Young Israel of East Brunswick Membership Application form a

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 [phone] or email [e-mail].
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 [e-mail].

____________________________ _____________________________ __________________

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 [phone] or email [e-mail].

____________________________ _____________________________ ________________

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