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General Information

* Why would you like to join Temple Israel?

* Is there someone we may thank for referring you to Temple Israel?

* Please list the names of any relatives or close friends who already belong to Temple Israel:

Personal Information
Adult Member 1

* Full name

Nickname or name you'd prefer to go by (if applicable)

Title

Mrs., Mr., Dr. or other

Mailing Address:

Email:

As a member, we will automatically add you to our email list.
If you would like to opt out, please check this box.

Opt out

As an organization open to the public, Temple Israel may take and use photos or video of members and guests in digital or print communications. If you have any questions, please contact Erin Wolfman May, Communications Director, at [email protected] or 314-432-8050.

Cell phone #

Home phone #

Gender- I identify as

Personal status

If married, please list your anniversary date

DD/MM/YYYY

Date of birth

MM/DD/YYYY

Birthplace

City and State of previous residence

Accommodations needed

Large print prayerbook
Assisted hearing device
Physically challenged
Other

Please list any "other" special accomodations needed

Religious background in which you were raised

If you were not raised in the Jewish tradition, do you identify as

Other from above (if applicable)

Your Hebrew name (if applicable)

Hebrew proficiency

Read
Speak
Chant Torah
None

If you became Jewish as an adult, please list:
Date of conversion, congregation, city, and state

Congregation with whom you're most recently or currently affiliated

Employer

Occupation/Title

Area of specialization

Work email

Work phone

Work fax

If retired, name of industry or job that you served most of your career

We love when members participate as much as they are comfortable with, and we have many opportunities to be involved. Each individual’s participation will help strengthen the community and make the experience at TI more meaningful. Please let us know more about your interests and special skills and feel free to write in any that are not listed.

Interests, passions, and special skills

Personal Information
Adult Member 2 (If applicable)

Full name

Nickname or name you'd prefer to go by (if applicable)

Title

Mrs., Mr., Dr. or other

Mailing address

If same as Adult #1, put "SAME" in box

Email

As a member, we will automatically add you to our email list.
If you would like to opt out, please check this box.

Opt out

Cell phone #

Home phone #

Gender- I identify as

Personal status

Date of birth

MM/DD/YYYY

Birthplace

City and State of previous residence

Accommodations needed

Large print prayerbook
Assisted hearing device
Physically challenged
Other

Please list any "other" special accomodations needed

Religious background in which you were raised

If you were not raised in the Jewish tradition, do you identify as

Other from above (if applicable)

Your Hebrew name (if applicable)

Hebrew proficiency

Read
Speak
Chant Torah
None

If you became Jewish as an adult, please list:
Date of conversion, congregation, city, and state

Congregation with whom you're most recently or currently affiliated

Employer

Occupation/Title

Area of specialization

Work phone

Work email

Work fax

If retired, name of industry or job that you served most of your career

We love when members participate as much as they are comfortable with, and we have many opportunities to be involved. Each individual’s participation will help strengthen the community and make the experience at TI more meaningful. Please let us know more about your interests and special skills and feel free to write in any that are not listed.

Interests, passions, and special skills

Child #1 Info
(if applicable)

Child #2 Info
(if applicable)

Child #3 Info
(if applicable)

Child #4 Info
(if applicable)

Yahrzeit Information

Please list names of family members no longer living.
Include date of death and family relationship for each (maternal/paternal)

Please specify above with *** if any of these family members died in service to our country.

Annual Membership & Dues

* Membership intent:

I / We hereby apply for membership in Congregation Temple Israel, St. Louis, Missouri.

* Dues payment acknowledgement:

If our application is approved, I / we hereby agree to submit the Dues Payment Form as well as the pro-rated portion for the current year.

* Dues adjustments:

I / We hereby understand dues are subject to annual adjustments.

We offer varying support levels for our members and are proud we do not turn anyone away due to financial hardship. Our Executive Director, Rachel Andreasson, will contact you once you complete the application and discuss options.

Electronic Signature

In order to join Congregation Temple Israel, your typed name below indicates you affirm that the following statements are true:

-All financial obligations to current or previous congregations are current
-All previous obligations as to dues, building funds, or other pledges have been paid
-Agreed upon dues with TI must be current to receive rabbinical services
-If we wish to resign from TI, we will do so in writing and all amounts owed at the time of resignation will remain our obligation until fully paid or otherwise discharged

* Adult #1: Full name

Adult #2: Full name (if applicable)

Dues Payment Selection

Please select the payment schedule you'd prefer

	Annual payment
	Quarterly (Jan., April, July, Oct.)
	Monthly

Payment method you'd like to use upon application approval

	Credit card
	Mailing a check
	ACH (Checking account)
	Stock transfer

Membership Application: Congregation Temple Israel

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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	Not in age group

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	Not in age group

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	Not in age group