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Membership Application
Please verify reCaptcha before submitting the form.
APPLICANT #1
APPLICANT #2
*
First Name
First Name
*
Last Name
Last Name
*
Birthdate MM/DD/YYYY
Birthdate MM/DD/YYYY
Gender Pronoun
Please select or fill in "other" below
He/him
She/her
They/them
Gender Pronoun
Please select or fill in "other" below
He/him
She/her
They/them
Other:
Other:
*
Mobile Phone #
Mobile Phone #
*
Email Address
Email Address
Occupation
Occupation
Employer
Employer
Business Phone
Business Phone
Hebrew Name (Transliteration or Hebrew)
Hebrew Name (Transliteration or Hebrew)
Father's Hebrew Name(Transliteration or Hebrew)
Father's Hebrew Name(Transliteration or Hebrew)
Mother's Hebrew Name (Transliteration or Hebrew)
Mother's Hebrew Name (Transliteration or Hebrew)
Religious Background
Reform
Conservative
Reconstructionist
Orthodox
Converted to Judaism
Unaffiliated
Non-Jewish spouse/partner
Religious Background
Reform
Conservative
Reconstructionist
Orthodox
Converted to Judaism
Unaffiliated
Non-Jewish spouse/partner
Jewish Education
None
Adult Education
College Courses
Religious School
Day School or Yeshiva
Jewish Education
None
Adult Education
College Courses
Religious School
Day School or Yeshiva
Home Observance
None/very little
Light candles occasionally
Light candles most of the time
Celebrate major holidays
Observe Kashrut
Home Observance
None/very little
Light candles occasionally
Light candles most of the time
Celebrate major holidays
Observe Kashrut
*
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
Home Phone Number
Marital Status
Please Choose
Single
Engaged
Partnered
Married
Separated
Divorced
Widowed
Children (under 25 years of age)
Child 1
First & Last Name
Hebrew Name
Birthdate MM/DD/YYYY
Gender Pronoun
Please Choose One
He/him
She/her
They/them
Other
School
Grade
Child 1 - I wish to enroll this child in Torah La'am
Please Select One
Yes
No
Child 2
First & Last Name
Hebrew Name
Birthdate MM/DD/YYYY
Gender Pronoun
Please Choose One
He/him
She/her
They/them
Other
School
Grade
Child 2 - I wish to enroll this child in Torah La'am
Please Select One
Yes
No
Child 3
First & Last Name
Hebrew Name
Birthdate MM/DD/YYYY
Gender Pronoun
Please Choose One
He/him
She/her
They/them
Other
School
Grade
Child 3 - I wish to enroll this child in Torah La'am
Please Select One
Yes
No
Child 4
First & Last Name
Hebrew Name
Birthdate MM/DD/YYYY
Gender Pronoun
Please Choose One
He/him
She/her
They/them
Other
School
Grade
Child 4 - I wish to enroll this child in Torah La'am
Please Select One
Yes
No
Yahrzeit(s) of Family/Loved Ones
(please complete if you wish to receive an annual reminder)
English Name
Hebrew Name
Relationship
Date of Death (Gregorian) MM/DD/YYYY
Before/After Sundown
Please Choose One
Before Sundown
After Sundown
English Name
Hebrew Name
Relationship
Date of Death (Gregorian) MM/DD/YYYY
Before/After Sundown
Please Choose One
Before Sundown
After Sundown
English Name
Hebrew Name
Relationship
Date of Death (Gregorian) MM/DD/YYYY
Before/After Sundown
Please Choose One
Before Sundown
After Sundown
English Name
Hebrew Name
Relationship
Date of Death (Gregorian) MM/DD/YYYY
Before/After Sundown
Please Choose One
Before Sundown
After Sundown
What inspired you to join?
Family/friends are members
Live nearby
Philosophy aligned with Reconstructionism
Community feel/support
Children reaching school age
Shorashim experience
Adult education opportunities
Clergy
Other
How did you hear about Bet Am Shalom?
Names of friends and/or relatives now members of Bet Am Shalom
Former congregational affiliation(s)
How might you like to get involved at Bet Am Shalom?
APPLICANT #1
APPLICANT #2
Continuing Education
Acharei Kiddush
Adult Bible Study
BAS Book Club
Hebrew Literacy Class
Hebrew Reading Group
Libraries
Parashah of the Week Study Group
Summer Study Group
Talmud Weekly Study Group
Yiddish Conversation Circle
Continuing Education
Acharei Kiddush
Adult Bible Study
BAS Book Club
Hebrew Literacy Class
Hebrew Reading Group
Libraries
Parashah of the Week Study Group
Summer Study Group
Talmud Weekly Study Group
Yiddish Conversation Circle
Community Outreach & Support
BAS Connections
BAS Pen Pals
Bikur Cholim (caring for the sick)
College Connect
Coronavirus Congregational Outreach/Support
Meal of Consolation (Se'udat Havra'ah)
Refu'at HaNefesh (Healing of Spirit)
Seder Shidduch
Shiva Support
Community Outreach & Support
BAS Connections
BAS Pen Pals
Bikur Cholim (caring for the sick)
College Connect
Coronavirus Congregational Outreach/Support
Meal of Consolation (Se'udat Havra'ah)
Refu'at HaNefesh (Healing of Spirit)
Seder Shidduch
Shiva Support
Family Programming
Family Engagement
Parent Association for Torah La'am
School Board
Shorashim (monthly 0-5 years program)
Shabbat Kulanu
Tot Shabbat
Young Family Brunch
Family Programming
Family Engagement
Parent Association for Torah La'am
School Board
Shorashim (monthly 0-5 years program)
Shabbat Kulanu
Tot Shabbat
Young Family Brunch
Torah in Action
Refugee Resettlement
Blood Drive
Holiday Meals at Local Shelters
Interfaith Jewish/Muslim Activities
Food for Open Arms Shelter
Green Chevra
Hunger & Homelessness
Kiddush Food Delivery to Shelter
Midnight Run
Mitzvah Knits
Social Action Concert
Special Needs Shabbat
Tikkun Olam (repair the world)
Torah in Action
Refugee Resettlement
Blood Drive
Holiday Meals at Local Shelters
Interfaith Jewish/Muslim Activities
Food for Open Arms Shelter
Green Chevra
Hunger & Homelessness
Kiddush Food Delivery to Shelter
Midnight Run
Mitzvah Knits
Social Action Concert
Special Needs Shabbat
Tikkun Olam (repair the world)
Art, Literature & Music
Bet Am Shalom Gallery
Cinematheque
Selected Jewish Short Stories
Shirat Ha'am (choir)
Writers Chug (Original Jewish Short Stories)
Art, Literature & Music
Bet Am Shalom Gallery
Cinematheque
Selected Jewish Short Stories
Shirat Ha'am (choir)
Writers Chug (Original Jewish Short Stories)
Shabbat & Minyans
Candlelighting via Zoom
Havdalah for Families
Homemade Kiddush
Meditation Before Tefilah
Morning Minyan
Shabbat Scotch Tasting
Shabbat Morning Service Coordination
Sunday Shacharit
Shabbat & Minyans
Candlelighting via Zoom
Havdalah for Families
Homemade Kiddush
Meditation Before Tefilah
Morning Minyan
Shabbat Scotch Tasting
Shabbat Morning Service Coordination
Sunday Shacharit
Holidays
Lulav & Etrog Trip and Market
Mishloach Manot (giving of Purim giftbags)
Purim Spiel
Simchat Torah
Sukkah Decorating
Tu B'Shevat Celebration
Yom HaShoah (Holocaust Remembrance Day)
Yom Kippur Break Fast
Holidays
Lulav & Etrog Trip and Market
Mishloach Manot (giving of Purim giftbags)
Purim Spiel
Simchat Torah
Sukkah Decorating
Tu B'Shevat Celebration
Yom HaShoah (Holocaust Remembrance Day)
Yom Kippur Break Fast
Israel
Israel Action
Shalom Yisrael (Zahal Shalom)
Israel
Israel Action
Shalom Yisrael (Zahal Shalom)
Organization & Administration
BAS Facebook Community Group
Communications & Marketing
Congregational Emails
Congregational Flyers
Financial Advisory Committee
Gardening
Innovation Task Force
Library
Newsletter (Lev La'am)
Photography
Program Committee
Security
ShulCloud Transition
Website
Zoom
Organization & Administration
BAS Facebook Community Group
Communications & Marketing
Congregational Emails
Congregational Flyers
Financial Advisory Committee
Gardening
Innovation Task Force
Library
Newsletter (Lev La'am)
Photography
Program Committee
Security
ShulCloud Transition
Website
Zoom
Please indicate other interests or special skills that you'd like to bring to Bet Am Shalom
Advertising, Marketing, Public Relations
Artistic/Creative
Building Systems/Grounds Knowledge
Carpentry
Children's Programming
Communications/Writing/Copy/Editing/Proofing
Computers/Spreadsheets
Cooking/Baking
Event Planning/Logistics
Financial Planning
Fundraising
Game/Sports Leader
Gardening
Graphic Arts/Design
Grant Writing
Insurance Background
Interior Design
Legal/Law
Leading Meditation/Yoga
Musician
Organizational Skills
Photography/Videography
Physical Labor (setup events)
Team/Group Facilitator
Technology/Social Media/Website
Torah/Haftarah Reading
Strategic Planning
Teaching
Please indicate other interests or special skills that you'd like to bring to Bet Am Shalom
Advertising, Marketing, Public Relations
Artistic/Creative
Building Systems/Grounds Knowledge
Carpentry
Children's Programming
Communications/Writing/Copy/Editing/Proofing
Computers/Spreadsheets
Cooking/Baking
Event Planning/Logistics
Financial Planning
Fundraising
Game/Sports Leader
Gardening
Graphic Arts/Design
Grant Writing
Insurance Background
Interior Design
Legal/Law
Leading Meditation/Yoga
Musician
Organizational Skills
Photography/Videography
Physical Labor (setup events)
Team/Group Facilitator
Technology/Social Media/Website
Torah/Haftarah Reading
Strategic Planning
Teaching
Other:
Other:
Responsibilities of Membership
I/we understand that we are expected to participate in the life of Bet Am Shalom and look forward to our active involvement. I/we agree to abide by its by-laws and ritual practices as authorized by the Board of Trustees and Ritual Committee. I/we also understand the financial commitments of membership as outlined in the Fee Schedule received with the membership package. I/we will be responsible for all dues, pledges, tuitions, fees, and assessments for which we become obligated as a result of our membership and agree to initiate a confidential discussion with a Bet Am Shalom financial officer, if genuine financial need warrants.
*
Electronic Signature on Behalf of All Applicants
Mon, December 11 2023 28 Kislev 5784
