New Membership Application

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

* Title

* First (& Middle) Name

* Last Name

* Email Address

* Cell Phone Number

* Street (House/Apt.#)

* City

* Zip Code

* My Full Hebrew Name

My Father's Hebrew Name

My Mother's Hebrew Name

* For men:

Select Cohen, Levi or Yisroel

Spouse information:

Spouse Title

Spouse First (& Middle) Name

Spouse Last Name

Maiden Name

Spouse Email

Spouse Cell Phone Number

Spouse Full Hebrew Name

Spouse Father Hebrew Name

Spouse Mother Hebrew Name

Children information:

Child 1 First Name

Child 1 Last Name

Child 1 Hebrew Name

Child 1 DOB

Child 2 First Name

Child 2 Last Name

Child 2 Hebrew Name

Child 2 DOB

Child 3 First Name

Child 3 Last Name

Child 3 Hebrew Name

Child 3 DOB

Child 4 First Name

Child 4 Last Name

Child 4 Hebrew Name

Child 4 DOB

List additional Children and their DOBs

Yartzeit information:

Yartzeit 1 Title, First & Last Name

Yartzeit 1 Full Hebrew Name ben/bas Father's Full Hebrew Name

Relationship

Hebrew date of Yartzeit 1

Yartzeit 2 Title, First & Last Name

Yartzeit 2 Full Hebrew Name ben/bas Father's Full Hebrew Name

Relationship

Hebrew date of Yartzeit 2

Yartzeit 3 Title, First & Last Name

Yartzeit 3 Full Hebrew Name ben/bas Father's Full Hebrew Name

Relationship

Hebrew date of Yartzeit 3

Yartzeit 4 Title, First & Last Name

Yartzeit 4 Full Hebrew Name ben/bas Father's Full Hebrew Name

Relationship

Hebrew date of Yartzeit 4

List additional Yartzeit(s) information here:

* $500 Annual Membership Dues

$500 Annual Membership DuesBy selecting, I hereby agree to abide by the rules and regulations of Congregation Beth Hakneses Hachodosh, and to maintain membership in good standing through timely payment of dues.

Total Due

By submitting this form, the accuracy of the information provided is confirmed.

Thu, September 18 2025 25 Elul 5785

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