Become a Member

* By clicking on this checkbox I/We acknowledge the desire to join Etz Chaim Synagogue and accept the obligation of Membership Dues and Security beginning as of the join date. I/We also agree to abide by the laws and rules of our congregation and other regulations as may be adopted by the Board of Directors. I/We accept that Membership will renew itself automatically at the beginning of each fiscal year (September 1st) unless written notice is received by Etz Chaim Synagogue a minimum of 15 days in advance.

By clicking on this checkbox I/We acknowledge the desire to join Etz Chaim Synagogue and accept the obligation of Membership Dues and Security beginning as of the join date. I/We also agree to abide by the laws and rules of our congregation and other regulations as may be adopted by the Board of Directors. I/We accept that Membership will renew itself automatically at the beginning of each fiscal year (September 1st) unless written notice is received by Etz Chaim Synagogue a minimum of 15 days in advance.

* Which Membership type is best applicable to you? Please select one:

Family Membership (64 years old and under and more than one person)Single Membership (64 years old and single)Associate Membership (member in good standing of another synagogue within 150 miles. Further information will be requested)Senior Family Membership (65 years old and over and more than one person)Senior Single Membership (65 years old and over and single)

Please complete the following family census form. You may pay on the next page or send/bring a check to the office. Your payment must cover at least your first month's Membership Dues. Our Membership Dues include Dues for the Union of Orthodox Jewish Congregations of America.

* First Name:

* Last Name:

* Title:

* Email:

* Hebrew name:

* Date of Birth

* Cell phone number:

Work phone number:

* Father's Name:

* Father's Hebrew Name:

* Father's tribe:

* Mother's Name:

* Mother's Hebrew Name:

* Mother's tribe:

* Did you or your mother convert to Judaism?

Please Select OneYesNoIf yes, please provide us with all documentation of conversion from the Beit Din that officiated the conversion.

* Marital Status:

If married, what was your wedding date?

* Home street address:

Home address unit/apartment:

* Home address city:

* Home address State:

* Home address zip code:

Spouse First Name:

Spouse Last Name:

Spouse Title:

Spouse Email:

Spouse Hebrew name:

Spouse Date of Birth

Spouse cell phone number:

Spouse work phone number:

Spouse Father's Name:

Spouse father's Hebrew Name:

Spouse father's tribe:

Spouse mother's Name:

Spouse mother's Hebrew Name:

Spouse mother's tribe:

Did your spouse or his/her mother convert to Judaism?

YesNoIf yes, please provide us with all documentation of conversion from the Beit Din that officiated the conversion.

Click the Plus (+) sign to add information for each of your children (if applicable):

* English Name:

* Hebrew Name:

* Gender:

Please Select OneMaleFemale

* Date of Birth:

Click the Plus (+) sign to add information for each Yahrzeit observed (as applicable):

* Name of Deceased:

* Relationship to Member

* English Date:

* After Sunset?

Please Select OneYesNo

Hebrew Date:

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