Membership Application - Temple Anshe Hesed

MEMBER 1 INFORMATION

* Member 1 - Title

* Member 1 - First Name

Member 1 - Middle Name

* Member 1 - Last Name

* Member 1 - Cell Phone

* Member 1 - Email Address

* Member 1 - Date of Birth

* Member 1 - Gender

* Member 1 - Home Address

* Member 1 - Marital Status

Member 1 - Anniversary Date

if applicable

Member 1 - Name of Congregation where most recently affiliated, if applicable

if applicable

* Member 1 - Profession/Occupation

* Member 1 - Employer

* Member 1 - Work Phone

Member 1 - Hebrew Name

(if known & applicable)

Member 1 - Religious Background

Member 1 - Is there anything you would like to inform us about your religious background?

Member 1 - Special Skills / Talents you’d like to share

* Member 1 - Chant Torah / Read Hebrew

* Member 1 - May we call upon you to be a Hebrew Torah reader?

Member 1 - Special accommodations needed

Hearing Assistance DeviceVisual ImpairmentOther

Member 1 - If other, please specify

TEMPLE ANSHE HESED INVOLVEMENT

We are always interested in involving our members in the life and activities of our Congregation. Please indicate any areas of interest to the adults in your household.

Member 1 - Please choose the areas you would like to involved in:

Engagement ( Includes Communication, Tikkun Olam, In-reach & Outreach)Gesher Committee (Provides for Youth and Adult Education)Finance (Oversees financial operations of the Congregation)Governance Committee (Ensures leadership succession/development)House/Physical Plant (Supervises maintenance & security, includes the Cemetery)Membership (Responsible for recruitment, integration, retention of members, includes Caring Committee)Special Events (Promotes sense of community, shared observances and holidays)Worship (Coordinates worship, ritual & observances, includes Music Committee)

Member 1 - What additional information would you like to have about the Committees or Temple offerings?

Member 1 - What additional information would you like to share about your interests, skills, or talents?

ADDITIONAL INFORMATION

* Is there a second adult applying for membership?

MEMBER 2 INFORMATION

* Member 2 - Title

* Member 2 - First Name

* Member 2 - Middle Name

* Member 2 - Last Name

* Member 2 - Cell Phone

* Member 2 - Email Address

* Member 2 - Date of Birth

* Member 2 - Gender

* Member 2 - Marital Status

Member 2 - Anniversary Date

if applicable

Member 2 - Name of Congregation where most recently affiliated, if applicable

if applicable

* Member 2 - Profession/Occupation

* Member 2 - Employer

* Member 2 - Work Phone

* Member 2 - Work Address

Member 2 - Hebrew Name

(if known & applicable)

Member 2 - Religious Background

Member 2 - Is there anything you would like to inform us about your religious background?

Member 2 - Special Skills / Talents you’d like to share

* Member 2 - Chant Torah / Read Hebrew

* Member 2 - May we call upon you to be a Hebrew Torah reader?

Member 2 - Special accommodations needed

Hearing Assistance DeviceVisual ImpairmentOther

Member 2 - If other, please specify

Member 2 - Please choose the areas you would like to involved in:

Member 2 - What additional information would you like to have about the Committees or Temple offerings?

Member 2 - What additional information would you like to share about your interests, skills, or talents?

CHILDREN'S INFORMATION

* How many children live in your household?

CHILD 1 INFORMATION

* Child 1 - Name

Child 1 - Hebrew Name

* Child 1 - Date of Birth

Child 1 - Gender/Preferred Pronoun

* Child 1 - Grade (or College level)

* Child 1 - Name of School

Child 1 - Address if not living

Child 1 - Cell Phone, Email, if applicable

CHILD 2 INFORMATION

* Child 2 - Name

Child 2 - Hebrew Name

* Child 2 - Date of Birth

Child 2 - Gender/Preferred Pronoun

* Child 2 - Grade (or College level)

* Child 2 - Name of School

Child 2 - Address if not living

Child 2 - Cell Phone, Email, if applicable

CHILD 3 INFORMATION

* Child 3 - Name

Child 3 - Hebrew Name

* Child 3 - Date of Birth

Child 3 - Gender/Preferred Pronoun

* Child 3 - Grade (or College level)

* Child 3 - Name of School

Child 3 - Address if not living

Child 3 - Cell Phone, Email, if applicable

CHILD 4 INFORMATION

* Child 4 - Name

Child 4 - Hebrew Name

* Child 4 - Date of Birth

Child 4 - Gender/Preferred Pronoun

* Child 4 - Grade (or College level)

* Child 4 - Name of School

Child 4 - Address if not living

Child 4 - Cell Phone, Email, if applicable

OTHER ADULT INFORMATION

* How many Other Adults live in your household?

* Other Adult 1 - Name

* Other Adult 1 - Date of Birth

* Other Adult 1 - Relationship

* Other Adult 1 - Gender/ Preferred Pronoun

* Other Adult 2 - Name

* Other Adult 2 - Date of Birth

* Other Adult 2 - Relationship

* Other Adult 2 - Gender/ Preferred Pronoun

REMEMBRANCE FUND/PERPETUAL MEMORIAL FUND

At Temple Anshe Hesed, we have a special Remembrance/Perpetual Memorial Fund, which is a memorial to a loved one by inscription of his or her name on the Perpetual Memorial List, with a recital on the anniversary of the death, and a listing in the Yom Kippur Roll of Remembrance.

A contribution of $200 or more to the Fund provides these memorials.

* Please choose to remember your loved one’s Yahrzeit (annual remembrance date of relatives who have passed away) by either the Jewish or English calendar. How many Yahrzeit's would you like to remember?

Name of Deceased

Relationship

Relationship to whom?

Date of Death

Please use:

Name of Deceased

Relationship

Relationship to whom?

Date of Death

Please use:

Name of Deceased

Relationship

Relationship to whom?

Date of Death

Please use:

Name of Deceased

Relationship

Relationship to whom?

Date of Death

Please use:

I would like to make a donation to the Remembrance Fund/Perpetual Memorial in the following amount:

TEMPLE ANSHE HESED FINANCIAL COMMITMENTS

A Finance Committee member will contact you to discuss Temple Anshe Hesed finances and yearly dues commitments once your membership is approved.

L’Shalom

Temple Anshe Hesed Finance Committee

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