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Membership Application
Please verify reCaptcha before submitting the form.
*
Congregant #1 First Name
Congregant #2 First Name
*
Last Name
Last Name
*
Cell Phone
Cell Phone
Email
Email
*
Birth Date (MM/DD/YYYY)
Birth Date (MM/DD/YYYY)
Religious Background
Religious Background
Employer
Employer
Hebrew First Name
Hebrew First Name
Father's Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Mother's Hebrew Name
Hometown
Hometown
Marital Status
Single
Married
Engaged
Divorced
Widowed
Seperated
N/A
Partnered
Anniversary (if applicable) (MM/DD/YYYY):
*
Address
Address line 2 (if needed)
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
Home Phone (if applicable)
Emergency contact
Emergency contact phone #
1st Child's name
Hebrew First Name
Date of Birth (MM/DD/YYYY):
Grade
2nd Child's name
Hebrew First Name
Date of Birth (MM/DD/YYYY):
Grade
3rd Child's name
Hebrew First Name
Date of Birth (MM/DD/YYYY):
Grade
4th Child's name
Hebrew First Name
Date of Birth (MM/DD/YYYY):
Grade
Name of Deceased
Date of Death (MM/DD/YYYY):
Hebrew Name (if known)
Hebrew Date of Death (if known)
Mourner
Relationship to Mourner
Name of Deceased
Date of Death (MM/DD/YYYY):
Hebrew Name (if known)
Hebrew Date of Death (if known)
Mourner
Relationship to Mourner
Name of Deceased
Date of Death (MM/DD/YYYY):
Hebrew Name (if known)
Hebrew Date of Death (if known)
Mourner
Relationship to Mourner
*
How did you hear about Ner Tamid?
Our Website
URJ Referral
Congregant Referral
Word of mouth
Las Vegas Israelite
N/A
*
What activities in the temple would you be interested in?
Preschool
Religious School
Chavurah (small group meetings based on interests)
Interfaith
Mensch Club
Sisterhood
NextGen (20s & 30s)
OurGen (40's, 50's & 60's)
Adult Education
Conversion
Youth Group (Elementary, Middle & High School groups)
N/A
*
Committee Interest Information
Building & Grounds
Fundraising
Ritual
Chesed (internal social action)
Membership
ECEC Parent Committee
Finance
Religious School Family Connection
Nevadans for the Common Good (external social action)
N/A
*
Would you like to help as a volunteer?
In the Temple or education office
Be a greeter on Shabbat
Design promotional materials (flyers, posters, etc)
Adult Choir
N/A
Please submit a family photo
Tell us about yourself! Please include a few sentences about yourself, family, career, etc.
Fri, July 26 2024 20 Tammuz 5784
