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Temple Beth Shalom Membership Form
Please verify reCaptcha before submitting the form.
Please fill in the following information for one Adult Member:
*
First Name
*
Last Name
Title
Nickname
*
Date of Birth
Gender
Select Gender
Male
Female
Nonbinary
Other
Specify Other
Preferred Pronouns
*
Email
Mobile Phone Number
Secondary Phone or Landline
Full Hebrew Name, including parents' names (if known). Please use English letters
Tribe
Dont know/None
Kohen
Levi
Israelite
Occupation (if applicable)
Company Name (if applicable)
*
Primary Address
*
Primary Address City
*
Primary Address State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Primary Address Zip
*
Is there a second adult?
Please Select One
No
Yes
*
Adult Two First Name
*
Adult Two Last Name
Adult Two Title
Adult Two Nickname
Adult Two Date of Birth
Adult Two Gender
Select Gender
Male
Female
Nonbinary
Other
Specify Gender Other (if applicable)
Preferred Pronouns
Adult Two Email
Adult Two Mobile Phone
Adult Two Full Hebrew Name, including parents' names (if known). Please use English letters
Adult Two Tribe
Don't know / None
Kohen
Levi
Israelite
Adult Two Occupation (if applicable)
Adult Two Company Name (if applicable)
Marital Status
Married
Divorced
Widowed
Single
Wedding Anniversary (if applicable)
*
How many children do you have? (even if they are adults)
I do not have children
1
2
3
4
5
Child One First and Last Name
Child One Date of Birth
Child One Hebrew Name
Child One Gender
Select Gender
Male
Female
Nonbinary
Other
Child One School Name and Grade (if applicable)
Child Two First and Last Name
Child Two Date of Birth
Child Two Hebrew Name
Child Two Gender
Select Gender
Male
Female
Nonbinary
Other
Child Two School Name and Grade (if applicable)
Child Three First and Last Name
Child Three Date of Birth
Child Three Hebrew Name
Child Three Gender
Select Gender
Male
Female
Nonbinary
Other
Child Three School Name and Grade (if applicable)
Child Four First and Last Name
Child Four Date of Birth
Child Four Hebrew Name
Child Four Gender
Select Gender
Male
Female
Nonbinary
Other
Child Four School Name and Grade (if applicable)
Child Five First and Last Name
Child Five Date of Birth
Child Five Hebrew Name
Child Five Gender
Select Gender
Male
Female
Nonbinary
Other
Child Five School Name and Grade (if applicable)
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship
Temple Beth Shalom members who are your relatives (and their relationship to you)
Deceased loved ones for your yahrzeit records. Please list names, date of death (before or after sundown), and relationship to member.
Please check the areas of interest and activities that are of interest to you and/or your family
Adult Education
Bikur Cholim (visit the sick)
Chesed (provide visits, meals, rides and other help to members in need)
College Connection (send greetings and gift boxes to college students)
Diversity & Inclusion (work to ensure that TBS is inviting, welcoming and accessible for all congregants and guests
Family Programming (provide programs geared toward families with preschool and primary aged children)
Finance & Budget (support the Treasurer and advise on Temple financial planning)
Fundraising
Israel Affairs (develop programs to encourage our congregation’s knowledge of and engagement with Israel)
Landscaping (maintain and enhance our outdoor space)
Membership
Men’s Club
PTA for Preschool and/or Religious School
Publicity & Marketing
Ritual (support the Rabbi and Cantors in planning for ritual observances and implementing practices)
Sisterhood
Social Action/Tikkun Olam (provide opportunities for community service and volunteer projects)
Teen Activities
Are there any other skills or services you would be interested in sharing with the congregation?
What and/or who prompted you to join our temple?
Sun, June 15 2025
19 Sivan 5785
Friday Night
Candle Lighting
: 8:14pm
Shabbos Day
Havdalah
: 9:22pm
This week's Torah portion is
Parshas Sh'lach
Candle Lighting
Friday, Jun 20, 8:14pm
Havdalah
Motzei Shabbos, Jun 21, 9:22pm
Shabbos Mevarchim
Shabbos, Jun 21
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Sun, June 15 2025 19 Sivan 5785
