Membership Application

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We are thrilled that you have decided to join the Or Hadash Community! In order to properly welcome you, please provide us with the following information. If you have any questions, please contact us!

Membership Application Type(Required)

Family

Couple

Single

Family Membership Options(Required)

Family (Regular)

Family (Under 40)

Couple Membership Options(Required)

Couple (Regular)

Couple (Under 30)

Couple (Senior)

Couple (Seasonal)

Single Membership Options(Required)

Single (Regular)

Single (Senior)

Single Parent (with Children)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you a current member at another synagogue?(Required)

Yes

Additional Synagogue Information(Required)

Please provide details on your membership at other synagogues. Example: Snowbird, alternate residence, etc.

Do you have any previous synagogue affiliations?(Required)

Yes

Previous Synagogue Affiliation Information(Required)

Please provide details of any previous synagogue affiliations. Example: Previous resident location, religious school background, etc.

Please provide details for each person that is applying for membership.

Adult 1

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Occupation(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Tribal Affiliation(Required)

Kohen

Levi

Israel

Jewish by Choice

Unknown

Not Jewish

Applicant’s Hebrew Name(Required)

Father's Hebrew Name

Mother's Hebrew Name

Conversion Certificate

Please attach a copy of the conversion certificate related to this applicant.

Accepted file types: jpg, gif, png, pdf, Max. file size: 25 MB.

Adult 2

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Occupation(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Tribal Affiliation(Required)

Kohen

Levi

Israel

Jewish by Choice

Unknown

Not Jewish

Applicant’s Hebrew Name(Required)

Father's Hebrew Name

Mother's Hebrew Name

Conversion Certificate

Please attach a copy of the conversion certificate related to this applicant.

Accepted file types: jpg, gif, png, pdf, Max. file size: 25 MB.

Children

Please list all dependent children to be included in membership

Full Name of Child

Date of Birth

Hebrew Name

Please provide information on any important dates for your family.

Wedding Anniversary Date(Required)

MM slash DD slash YYYY

Yahrtzeit(s) to be recorded

Please provide details of any Yahrtzeit(s) you wish to be recorded. All dates must be entered based on the Gregorian calendar.

Full Name

Hebrew Name

Relationship

Date of Death (AM or PM)

Application Terms and Electronic Signature

Application Terms and Conditions(Required)

Upon receipt of your application, we will contact you using the information provided on this form to discuss your application and options for financial contributions. Once agreed upon, financial obligations to Or Hadash shall continue until the member submits a letter of resignation to the synagogue office. Upon receipt of said letter of resignation, outstanding obligations of the member shall be pro-rated.

By accepting these terms and entering your name below, you are submitting your electronic signature and agreement.

I agree to the terms of this application.

Name of Person Signing Application(Required)

Please enter the name of the person that is signing and submitting the application. This person is agreeing to the terms and conditions on behalf of all applicants included on the application.

First Last