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Membership Application Temple Emanuel of Greater New Haven (Easyshul)

150 Derby Avenue, Orange, CT 06477 | Phone: 203-397-3000 Fax 203-397-5820

email: [email protected] | [email protected]

Member 1

Title

Please let us know how you would like to be addressed in correspondance (optional)

* First Name

* Last Name

* Street Address

* City, State, Zip

* Home Phone

* Birth date

Cell Phone

Work Phone

Occupation

* Email

If Married, Anniversary Date

Member 2

Title

Please let us know how you would like to be addressed in correspondance (optional)

First Name

Last Name

If different

Birth date

Cell Phone

Work Phone

Occupation

Hebrew Names

Member 1 Hebrew Name

Please enter YOUR Hebrew name, if known

Member 1 Parents' Hebrew names

Please enter your Parents' Hebrew names, if known.

Member 2 Hebrew Name

Member 2 Parents' Hebrew names

Please enter your Parents' Hebrew names, if known.

Children

Child 1

First Name, Last Name

Gender

Birth Date

Hebrew Name

Grade

Child 2

First Name, Last Name

Gender

Birth Date

Hebrew Name

Grade

Child 3

First Name, Last Name

Gender

Birth Date

Hebrew Name

Grade

Member Participation

Would you like to participate in:

Member 1

Torah Reading/Chanting

Haftarah Chanting

Leading a Service

Member 2

Torah Reading/Chanting

Haftarah Chanting

Leading a Service

Please tell us what committees/activities you would like to be involved with at Temple Emanuel:

Member 1

Adult Education

Cemetery

Fund Raising

Buildings/Grounds

Ritual

Youth Advisory

Sisterhood

Men's Club

Caring Community

Education (Religious School)

Finance

Membership

Publicity

Tikkun Olam (Repairing the World)

TE Band

Member 2

Adult Education

Cemetery

Fund Raising

Buildings/Grounds

Ritual

Youth Advisory

Sisterhood

Men's Club

Caring Community

Education (Religious School)

Finance

Membership

Publicity

Tikkun Olam (Repairing the World)

TE Band

Other Programs or activities of interest to you:

Signature

I/we hereby make application for membership to Temple Emanuel.
(All information on this form will be kept confidential).

Signed, Member 1

Signed, Member 2

Date

Once this application is approved, you will receive a link to Temple Emanuel Member Portal where you will be able to enter additional details, yahrzeits and access calendar and member directory

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

The fees are significantly lower for Electronic Checks. Please consider paying with an Electronic Check. If you are paying by credit card, please select YES to increase the amount by 3% to cover credit card fees.

Comments

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