Membership Application Form

I hereby apply for membership in TEMPLE ADAS ISRAEL, a Reform Jewish Congregation affiliated with the Union for Reform Judaism, and subscribe to the statement of purpose of the Temple as defined in its by-laws: “To maintain a house of worship for persons of the Jewish Faith; to provide spiritual guidance, moral and ethical teaching according to the faith of our Fathers and Mothers; to perpetuate the traditions of Jewish learning and culture; and to provide a center for the social life of the Jewish community.”

Type of Membership (please select one):  

Are you a member of another Reform congregation?  Yes No
Member #1   Full Name:   Home Phone:   Business Phone:   Cell Phone:  Email:	Member #2      Full Name:   Home Phone:   Business Phone:   Cell Phone:  Email:

 Dependent Children:   

Name:	Date of Birth:  [None]
Name:	Date of Birth:   [None]
Name:	Date of Birth:   [None]
Name:	Date of Birth:   [None]

Primary Address:  

Street:
Street 2:
City:
State: Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip: 
Phone:  

Effective Dates: 

From:  [None]  
To:  [None]  
 

Secondary Address: 

Street:
Street 2:
City:
State: Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip: 
Phone:  

Effective Dates: 

From:  [None]  
To:  [None]  
 

Yahrzeits you would like remembered:  

Name: 
Relationship: 
Date of Death:   [None]  

Name:
Relationship:
Date of Death:    [None]  

Name:
Relationship:
Date of Death:   [None]  

Name:
Relationship:
Date of Death:    [None]   

*    Please note: If the building fund commitment is paid in full upon joining, the first year’s dues are automatically waived.  

 Contact Membership Chair for other payment options.

 Please make checks payable to: TEMPLE ADAS ISRAEL.

 Please also complete our SURVEY and mail in with your check!