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New Member Database Form


New Member Database Form


 

We ask that you take a few moments to complete this form in its entirety, as having the most up-to-date information will allows us to better serve you. Items identified by an * must be provided. You may indicate whether or not you wish for certain items to be kept confidential. We are here for you, so please, if you have any questions or need assistance call the office at (561) 833-8421.
  ADULT 1 INFORMATION                             
 
if applicable
if applicable
  ADULT 1 - ADDITIONAL INFORMATION                             
 
List Name and relationship of each.
Let's Connect on Social Media
Receive notifications & information for events & programs. Connect with TI family.
Let's Connect on Social Media
Receive notifications & information for events & programs. Connect with TI family.
  ADULT 1 - EMERGENCY CONTACT INFORMATION                    

Adult Contact other than Spouse
 
  ADULT 1 - COMMUNITY INVOLVEMENT                    

Religious & Non-Religious Affiliations
 
Title/Role/Name of Organization/Location
  ADULT 1 - BUSINESS INFORMATION                    

If retired, please still indicate field of work or specialty
 
City, State, Zip, Phone, Fax, Email
  ADULT 1 - OPPORTUNITIES FOR PARTICIPATION                    

Here at temple Israel, we believe that we are stronger when more of our members participate in the work of the Temple. Therefore, we ask that you lend your voice, skills, and talents to any of our committees that interest you. Please indicate which of these areas appeal to you by checking the appropriate box or boxes.
 
  ADULT 1 - PHOTO & VIDEO CONSENT                    

I/We authorize Temple Israel to take my/our picture and use it in agreement with the statements below to promote Temple Israe to West Palm Beach.
 
  ADDITIONAL ADULT INFORMATION                             
 
  ADULT 2 INFORMATION                             
  
if applicable
if applicable
  ADULT 2 - ADDITIONAL INFORMATION                             
  
List Name and relationship of each.
Let's Connect on Social Media
Receive notifications & information for events & programs. Connect with TI family.
Let's Connect on Social Media
Receive notifications & information for events & programs. Connect with TI family.
  ADULT 2 - EMERGENCY CONTACT INFORMATION                    

Adult Contact other than Spouse
  
  ADULT 2 - COMMUNITY INVOLVEMENT                    

Religious & Non-Religious Affiliations
  
Title/Role/Name of Organization/Location
  ADULT 2 - BUSINESS INFORMATION                    

If retired, please still indicate field of work or specialty
 
City, State, Zip, Phone, Fax, Email
  ADULT 2 - OPPORTUNITIES FOR PARTICIPATION                    

Here at temple Israel, we believe that we are stronger when more of our members participate in the work of the Temple. Therefore, we ask that you lend your voice, skills, and talents to any of our committees that interest you. Please indicate which of these areas appeal to you by checking the appropriate box or boxes.
 
  ADULT 2 - PHOTO & VIDEO CONSENT                    

I/We authorize Temple Israel to take my/our picture and use it in agreement with the statements below to promote Temple Israe to West Palm Beach.
 
  CHILD(REN)'S INFORMATION                    

Please click the + button to add each child under 26 years of age.
  Child's Information                                                 
  Yarzheit Information                                                 

• *If choosing to pay by credit card, a 3% processing fee will be added to your bill.

• Associate Membership is a secondary affiliation and does not include High Holy Day Tickets and Life Cycle Events.

• Please note that children “age out” at the end of their 26th year, requiring their own membership.

• Commitments can also be paid online through your Shulcloud account via Credit Card or ACH.


  MANDATORY SECURITY FEE                   
Sat, December 21 2024 20 Kislev 5785