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Membership Application
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Temple Shaaray Tefila welcomes you to our community. Please call (914) 666-3133 if you have any questions or need assistance with this form. For Questions about membership please contact Howard Greenstein, Executive Director at
hgreenstein@templest.org
or 914.307.0467.
ADULT MEMBER 1
Member 1 - Title
*
Member 1 - First Name
Member 1 - Middle Name
*
Member 1 - Last Name
*
Member 1 - Date of Birth
Member 1 - Cell Phone
*
Member 1 - Email
Member 1 - Occupation
Member 1 - Employer
Member 1 - Business Phone
Member 1 - Business Email
Member 1 - Religion
Member 1 - Hebrew Name
Member 1 - Do you read Hebrew?
Please Select One
Yes
No
ADULT MEMBER 1 - INTERESTS
Adult Learning
Caring Community/helping sick and bereaved
Event Coordination
Facilities and Planning
Finance
Fundraising
Israel
Jewish Observance at the Temple
Jewish Observance in the home
Learning for children
Learning for Teens
Marketting and Communications
Music and Choir
Musical Instruments
Sisterhood/Brotherhood
Social Action
ADULT MEMBER 1 - TALENTS
Bicycling
Computer Skills
Cooking
Dancing
Decorating
Gardening
Graphic Arts
Hiking
Knitting
Mah Jongg
Music
Painting
Photography
Reading
Sewing
Sports
Theatre
Writing
*
Is there a second adult applying for membership?
Please Select One
Yes
No
ADULT MEMBER 2
Member 2 - Title
Member 2 - First Name
Member 2 - Middle Name
Member 2 - Last Name
Member 2 - Date of Birth
Member 2 - Cell Phone
Member 2 - Email
Member 2 - Occupation
Member 2 - Employer
Member 2 - Business Phone
Member 2 - Business Email
Member 2 - Religion
Member 2 - Hebrew Name
Member 2 - Do you read Hebrew?
Please Select One
Yes
No
ADULT MEMBER 2 - INTERESTS
Adult Learning
Caring Community/helping sick and bereaved
Event Coordination
Facilities and Planning
Finance
Fundraising
Israel
Jewish Observance at the Temple
Jewish Observance in the home
Learning for children
Learning for Teens
Marketting and Communications
Music and Choir
Musical Instruments
Sisterhood/Brotherhood
Social Action
ADULT MEMBER 2 - TALENTS
Bicycling
Computer Skills
Cooking
Dancing
Decorating
Gardening
Graphic Arts
Hiking
Knitting
Mah Jongg
Music
Painting
Photography
Reading
Sewing
Sports
Theatre
Writing
FAMILY INFORMATION
*
Address
*
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 Code
Home Phone
*
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Anniversary Date
if applicable
CHILD(REN) INFORMATION
*
How many children live with you?
Please Select One
One child
Two children
Three Children
Four children
None
CHILD 1 INFORMATION
Child 1 - First Name
Child 1 - Middle Name
Child 1 - Last Name
Child 1 - Gender
Please Select One
Male
Female
Non-Binary
Prefer not to say
Child 1 - Date of Birth
Child 1 - Hebrew Name
Child 1 - Grade/School or address if not at home:
CHILD 2 INFORMATION
Child 2 - First Name
Child 2 - Middle Name
Child 2 - Last Name
Child 2 - Gender
Please Select One
Male
Female
Non-Binary
Prefer not to say
Child 2 - Date of Birth
Child 2 - Hebrew Name
Child 2 - Grade/School or address if not at home:
CHILD 3 INFORMATION
Child 3 - First Name
Child 3 - Middle Name
Child 3 - Last Name
Child 3 - Gender
Please Select One
Male
Female
Non-Binary
Prefer not to say
Child 3 - Date of Birth
Child 3 - Hebrew Name
Child 3 - Grade/School or address if not at home:
CHILD 4 INFORMATION
Child 4 - First Name
Child 4 - Middle Name
Child 4 - Last Name
Child 4 - Gender
Please Select One
Male
Female
Non-Binary
Prefer not to say
Child 4 - Date of Birth
Child 4 - Hebrew Name
Child 4 - Grade/School or address if not at home:
OTHER FAMILY INFORMATION
*
Do any other family members live with you?
Please Select One
No
One other
Two others
Full Name of other family Member
Gender
Please Select One
Male
Female
Non-Binary
Prefer not to say
Date of Birth
Hebrew Name
Full Name of other family Member
Gender
Please Select One
Male
Female
Non-Binary
Prefer not to say
Date of Birth
Hebrew Name
MARRIED CHILD(REN) INFORMATION
*
Do you have any married children?
Please Select One
No
One married child
Two married children
There married children
Full Name and age of Child
Spouses Name and age
if applicable
Address
Children's Names
if applicable
Full Name and age of Child
Spouses Name and age
if applicable
Address
Children's Names
if applicable
Full Name and age of Child
Spouses Name and age
if applicable
Address
Children's Names
if applicable
YAHRZEIT INFORMATION
*
How many yahrzeits would you like to observe?
Please Select One
None
One yahrzeit
Two Yahrzeits
Three Yahrzeits
Four Yahrzeits
Deceased Name
Related to:
Please Select One
Member 1
Member 2
English Date of Passing
Deceased Name
Related to:
Please Select One
Member 1
Member 2
English Date of Passing
Deceased Name
Related to:
Please Select One
Member 1
Member 2
English Date of Passing
Deceased Name
Related to:
Please Select One
Member 1
Member 2
English Date of Passing
HELP US PLAY JEWISH GEOGRAPHY
City where you grew up:
Member 1
Member 2
Childhood Temple:
Member 1
Member 2
Camp(s):
Member 1
Member 2
Colleges/Grad Schools:
Member 1
Member 2
Sorority/Fraternity:
Member 1
Member 2
HOW DID YOU HEAR ABOUT US
How did you hear about us? Check all that apply.
Friends/Relatives
Advertising
TST Website
Social Media
Other
*
If friends/relatives was check, please tell us their names; if Advertising was checked, please tel us the name of the publication; if Other was checked, please specify:
Reasons for joining:
Child(run) will be starting religious school
Looking for Jewish family activities/programs
Want to connect to the Jewish community
Adult Learning
Adult social programs
B'nai Mitzvah or other life cycle events
Holiday and Shabbat worship services
Other
If other was checked above, please specify reason for joining.
Being part of the Temple Shaaray Tefila family is a covenantal relationship.
As partners in our community, we ask that you make a commitment to our community.
. We ask that you and your family become part of our community by regularly attending services and participating in programs
. We ask that you share your talents and ideas with our temple leaders and congregation
. We ask that you pay all dues and fees in a timely manner and that you consider making additional financial contributions to the Temple in a way that is meaningful to you
. We ask that you agree to abide by the constitution and by-laws of the Temple
Your agreement below (in lieu of your signature) indicates your willingness to join and to become a partner in the Temple Shaaray Tefila community in accordance with the expectations above.
Additionally, you give permission for photographs, slides, videos, or audiotapes of yourself and/or child(ren) to be used for our website, public relations purposes, and promotion of Temple Shaaray Tefila and our school.
Checking the box below indicates your authorization.
Yes, I /we agree.
Yes, I /we agree.
Mon, June 5 2023 16 Sivan 5783
