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Sponsored by: The Torat Emet website is sponsored in memory of Marcie Gilbert through the generosity of Larry Gilbert
Sponsored by: The Torat Emet website is sponsored in memory of Marcie Gilbert through the generosity of Larry Gilbert
The Torat Emet website is sponsored in memory of Marcie Gilbert through the generosity of Larry Gilbert
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The Main Event 2023: A Night on the Town
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The Main Event 2023: A Night on the Town
Torat Emet Membership Application
Please verify reCaptcha before submitting the form.
Adult Information
Adult 1
Title
First Name
Middle Name
Last Name
Birthday
Personal Email Address
Cell Phone #
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Company Name
Street
Suite/Floor
City, State Zip
Business Email Address
Business Phone #
Preferred Contact Method(s)
Home Phone
Cell Phone
Business Phone
Personal Email
Business Email
Marital Status
Please Select One
Single
Married
Divorced
Widowed
Adult 2
Title
First Name
Middle Name
Last Name
Birthday
Personal Email Address
Cell Phone #
Hebrew Name
Father's Hebrew Name
Mother's Hebrew Name
Company Name
Street
Suite/Floor
City, State Zip
Business Email Address
Business Phone #
Preferred Contact Method(s)
Home Phone
Cell Phone
Business Phone
Personal Email
Business Email
Marital Status
Please Select One
Single
Married
Divorced
Widowed
Household Information
Home Address
Street
Apt
City
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
Zip
Home Phone #
Preferred Billing Location
Home
Office
Are you (and your spouse) Jewish by Birth?
Yes
No
If no, please explain:
Picture Time!
Please provide a picture of yourself / yourselves
Child Information
Child 1
First Name
Last Name
Hebrew Name
Sex
Please Select One
Male
Female
Birthday
Bar/Bat Mitzvah Date
School Name
Grade
Please Select One
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Collegiate
Supp./Religious School Name
Child 2
First Name
Last Name
Hebrew Name
Sex
Please Select One
Male
Female
Birthday
Bar/Bat Mitzvah Date
School Name
Grade
Please Select One
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Collegiate
Supp./Religious School Name
Child 3
First Name
Last Name
Hebrew Name
Sex
Please Select One
Male
Female
Birthday
Bar/Bat Mitzvah Date
School Name
Grade
Please Select One
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Collegiate
Supp./Religious School Name
Child 4
First Name
Last Name
Hebrew Name
Sex
Please Select One
Male
Female
Birthday
Bar/Bat Mitzvah Date
School Name
Grade
Please Select One
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Collegiate
Supp./Religious School Name
Child 5
First Name
Last Name
Hebrew Name
Sex
Please Select One
Male
Female
Birthday
Bar/Bat Mitzvah Date
School Name
Grade
Please Select One
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Collegiate
Supp./Religious School Name
Child 6
First Name
Last Name
Hebrew Name
Sex
Please Select One
Male
Female
Birthday
Bar/Bat Mitzvah Date
School Name
Grade
Please Select One
Pre-K
Kingergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Collegiate
Supp./Religious School Name
Yahrzeit Information
1.
Full Name
Hebrew Name
Relationship
Date of Death
Day or Evening?
Day
Evening
2.
Full Name
Hebrew Name
Relationship
Date of Death
Day or Evening?
Day
Evening
3.
Full Name
Hebrew Name
Relationship
Date of Death
Day or Evening?
Day
Evening
4.
Full Name
Hebrew Name
Relationship
Date of Death
Day or Evening?
Day
Evening
Membership Commitment
Enhanced Membership ($2,160)
Enhanced Membership ($2,160)
Regular Membership ($1,200)
Regular Membership ($1,200)
Associate Membership ($600)
Associate Membership ($600)
Single Membership ($600)
Single Membership ($600)
Adjusted Membership Requested (You will be contacted to discuss a level of support)
Adjusted Membership Requested (You will be contacted to discuss a level of support)
Additional Contribution
At what synagogue do you hold primary membership?
At what other synagogues do you hold associate memberships?
You will be notified of your membership after your application has been received and processed by committee.
Thu, June 8 2023 19 Sivan 5783
