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 $1,500-$10,000Single $750-$5,000Retired $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.