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______