New Member Application Form

Welcome! We ask that you please complete the following form to help us get to know you better. Your name, address, adult emails, and preferred phone numbers will be published in our directory, available only to congregants. All information will be kept confidential.

ADULT 1 INFORMATION

* Adult 1 - First Name

* Adult 1 - Last Name

* Adult 1 - Date of Birth

* Adult 1 - Place of Birth

Adult 1 - Hebrew Name

If applicable.
Use English letters

Adult 1 - Father's Hebrew Name

If applicable.
Use English letters.

Adult 1 - Mother's Hebrew Name

If applicable.
Use English letters.

* Adult 1 - Marital Status

* Adult 1 - Mobile Phone

* Adult 1 - Email Address

* Adult 1 - Occupation

* Adult 1 - Employer

ADULT 1 INTERESTS

At Etz Chayim, we encourage active involvement in our community thru participation and volunteering. For more information about any of these opportunities click here.

Participation - Interested? Check all that apply

ADULT 2 INFORMATION

* Adult 2 - First Name

* Adult 2 - Last Name

* Adult 2 - Date of Birth

* Adult 2 - Place of Birth

Adult 2 - Hebrew Name

If applicable.
Use English letters.

Adult 2 - Father's Hebrew Name

If applicable.
Use English letters.

Adult 2 - Mother's Hebrew Name

If applicable.
Use English letters.

* Adult 2 - Marital Status

* Adult 2 - Mobile Phone

* Adult 2 - Email Address

* Adult 2 - Occupation

* Adult 2 - Employer

ADULT 2 INTERESTS

At Etz Chayim, we encourage active involvement in our community thru participation and volunteering. For more information about any of these opportunities click here.

Participation - Interested? Check all that apply

ADDRESS INFORMATION

* Address

* City

* State

* Zip Code

Home Phone

if applicable

MAILING ADDRESS, IF DIFFERENT

Address

City

State

Zip Code

CHILDREN (LIVING AT HOME)

* How many children live at home?

CHILD 1 (LIVING AT HOME)

* Child 1 - First Name

* Child 1 - Last Name

Child 1 - Hebrew Name

If applicable.

* Child 1 - Date of Birth

* Child 1 - Email Address

Different than parent

* Child 1 - Cell Phone

Different than parent

* Child 1 - School Grade

* Child 1 - Are you interested in Religious School for this child?

CHILD 2 (LIVING AT HOME)

* Child 2 - First Name

* Child 2 - Last Name

Child 2 - Hebrew Name

If applicable.

* Child 2 - Date of Birth

* Child 2- Email Address

Different than parent

* Child 2 - Cell Phone

Different than parent

* Child 2 - School Grade

* Child 2 - Are you interested in Religious School for this child?

CHILD 3 (LIVING AT HOME)

* Child 3 - First Name

* Child 3 - Last Name

Child 3 - Hebrew Name

If applicable.

* Child 3 - Date of Birth

* Child 3 - Email Address

Different than parent

* Child 3 - Cell Phone

Different than parent

* Child 3 - School Grade

* Child 3 - Are you interested in Religious School for this child?

CHILD 4 (LIVING AT HOME)

* Child 4 - First Name

* Child 4 - Last Name

Child 4 - Hebrew Name

If applicable.

* Child 4 - Date of Birth

* Child 4 - Email Address

Different than parent

* Child 4 - Cell Phone

Different than parent

* Child 4 - School Grade

* Child 4 - Are you interested in Religious School for this child?

CHILD 5 (LIVING AT HOME)

* Child 5 - First Name

* Child 5 - Last Name

Child 5 - Hebrew Name

If applicable.

* Child 5 - Date of Birth

* Child 5 - Email Address

Different than parent

* Child 5 - Cell Phone

Different than parent

* Child 5 - School Grade

Different than parent

* Child 5 - Are you interested in Religious School for this child?

Different than parent

ADULT CHILDREN NOT LIVING WITH YOU

How many children do not live in the family home?

ADULT CHILD 1

First Name

Last Name

Hebrew Name

If applicable.

Email Address

City

State

Preferred Phone Number

ADULT CHILD 2

First Name

Last Name

Hebrew Name

If applicable.

Email Address

City

State

Preferred Phone Number

ADULT CHILD 3

First Name

Last Name

Hebrew Name

If applicable.

Email Address

City

State

Preferred Phone Number

ADULT CHILD 4

First Name

Last Name

Hebrew Name

If applicable.

Email Address

City

State

Preferred Phone Number

YAHRZEIT INFORMATION

How many Yahrzeits would you like to add to your profile?

Please add the details of each Yahrzeit below.

Name of Deceased

Relationship

ie, Father of...

To whom?

Please Select OneAdult 1Adult 2

English Date of Death

Before or after sundown?

Please Select OneBeforeAfter

Name of Deceased

Relationship

ie, Father of...

To whom?

Please Select OneAdult 1Adult 2

English Date of Death

Before or after sundown?

Please Select OneBeforeAfter

Name of Deceased

Relationship

ie, Father of...

To whom?

Please Select OneAdult 1Adult 2

English Date of Death

Before or after sundown?

Please Select OneBeforeAfter

Name of Deceased

Relationship

ie, Father of...

To whom?

Please Select OneAdult 1Adult 2

English Date of Death

Before or after sundown?

Please Select OneBeforeAfter

MEMBERSHIP COMMITMENT

These are the suggested membership contribution levels for Fiscal Year 2025 (July 1, 2024 - June 30, 2025):

$3440 - Two Adult Family Membership
$2900 - Single Adult Family Membership
$1770 - Single Adult Membership

Above and Beyond - Because You Can - If you are able to make more than the suggested contribution, we hope you will consider joining the 29% of our members who are part of the "Above and Beyond" group of congregants who help keep Etz Chayim a diverse, active, and welcoming community. Please consider making a commitment of 1.8% of your income or another amount that feels meaningful to you.

If You Can't - Congregation Etz Chayim never wants finances to be a barrier to full membership or participation in our community. If you can't pay the suggested membership commitment, please contact our Executive Director, Ellen Bob (ellen@etzchayim.org), and enter here the agreed upon amount.

We can bill your membership commitment all at once or in installments. Regardless of how you are billed, you can pay differently. Some of our members prefer to pay monthly. There is no issue with making a partial payment.

Pleas tell us how frequently you would like to be billed.

BUILDING FUND COMMITMENT

In the 15 years that we've owned this building, current members have contributed well over $6 million dollars to purchase, upgrade, and maintain our facility. We ask our new members to make a contribution towards this effort as well:

$2000 - Two Adult Family Membership
$1800 - Single Adult Family Membership
$1100 - Single Adult Membership

These contributions can be made all at once or spread over 5 years.

Please indicate your Building Fund billing preference:

Please click the submit button below to submit your Membership Form now.

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