Membership Signup

Membership Signup Form

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

    Birthdate

    Maiden name

    Home address

    City, State, ZIP

    Phone

    Employer

    Business address

    Phone

    Name(s) of children

    Sex

    Birthdate

    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.