Membership Application - Form

Are you registering 2 adult members?

* Full Name

Adult Member 1

* Full Name

Adult Member 2

* Gender

Please Select OneMaleFemale Other

* Gender

Please Select OneMale FemaleOther

If Other, Please Specify

Pronouns (Choose 1)

HimHerThem

Pronouns (Choose 1)

HimHerThem

* Date of Birth

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Religion

* Preferred Name

* Address

* City

* State

* Zip

Home Phone

* Cell Phone

* Email

Occupation

Employer

Business Address

Wedding Anniversary

Do you have a preference for which Rabbi contacts you? An introductory conversation with one of our rabbis is required to fully process your membership application.

Rabbi Spike AndersonRabbi Rachael MillerRabbi Max MillerNo Preference

Are you registering a child or children?

Please register any child under 22.

Child Member 1

Child Member 2

Child Member 3

Gender

MaleFemale

Gender

MaleFemale

Gender

MaleFemale

Date of Birth

Religion

Hebrew Name

B'nei Mitzvah Date Assigned?

YesNo

B'nei Mitzvah Date Assigned?

YesNo

B'nei Mitzvah Date Assigned?

YesNo

Date

School Name

Grade

Do you have children 22 years of age or older?

Name

Gender

MaleFemaleOther

Date of Birth

Cell Number

Email Address

City/State

Occupation

Name

Gender

MaleFemaleOther

Date of Birth

Cell Number

City/State

Occupation

Name

Gender

Male FemaleOther

Date of Birth

Cell Number

City/State

Occupation

Is there anything specific you'd like us to know about your adult child.

Yahrzeit Information

Please complete this section if you would like to be reminded of the anniversary of the death of a sibling, spouse, parent or child. You will be notified according to the Hebrew Calendar.

Name of Deceased

Relationship To You

Date of Death

Time of Death

Before SundownAfter Sundown

Time of Death

Before SundownAfter Sundown

Time of Death

Before SundownAfter Sundown

If there are additional Yahrzeit's for a sibling, spouse, parent or child you'd like us to have on file, please email Marina Alberhasky at (malberhasky@teatlanta.org) with the information mentioned in this section.

Membership Categories

(For Associate Membership) Please list the name and address of your primary synagogue.

Special Circumstances or Needs

Please use this space to share any special circumstances or needs not addressed anywhere above.

Membership Payment Information

Our congregation has its own timely financial obligations; it becomes critical that if you choose to make periodic payments, as defined in the schedule below or through special arrangement, you adhere to the schedule selected. If you are unable to make your schedule, contact the Executive Director to determine an alternative payment schedule

* I/We have elected the following payment option:

Please read the following carefully:

I/We understand that as a member of the Temple Emanu-El community I/we am/are committing to be a part of a sacred community. In acceptance of that responsibility, I/We am/are committing to pay the dues as specified above and the assessments as may be fixed by the Congregation Board.
I/We agree to pay the selected dues for our Temple Emanu-El dues and fees through May 31

* Signature

Adult Member 1

* Signature

Adult Member 2

* Date

Volunteer Interest Form

I am interested in the following areas (check all that apply) :

Please list other talents you would like to share with the congregation or any ideas, comments or suggestions.

* How did you hear about Temple Emanu-El?