Membership Application – Congregation Rodeph Sholom

Welcome to Congregation Rodeph Sholom. We are delighted to have you join our sacred community.

Member A Information

Prefix (Select one) **

If you selected "other", please tell us here

Name **

First Middle Last

Prefers to be called: **

Gender

Marital Status **

Date of Birth **

Date of Anniversary

Religious Upbringing

Current Religious Status

Home Address **

Street Address Address Line 2 City State ZIP Code

Home Phone

Primary Email**

Cell Phone**

Billing Address **

Home
Business

Name of Employment

Occupation or Profession

Employment Title

Business Address

Street Address Address Line 2 City State ZIP Code

Business Phone

Business E-mail

Have you previously been a member of Congregation Rodeph Sholom? **

Yes
No

If Yes, when?

Member B Information

Prefix (Select one)

If you selected "other", please tell here

Name

First Middle Last

Gender

Prefers to be called**

Date of Birth**

Personal Email**

Cell Phone**

Religious Upbringing

Current Religious Status

Name of Employment

Occupation or Profession

Employment Title

Business Address

Street Address Address Line 2 City State ZIP Code

Business Phone

Business E-mail

Have you previously been a member of Congregation Rodeph Sholom?

Yes
No

If Yes, when?

Relatives or friends who are now members of Rodeph Sholom:

Does anyone in your household have any special needs of which we should be aware? **

Yes
No

If Yes, please describe:

Do you have any children? **

Child Information

Child's Name

First Middle Last

Hebrew Name

Prefers to be called**

Gender

Date of Birth**

School Attending/Attended

Email

Add child

Child Information (B)

Child's Name

First Middle Last

Hebrew Name

Prefers to be called**

Gender

Date of Birth**

School Attending/Attended

Email

Add a third child

Child Information (C)

Child's Name

First Middle Last

Hebrew Name

Prefers to be called**

Gender

Date of Birth**

School Attending/Attended

Email

Add a fourth child

Child Information (D)

Child's Name

First Middle Last

Hebrew Name

Prefers to be called**

Gender

Date of Birth**

School Attending/Attended

Email

Add fifth child

Child Information (E)

Child's Name

First Middle Last

Hebrew Name

Prefers to be called**

Gender

Date of Birth**

School Attending/Attended

Email

Yahrzeit Observance

If you have loved ones whose names you would like to be [placed on our Kaddish list, regardless of their religious identity, please list the names blow. While it is customary to observe Yahrzeit on the Hebrew date of death, some members prefer to use the English date. Please let us know if you would like assistance in determining the Hebrew date. A Yahrzeit reminder letter will be sent approximately one month prior to the date.

Would you like to add a name to our Yahrzeit list? **

Yahrzeit Information

Deceased's Name

First Last

Remembered By

Relationship

Observe**

Hebrew Date**

Hebrew Month**

Hebrew Year**

English Date*

Add a second name to our Yahrzeit list

Yahrzeit Information (B)

Deceased's Name

First Last

Remembered By

Relationship

Observe*

Hebrew Date**

Hebrew Month**

Hebrew Year**

English Date

Add a third name to our Yahrzeit list

Yahrzeit Information (C)

Deceased's Name

First Last

Remembered By

Relationship

Observe

Hebrew Date**

Hebrew Month**

Hebrew Year**

English Date

Add a fourth name to our Yahrzeit list

Yahrzeit Information (D)

Deceased's Name

First Last

Remembered By

Relationship

Observe

Hebrew Date**

Hebrew Month*

Hebrew Year**

English Date

Add a fifth name to our Yahrzeit list

Yahrzeit Information (E)

Deceased's Name

First Last

Remember By

Relationship

Observe

Hebrew Date**

Hebrew Month**

Hebrew Year**

English Date

Membership Categories

Please select the appropriate membership category **

HIGH HOLY DAY SEATING LOCATION High Holy Day tickets are included in all membership categories listed above. Services are held in three locations in the Synagogue: Main Sanctuary, Schafler Forum and Schnurmacher Chapel. Children under the age of 25 and living at home or in college may receive High Holy Day tickets in unreserved seating locations upon request. Children under the age of 18 DO NOT NEED TICKETS. Arrangements can also be made for members’ children to sit in the Main Sanctuary at an additional cost. Please contact the Membership Services Department at (646) 454-3045.

I (we) prefer to sit in the following area (all locations subject to availability) **

* The Director of Membership Services will be in touch with you shortly to discuss Main Sanctuary seating options.

Do you have a preference of the Schnurmacher Chapel or Schafler Forum?

On occasion, events at Congregation Rodeph Sholom are recorded with audio, video and/or photographic equipment. Those attending such events are respectfully asked to grant permission to Congregation Rodeph Sholom to use any such recordings for promotional and/or everyday use. **

I understand, and consent, to the above

CRS is committed to being accessible to all families regardless of financial circumstances. Please check here if you would like to talk about financial aid.

I would like to talk about financial aid

I (we) hereby apply for membership in Congregation Rodeph Sholom and if I (we) become a member(s) I (we) agree to abide by the by-laws, rules and regulations of the congregation. (A copy of the by-laws is available in the Executive Director’s office.)

Member A Electronic Signature **

Date **

Member B Electronic Signature

Date