Rabbi Mordechai Kalatsky
Joey Greenberg, President
Jerome M. Herzog, Rabbi Emeritus
Chaim Goldberger, Rabbi Emeritus
Date
Family name
Husband's name
Birthdate
Wife's name
Maiden name
Home address
City, State, ZIP
Phone
Email
Employer
Business address
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Name(s) of children
Sex
Date of Marriage
Husband's Hebrew Name
Wife's Hebrew Name
Husband's Father's Hebrew Name
Wife's Father's Hebrew Name
Husband's Mother's Hebrew Name
Wife's Mother's Hebrew Name
Are there any conversion in your family? YesNo If "Yes", please explain:
I wish to have the following Yahrzeit dates recorded:
English Name
Hebrew name and Father's Hebrew name
Relationship
Date of Death
Reason for selecting KI:
We would like information on participation in the following activities:
Youth ProgramsKol HaKahalSisterhoodHouse Committee
Adult EducationPublicityFund raisingMembership
Young AdultsProgrammingEducationBuilding
Plan Type/ Amount Family $1,725-$10,000Single $860-$1,500Retired $500-$1,500Associate Membership (non-voting) $360Student (non-voting) $300High Holidays only (non-voting) $300
Specify Amount
Please consider an additional donation to help cover costs of membership for those experiencing financial hardship
TOTAL AMOUNT:
Membership is not based on ability to pay. If you wish, you may discuss your annual dues amount with the Rabbi, President, or Membership Coordinator.
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