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PO Box 1378 |
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Rabbi Leon A. Morris |
Sag Harbor, NY 11963 |
Neal Fagin, President |
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MEMBERSHIP APPLICATION |
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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) ( ) Individual: Annual dues $500; Building Fund Commitment $750*
( )Family
(including dependent children): Annual dues
$1,000; Building Fund Commitment $1,500* |
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Are you a member of another Reform congregation? ( ) YES --- ( ) NO |
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Member #1_________________________________ |
Member #2_______________________________ |
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| Phone: Home ______________________________ | Phone: Home ____________________________ | ||
| Business ____________________________ | Business __________________________ | ||
| Cell ________________________________ | Cell ______________________________ | ||
| Email: _________________________________________ | Email: _______________________________________ | ||
| Dependent Children: | |||
| Name: ____________________________________ | Date of Birth: _____________________________ | ||
| Name: ____________________________________ | Date of Birth: _____________________________ | ||
| Name: ____________________________________ | Date of Birth: _____________________________ | ||
| Name: ____________________________________ | Date of Birth: _____________________________ | ||
| Primary Address: __________________________ | Effective dates: | ||
| __________________________________ | From ___________ to _____________ | ||
| __________________________________ | |||
| __________________________________ | |||
| __________________________________ | Phone: __________________________________ | ||
| Secondary Address: _______________________ | Effective dates: | ||
| __________________________________ | From ___________ to _____________ | ||
| __________________________________ | |||
| __________________________________ | |||
| __________________________________ | Phone: __________________________________ | ||
| Yahrzeits you would like remembered: | Relationship __________ Date of Death _______ | ||
| __________________________________ | ________ ______ | ||
| __________________________________ | ________ ______ | ||
| __________________________________ | ________ ______ | ||
| __________________________________ | ________ ______ | ||
| Signature: _________________________ | Date: _____________________ | ||
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Temple Adas Israel: adasisrael11963@optonline.net or 631-725-0904 Temple Administrator, Margaret Bromberg: adasisrael11963@optonline.net or 631-725-0904 |
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