Membership Application - Form - The Emanuel Synagogue

We are so happy you have made the decision to join The Emanuel Synagogue!

We look forward to sharing holidays, joyous occasions and opportunities for learning with you and your family. Please complete the form below, and if you have any questions, please contact Kobi Benita, Executive Director at kobi@emanuelsynagogue.org

ADULT 1 INFORMATION

Title

Please only include if other than Mr/Mrs/Ms

* First Name

Nickname

Middle Name

* Last Name

* Email Address

* Cell

Birthdate

Maiden Name

Gender

Pronouns

Hebrew Name

Tribe at Birth

Father Hebrew Name

Mother Hebrew Name

Business Name

Occupation

Business Phone

Special Skills or Areas of Expertise

ADULT 2 INFORMATION (IF NEEDED)

Title

Please only include if other than Mr/Mrs/Ms

First Name

Nickname

Middle Name

Last Name

Gender

Pronouns

Email Address

Cell

Birthdate

Maiden Name

Hebrew Name

Tribe at Birth

Father Hebrew Name

Mother Hebrew Name

Business Name

Occupation

Business Phone

Special Skills or Areas of Expertise

HOUSEHOLD INFORMATION

* Home Street Address

* City

* State

* Zip Code

Home Phone Number

Marital Status

Anniversary

CHILDREN

How many children do you have?

First Name

Nickname

Middle Name

Last Name

Gender

Pronouns

Birthday

After Sunset?

Tribe

Hebrew Name

Parent 1 Hebrew Name

Parent 2 Hebrew Name

YAHRZEITS

How many yahrzeits does your family observe?

* English Name of Deceased

Hebrew Name of Deceased

* Gender of Deceased

* English Date of Death

After Sunset?

* Observe Hebrew or English Date?

* Mourner in Family

* Relationship to Mourner

Deceased is XXX of mourner

Cemetery

Adult 1: If you would like to participate in services, please indicate here-

Chant/Read Torah Chant/Read HaftarahChant/Read Blessings

Adult 2: If you would like to participate in services, please indicate here-

Chant/Read Torah Chant/Read HaftarahChant/Read Blessings

Please enroll me/my family in membership in Emanuel Synagogue in the following membership category. For updated membership fees, please contact the Office at 860-236-1275.

Family/Couple-Membership--Couple-with-or-without-children-attending-Religious-SchoolSingle-Parent-Family-Membership--One-single-parent-and-all-children-under-age-22Individual-Adult-Membership--Single-Adult-with-no-children-attending-Religious-SchoolYoung-Family/Couple-Membership---Head-of-household-under-35-years-of-age-and/or-the-oldest-child-is-in-Public-School-2nd-grade-and/or-younger

* Please make checks payable to “The Emanuel Synagogue” and mail to 160 Mohegan Drive, West Hartford, CT 06117.

* All members are charged a Security Fee and a Building Improvement fee

Is there anything else you would like to share with us?