Membership Application

We invite you to join us as a member and become part of our extended family.

Our annual membership dues is:

$1200 for a couple and $600 for a single.

* Family Last Name

* Member Name

Spouse Name

* Local Street Address

* Local City

* Local State

* Local Zip

Local Phone

Cell Phone

Spouse Cell Phone

Northern Street Address

Northern City

Northern State

Northern Zip

Northern Phone

E-Mail Address

Spouse E-Mail Address

Emergency Contact

* Tribe

CommunityName

Member Date of Birth

Spouse Date of Birth

Anniversary

* Member Full Hebrew Name (Transliterated)

Spouse Full Hebrew Name (Transliterated)

Member Father's Full Hebrew Name (Transliterated)

Spouse Father's Full Hebrew Name (Transliterated)

* Member Mother's Full Hebrew Name (Transliterated)

Spouse Mother's Full Hebrew Name (Transliterated)

CHILDREN (Transliterate all Hebrew names)

Child 1 English Name

Child 1 Hebrew Name

Child 2 English Name

Child 2 Hebrew Name

Child 3 English Name

Child 3 Hebrew Name

Child 4 English Name

Child 4 Hebrew Name

YAHRZEITS (Transliterate all Hebrew names)

English Name of Deceased

Hebrew Name of Deceased

Hebrew Date of Passing

Relationship

English Name of Deceased

Hebrew Name of Deceased

Hebrew Date of Passing

Relationship

English Name of Deceased

Hebrew Name of Deceased

Hebrew Date of Passing

Relationship

English Name of Deceased

Hebrew Name of Deceased

Hebrew Date of Passing

Relationship

English Name of Deceased

Hebrew Name of Deceased

Hebrew Date of Passing

Relationship

English Name of Deceased

Hebrew Name of Deceased

Hebrew Date of Passing

Relationship

Tue, February 4 2025 6 Shevat 5785