Membership Form

Your Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Do you have a secondary/vacation address?

Yes

Secondary/Vacation Address

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Other Phone

E-mail*

Marital Status*

If married, date of marriage:

If married, location of marriage:

Member Information

Member #1 - English Name*

Member #2 - English Name

Member #1 - Hebrew Name

Member #2 - Hebrew Name

Member #1 - Father's Hebrew Name

Member #2 - Father's Hebrew Name

Member #1 - Mother's Hebrew Name

Member #2 - Mother's Hebrew Name

Member #1 - Date of Birth

Member #2 - Date of Birth

Member #1 - Occupation

Member #2 - Occupation

Member #1 - Office Phone

Member #2 - Office Phone

Member #1 - Cell Phone

Member #2 - Cell Phone

Member #1 - E-mail

Member #2 - E-mail

Member #1 - Is your father a:

Kohen
Levi
Yisrael

Member #2 - Is your father a:

Kohen
Levi
Yisrael

Member #1 - Special Skills or Interests

Member #2 - Special Skills or Interests

Member #1 - Membership in Community Organizations

Member #2 - Membership in Community Organizations

Are you related to a current CSZ member?

Yes
No

If so, whom?

Are you currently affiliated with another congregation?

Yes
No

Name of Congregation

Member #1 - Please indicate your interest in:

Check all that apply.

Member #2 - Please indicate your interest in:

Check all that apply.

Family Information

Unmarried Children in Household

Name	Date of Birth	Hebrew Name	Grade in School	Hebrew School Attending

Children in College / Out-of-Town Schools

Name	Date of Birth	School Address

Are both adults the children of Jewish parents?

Yes
No

Are any of the children adopted?

Yes
No

If yes, has each child, where necessary, been converted according to Jewish law?

Yes
No

If yes, what year and where?

Please note any pertinent information of which you feel we should be aware:

(i.e., Divorce, Re-Marriange, Children of previous marriages, etc.)

Yahrzeit Dates for Family Records

English Name	Hebrew Name	Relationship	Date of Death	Before or After Sunset?

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Membership Form

Member Information

Family Information

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