New Member Database Form - Form - Temple Israel of West Palm Beach

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

* Adult 1 - Title

* Adult 1 - First Name

Adult 1 - Middle Name

* Adult 1 - Last Name

* Adult 1 - Gender

Adult 1 - Hebrew Name

if applicable

* Adult 1 - Preferred Name

* Adult 1 - Date of Birth

* Adult 1 - Address

* Adult 1 - City

* Adult 1 - State

* Adult 1 - Zip Code

Adult 1 - Home Phone

* Adult 1 - Cell Phone

Adult 1 - Business Phone

* Adult 1 - Email Address

Adult 1 - Former City/State of Residence

* Adult 1 - Marital Status

Adult 1 - Anniversary Date

if applicable

* Adult 1 - Special Accommodation Needed

VisualAuditoryPhysicalNone

Adult 1 - Alternate Address

Adult 1 - Alternate City

Adult 1 - Alternate State

Adult 1 - Alternate Zip Code

ADULT 1 - ADDITIONAL INFORMATION

Adult 1 - Relatives who are TI Members

List Name and relationship of each.

ADULT 1 - EMERGENCY CONTACT INFORMATION

Adult Contact other than Spouse

* Contact Name

* Contact Relationship

* Contact Phone

* Contact Address

ADULT 1 - COMMUNITY INVOLVEMENT

Religious & Non-Religious Affiliations

* Adult 1 - Religious background in which you were raised

Adult 1 - Bar/Bat Mitzvah Date

Adult 1 - Confirmation Date

Adult 1 - Congregation and City

ADULT 1 - BUSINESS INFORMATION

If retired, please still indicate field of work or specialty

Adult 1 - Occupation

Adult 1 - Area of specialization

Adult 1 - Employer

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 - What are your passions? What are your interests?

Adult 1 - My contact information may be included in the Annual Journal and Membership Directory EXCEPT the follwing:

Adult 1 - Any other information you don't want displayed in the Journal or Directory?

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.

Print MediaSocial Media/Facebook etc.Temple Israel's Koleynu

Television BroadcastingTI's promotional materials

TI's WebsiteDo not use my photo/video

ADDITIONAL ADULT INFORMATION

* Is there a second Adult applying for Membership?

ADULT 2 INFORMATION

Adult 2 - Title

* Adult 2 - First Name

Adult 2 - Middle Name

* Adult 2 - Last Name

* Adult 2 - Gender

Adult 2 - Hebrew Name

if applicable

* Adult 2 - Preferred Name

* Adult 2 - Date of Birth

* Adult 2 - Address

* Adult 2 - City

* Adult 2 - State

* Adult 2 - Zip Code

Adult 2 - Home Phone

* Adult 2 - Cell Phone

Adult 2 - Business Phone

* Adult 2 - Email Address

Adult 2 - Former City/State of Residence

* Adult 2 - Marital Status

Adult 2 - Anniversary Date

if applicable

* Adult 2 - Special Accommodation Needed

VisualAuditoryPhysicalNone

ADULT 2 - ADDITIONAL INFORMATION

Adult 2 - Alternate Address

Adult 2 - Alternate City

Adult 2 - Alternate State

Adult 2 - Alternate Zip Code

Adult 2 - Alternate Phone

Adult 2 - Relatives who are TI Members

List Name and relationship of each.

Adult 2 - Facebook Profile

Let's Connect on Social Media
Receive notifications & information for events & programs. Connect with TI family.

Adult 2 - Twitter Profile

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

* Contact Name

* Contact Relationship

* Contact Phone

* Contact Address

ADULT 2 - COMMUNITY INVOLVEMENT

Religious & Non-Religious Affiliations

* Adult 2 - Religious background in which you were raised

Adult 2 - Bar/Bat Mitzvah Date

Adult 2 - Confirmation Date

Adult 2 - Congregation and City

Adult 2 - Leadership roles at Temple Israel

Adult 2 - Active organization involvement

Title/Role/Name of Organization/Location

ADULT 2 - BUSINESS INFORMATION

If retired, please still indicate field of work or specialty

Adult 2 - Occupation

Adult 2 - Area of specialization

Adult 2 - Employer

Adult 2 - Employer Address

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 - What are your passions? What are your interests?

Adult 2 - Mentoring Program: Are you interested in being a mentor to a new TI family?

YesNoDon'tKnow, Contact Me

Adult 2 - My contact information may be included in the Annual Journal and Membership Directory EXCEPT the follwing:

Adult 2 - Any other information you don't want displayed in the Journal or Directory?

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.

Print MediaSocial Media/Facebook etc.Temple Israel's Koleynu

Television BroadcastingTI's promotional materials

TI's WebsiteDo not use my photo/video

CHILD(REN)'S INFORMATION

Please click the + button to add each child under 26 years of age.

Child's Information

* First Name

Middle Name

* Last Name

Hebrew Name

* Date of Birth

Grade

Mobile Phone

Address, if not living with you

Interested in Religious School?

Is the child being raised in the Jewish faith?

YARZHEIT INFORMATION

Please click the + button to add each YARZHEIT.

Yarzheit Information

* Full Name of Deceased

* English Date of Birth

* Observe on English or Hebrew Date

* Relationship

* To whom?

Annual Commitment

We are so glad you would like to become a part of the Temple Israel family!

We are dedicated to fostering a welcoming community for all, and will work with individuals and families so that finances are not a barrier to affiliation. We encourage you to speak with Tamekia Graham at (561) 833-8421 or tamekia@temple-israel.com for more information.

* Please choose a Membership Option below:

Please choose a Membership Type:

Please choose a President's Circle Level of Giving:

• 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

There is a mandatory $125 Security Fee for all membership types

* I/We want to become a member(s) of Temple Israel and I/We am/are willing to make a personal and financial commitment to the support of continuation of this community.

I/We want to become a member(s) of Temple Israel and I/We am/are willing to make a personal and financial commitment to the support of continuation of this community.

* Please check the box to acknowledge that you are registering for Membership at Temple Israel of West Palm Beach Florida. 1901 North Flagler Drive West Palm Beach, Florida 33407

Please check the box to acknowledge that you are registering for Membership at Temple Israel of West Palm Beach Florida. 1901 North Flagler Drive West Palm Beach, Florida 33407

I wish to pay by:

Name

Date

Total Membership Commitment