Membership Application – Bet Chaverim

Thank you for your interest in joining Bet Chaverim! If you are looking for a friendly, diverse, and
participatory Jewish community, you have come to the right place.

If you have any questions, please use the contact form on this website to contact the Membership
Committee Chair.

Adult member of household #1:

Name

First

Last

Preferred Pronouns

Email

Phone

Can this phone number receive text messages?

Yes
No

Birth Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a different mailing address?

Yes
No

Address

Address Line 1

Address Line 2

City

State

Zip Code

Would you like to add a second adult member of the household?

Yes
No

Name

First

Last

Preferred Pronouns

Email

Phone

Can this phone number receive text messages?

Yes
No

Birth Date

Names and birth dates of minor children:

Member directory preferences:

Yes, all contact info O.K. to share with other members (not online)
No, do not list any of my information in the member directory.
Restrict my member directory listing to only the following:

What information would you like shared via the member directory?

Photo release preferences:

I grant Bet Chaverim permission to use my picture on printed material, on the website and on social media platforms.
I grant Bet Chaverim permission to use my child’s picture on printed material, on the website and on social media platforms.

Contact preferences:

Partner #1 contact preferences: (check all that apply)

Phone
Email
Text

Partner #2 contact preferences: (check all that apply)

Phone
Email
Text

Tell us more about yourself:

How did you hear about Bet Chaverim?

What brings you to Bet Chaverim? What are you hoping to find in this community?

Tell us about your Jewish journey. What was the most recent synagogue you belonged to, if any?

Describe your skills, interests, professions and hobbies:

If you observe any Yahrzeits (the anniversary of the death of a parent, grandparent, spouse, sibling or
child), please list below:

Name

First

Last

Relationship to you:

For example: Rachel's grandfather

Month and day of their death (Hebrew or secular date):

Would you like to add another?

Yes
No

or you:

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (3)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (4)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (5)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (6)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (7)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (8)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (9)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Would you like to add another? (10)

Yes
No

Name

First

Last

Relationship to you:

Month and day of their death (Hebrew or secular date):

Community Involvement and Volunteering

We welcome and encourage participation to keep our small congregation going. Please review the list of volunteer activities below and select two or three that you would be
interested in doing.

Partner #1 volunteer interests:

Partner #2 volunteer interests:

Member dues:

We very much appreciate our members making an investment to support the programs of Bet Chaverim. Please refer to the Dues and Payments page of this website for suggested dues levels based on your household income level. Dues adjustments and payment plans may be arranged in a confidential phone call with our treasurer. Note that a membership application deposit of $50 is required at the time you submit this form.

Adult member of household #1:

Names and birth dates of minor children:

Contact preferences:

Tell us more about yourself:

If you observe any Yahrzeits (the anniversary of the death of a parent, grandparent, spouse, sibling or child), please list below:

Community Involvement and Volunteering

Member dues:

If you observe any Yahrzeits (the anniversary of the death of a parent, grandparent, spouse, sibling or
child), please list below: