MEMBERSHIP APPLICATION

Date________________

I/We hereby apply for membership in Congregation Beth Hakneses Hachodosh.

Name____________________________________________________________________________

Mr./Dr./Mrs./Ms. Last First M.I.

Hebrew Name____________________________________________________________________

Men: Kohen_____ Levi______ Yisrael_____

Spouse__________________________________________________________________________

Mr./Dr./Mrs./Ms. Last First M.I.

Hebrew Name____________________________________________________________________

Men: Kohen____ Levi____ Yisrael____

Address_________________________________________________________________________

House/apt# Street City State Zip

E-mail _________________________________________________________________________

Telephone (_______)__________________________________

Membership Category

Full____ Associate______

CHILDREN

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