Membership Application - Form - Congregation Ner Tamid

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Membership Application

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* 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

Anniversary (if applicable) (MM/DD/YYYY):

* Address

Address line 2 (if needed)

* City

* State

* 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 WebsiteURJ ReferralCongregant ReferralWord of mouthLas Vegas IsraeliteN/A

* What activities in the temple would you be interested in?

PreschoolReligious SchoolChavurah (small group meetings based on interests)InterfaithMensch ClubSisterhoodNextGen (20s & 30s)OurGen (40's, 50's & 60's)Adult EducationConversionYouth Group (Elementary, Middle & High School groups)N/A

* Committee Interest Information

Building & GroundsFundraisingRitualChesed (internal social action)MembershipECEC Parent CommitteeFinanceReligious School Family ConnectionNevadans for the Common Good (external social action)N/A

* Would you like to help as a volunteer?

In the Temple or education officeBe a greeter on ShabbatDesign promotional materials (flyers, posters, etc)Adult ChoirN/A

Please submit a family photo

Tell us about yourself! Please include a few sentences about yourself, family, career, etc.

Tue, July 15 2025 19 Tammuz 5785

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