Young Israel of East Brunswick Membership Application form a



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Young Israel of East Brunswick Membership Application
FORM A
General information on form A will be shared, as necessary, only with those related to managing shul records. Form B is strictly for the Rabbi. Both forms must be completed. See Form B for more information.
Membership Categories:




Family ($1,250.00)




Senior ($650.00)




Individual ($650.00)




Associate Member ($250.00)


































Current Synagogue Membership



Building fund assessment is $600 annually for the first 6 years of membership ($3,600 total).




Applicant 1:

Last name:




First name:







Hebrew name:




Father’s Hebrew name:







Mother’s Hebrew name:




Bar Mitzvah Parsha:







Date of Birth
















Kohen




Levi




Yisrael


Applicant 2/ Spouse:

Last name:




First name:







Hebrew name:




Father’s Hebrew name:







Mother’s Hebrew name:




Anniversary Date:







Date of Birth












Home Address:




Home Phone:


















Cell Phone:

Applicant 1:




Applicant 2:




Email:

Applicant 1:




Applicant 2:





Children:





English name




Hebrew name




M/F




Date of birth




School and Grade

1.




























2.




























3.




























4.




























5.






























Job Information:




Applicant 1




Applicant 2/Spouse

Occupation:










Address:






















Phone:











Shul Activity: Please identify with H (husband) or W (wife) any of the following activities of interest:





Layning




Religious Affairs




Publicity




Youth




Haftorah




Adult Education




House Affairs




Mikvah




Davening




Fundraising




Sisterhood




Recruiting




Catering





















How did you hear about the Young Israel of East Brunswick? ____________________________________________

If you are experiencing financial hardships, please contact on a confidential basis our Special Circumstances Chair, Judy Silber, at 732-390-6596.


If you have any questions regarding this application, please call the Shul office at (732) 254-1860 or email membership@yieb.org.
Please return your completed application to:
Young Israel of East Brunswick

193 Dunhams Corner Road

East Brunswick, NJ 08816

Attn: Bertin Lefkovic, Office Manager


or e-mail to officemanager@yieb.org.

____________________________ _____________________________ __________________

Signature (Applicant 1) Signature (Applicant2/Spouse) Date

(03-2014) Young Israel of East Brunswick



Young Israel of East Brunswick Membership Application
FORM B
This form will be reviewed by the Rabbi only.

All information submitted on this form will be kept strictly confidential.



Applicant 1:

Last name:




First name:







Date of birth:

























Applicant 2:

Last name:




First name:







Date of birth













Marital Status:




Single




Divorced




Widowed




Married

Date of Marriage






If divorced, please submit a copy of the get along with this form.



Any conversions within the family?




No




Yes




If yes:




Self




Spouse




Child(ren)




Parent




Grandparent


If yes, please submit a copy of the conversion certificate along with this form.


Current/Prior Synagogue Affiliation:


Name:




Address:




Membership Status:










Please return this completed form to:


Young Israel of East Brunswick

193 Dunhams Corner Road

East Brunswick, NJ 08816

Attn: Rabbi Jay Weinstein


You may submit this form separately or along with Form A. The YIEB Office Manager will forward this form only to the Rabbi if submitted together. Membership will not be considered unless both forms are completed.
If you have any questions regarding this application, please call the shul office at (732) 254-1860 or email rabbiweinstein@yieb.org.

____________________________ _____________________________ ________________



Signature (Applicant 1) Signature (Applicant2/Spouse) Date
(03-2014) Young Israel of East Brunswick

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