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.