Dr., Professor

Mr., Mrs., Ms., Rabbi, Dr., Professor


Do you have minor or college age children?

Please provide information if any child has a last name different than primary parent or the Hebrew name of the father or mother is different than Adult A and/or B.  One line per child.



Do you (or any members of your household) observe a yahrzeit?

If so, how many yahrzeits are observed in the household?

Other information if needed.  

Waiver

I hereby apply for membership for my household in Congregation Beth Sholom, Teaneck, and, if accepted, agree to abide by its Constitution and bylaws. I have been informed of the applicable dues structure and building fund obligation and building fund obligation and agree to accept the financial obligations of membership in Beth Sholom.  I also understand that submission of this form allows use of any photographs taken at events/activities related to the synagogue to be used in any form of public relations inclusive of website and social media.  

 

Monday, May 29 2017 4 Sivan 5777