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Date
Family Name
Adult 1 - Home Telephone
*
Home Address
*
City
*
State
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*
Zip Code
*
Do you have a secondary/vacation address?
Please Select One
Yes
No
*
Secondary/Vacation 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 Code
*
Start Date at this Address
*
End Date at this Address
*
Adult 1 - Marital Status
Single
Married
Engaged
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Widowed
Separated
N/A
Partnered
Anniversary Date
*
Adult 1 - Title
*
Adult 1 - First Name
*
Adult 1 -Middle Name
*
Adult 1 -Last Name
*
Adult 1 - Tribe
Cohen
Levi
Yisrael
None Set
*
Adult 1 - Hebrew Name
*
Adult 1 - Your Father's Hebrew Name
*
Adult 1 - Your Mother's Hebrew Name
*
Adult 1 - Birthdate
*
Adult 1 - Mobile Phone
*
Adult 1 - Email Address
Adult 1 - Employer
Adult 1 - Occupation
Adult 1 - Business Phone
Adult 1 - Special Skills or Interests
Adult 1 - Membership in Community Organizations
Adult 1 - Please indicate your interest in: Check all that apply.
Adult Activities
Daily Minyan
Empty Nesters
Men's Club
Religious School PTO
Rimonim Young Adults
Seniors
Sisterhood
Social Action
Usher
Youth and Teen
*
Is there a second adult applying for membership?
Please Select One
Yes
No
*
Adult 2 - Title
*
Adult 2 - First Name
*
Adult 2 -Middle Name
*
Adult 2 -Last Name
*
Adult 2 - Tribe
Cohen
Levi
Yisrael
None Set
*
Adult 2 - Hebrew Name
*
Adult 2 - Your Father's Hebrew Name
*
Adult 2 - Your Mother's Hebrew Name
*
Adult 2 - Birthdate
*
Adult 2 - Mobile Phone
*
Adult 2 - Email Address
Adult 2 - Employer
Adult 2 - Occupation
Adult 2 - Work Phone
Adult 2 - Special Skills or Interests
Adult 2 - Membership in Community Organizations
Adult 2 - Please indicate your interest in: Check all that apply.
Adult Activities
Daily Minyan
Empty Nesters
Men's Club
Religious School PTO
Rimonim Young Adults
Seniors
Sisterhood
Social Action
Usher
Youth and Teen
*
How many Children do you have?
Please Select One
None
One child
Two children
Three children
Four children
*
Child 1 - Name
*
Child 1 - Birthdate
*
Child 1 - Hebrew Name
*
Child 1 - Hebrew School Attending
Child 1 - Email Address
Child 1 - Cell Phone
*
Child 1 - Lives:
Please Select One
in the family home
at College/Out-of-Town School
Child 1 - School Name
Child 1 - School Address
Child 1 - Is Child 1 adopted?
Please Select One
Yes
No
Child 1 - Please note any pertinent information of which you feel we should be aware:
(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)
Child 1 - If yes, has this child, where necessary, been converted according to Jewish law?
Please Select One
Yes
No
Child 1 - If yes, what year and where?
*
Child 2 - Name
*
Child 2 - Birthdate
*
Child 2 - Hebrew Name
*
Child 2 - Hebrew School Attending
Child 2 - Email Address
Child 2 - Cell Phone
*
Child 2 - Lives:
Please Select One
in the family home
at College/Out-of-Town School
Child 2 - School Name
Child 2 - School Address
Child 2 - Is Child 2 adopted?
Please Select One
Yes
No
Child 2 - Please note any pertinent information of which you feel we should be aware:
(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)
Child 2 - If yes, has this child, where necessary, been converted according to Jewish law?
Please Select One
Yes
No
Child 2 - If yes, what year and where?
*
Child 3 - Name
*
Child 3 - Birthdate
*
Child 3 - Hebrew Name
*
Child 3 - Hebrew School Attending
Child 3 - Email Address
Child 3 - Cell Phone
*
Child 3 - Lives:
Please Select One
in the family home
at College/Out-of-Town School
Child 3 - School Name
Child 3 - School Address
Child 3 - Is Child 3 adopted?
Please Select One
Yes
No
Child 3 - Please note any pertinent information of which you feel we should be aware:
(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)
Child 3 - If yes, has this child, where necessary, been converted according to Jewish law?
Please Select One
Yes
No
Child 3 - If yes, what year and where?
*
Child 4 - Name
*
Child 4 - Birthdate
*
Child 4 - Hebrew Name
*
Child 4 - Hebrew School Attending
Child 4 - Email Address
Child 4 - Cell Phone
*
Child 4 - Lives:
Please Select One
in the family home
at College/Out-of-Town School
Child 4 - School Name
if applicable
Child 4 - School Address
Child 4 - Is Child 4 adopted?
Please Select One
Yes
No
Child 4 - Please note any pertinent information of which you feel we should be aware:
(i.e., Divorce, Re-Marriage, Children of previous marriages, etc.)
Child 4 - If yes, has this child, where necessary, been converted according to Jewish law?
Please Select One
Yes
No
Child 4 - If yes, what year and where?
How many yahrzeits would you like to observe?
Please Select One
None
One yahrzeit
Two yahrzeits
Three yahrzeits
Four yahrzeits
*
English Name
*
Hebrew Name
*
Relationship
To whom?
Please Select One
Adult 1
Adult 2
Date of Death
*
Before or After Sunset?
Please Select One
Before
After
Observance (select one)
Please Select One
Hebrew Calendar
Secular Calendar
*
English Name
*
Hebrew Name
*
Relationship
*
To whom?
Please Select One
Adult 1
Adult 2
Date of Death
*
Before or After Sunset?
Please Select One
Before
After
Observance (select one)
Please Select One
Hebrew Calendar
Secular Calendar
*
English Name
*
Hebrew Name
*
Relationship
*
To whom?
Please Select One
Adult 1
Adult 2
Date of Death
*
Before or After Sunset?
Please Select One
Before
After
Observance (select one)
Please Select One
Hebrew Calendar
Secular Calendar
*
English Name
*
Hebrew Name
*
Relationship
*
To whom?
Please Select One
Adult 1
Adult 2
Date of Death
*
Before or After Sunset?
Please Select One
Before
After
Observance (select one)
Please Select One
Hebrew Calendar
Secular Calendar
*
How did you hear about CSZ?
Please Select One
I live in the neighborhood
I heard via word of mouth
I searched on the Internet
I know a congregant
I know of CSZ some other way
Are you related to a current CSZ member? If so, whom?
Are you currently affiliated with another congregation? If so, which one
Sat, April 27 2024 19 Nisan 5784
