Membership Application

DONATE

Home

DONATE

Membership Application

Please out the Membership Application below.

FAMILY RECORD

IndividualFamilyPlease indicate by checking the appropriate
box if you are registering for an individual or
a family membership.

Date of Marriage

If Family, Date of marriage.

* Email

* First Name

* Last Name

Cell Phone

* Home Address

Home Address line 2

* Home Address City

* Home Address Zip

* Hebrew Name

* Date of Birth

Place of Birth

Bar Mitzvah Portion

Tribe

Father's English Name

Father's Hebrew Name

Mother's Maiden English Name

Mother's Hebrew Name

Paternal Grandfather's English Name

Paternal Grandfather's Hebrew Name

Paternal Grandmother's English Name

Paternal Grandmother's Hebrew Name

Maternal Grandfather's English Name

Maternal Grandfather's Hebrew Name

Maternal Grandmother's English Name

Maternal Grandmother's Hebrew Name

Spouse's Name

Spouse's cell

Spouse's E-Mail

Spouse's Hebrew Name

Spouse's DOB

Spouse's Place of Birth

Spouse's Father's English Name

Spouse's Father's Hebrew Name

Spouse's Mother's English Name

Spouse's Mother's Hebrew Name

Spouse's Paternal Grandfather's English Name

Spouse's Paternal Grandfather's Hebrew Name

Spouse's Paternal Grandmother's English Name

Spouse's Paternal Grandmother's Hebrew Name

Spouse's Maternal Grandfather's English Name

Spouse's Maternal Grandfather's Hebrew Name

Spouse's Maternal Grandmother's English Name

Spouse's Maternal Grandmother's Hebrew Name

* Were there any conversions, divorces or adoptions in the family?

Please Select OneYesNo

If yes, please provide details and attach any relevant documentation.

CHILDREN

Child 1 Name

Child 1 Hebrew Name

Child 1 Date of Birth

Child 1 School attending/Grade

Child 2 Name

Child 2 Date of Birth

Child 2 School attending/Grade

Child 3 Name

Child 3 Hebrew Name

Child 3 Date of Birth

Child 3 School attending/Grade

Child 4 Name

Child 4 Hebrew Name

Child 4 Date of Birth

Child 4 School attending/Grade

Child 5 Name

Child 5 Hebrew Name

Child 5 Date of Birth

Child 5 School attending/Grade

YAHRZEIT INFORMATION
Please provide full Hebrew Name, i.e. "Yitzchok ben Avraham"/ "Dina bat Leah"
Hebrew name may be written in Hebrew or Transliteration.

YZ English Name

YZ Hebrew Name

YZ Relationship

YZ English Date

YZ Hebrew Date

YZ English Name 2

YZ Hebrew Name 2

YZ Relationship 2

YZ English Date 2

YZ Hebrew Date 2

YZ English Name 3

YZ Hebrew Name 3

YZ Relationship 3

YZ English Date 3

YZ Hebrew Date 3

YZ English Name 4

YZ Hebrew Name 4

YZ Relationship 4

YZ English Date 4

YZ Hebrew Date 4

ALIYA INFORMATION
Please provide English and Hebrew names and relationship to you that you would like to be mentioned upon receiving an aliya.

Aliya English Name

Aliya Hebrew Name

Aliya Relationship

Aliya English Name 2

Aliya Hebrew Name 2

Aliya Relationship 2

Aliya English Name 3

Aliya Hebrew Name 3

Aliya Relationship 3

Please upload a photo of yourself (and your spouse, if applicable).

Please upload a photo.

* I herewith apply for membership at Fifth Avenue Synagogue. I declare that I am not married contrary to the provisions of Jewish Law. I agree that, if elected to membership, I will abide by the Constitution, by-laws and other rules and regulations to the Congregation now in force or hearafter to be adopted. As a member, I expect to enjoy all the rights and privileges set forth in the Constitution and by-laws of the Congregation.

I herewith apply for membership at Fifth Avenue Synagogue. I declare that I am not married contrary to the provisions of Jewish Law. I agree that, if elected to membership, I will abide by the Constitution, by-laws and other rules and regulations to the Congregation now in force or hearafter to be adopted. As a member, I expect to enjoy all the rights and privileges set forth in the Constitution and by-laws of the Congregation.By checking this box, you agree to the terms described.

Sat, November 30 2024 29 Cheshvan 5785

Fifth Avenue Synagogue, 5 East 62 Street, NYC 10065 (212) 838-2122 www.5as.org

Privacy Settings | Privacy Policy | Member Terms