ETZ CHAIM Membership Form

We/I hereby apply for membership with ETZ CHAIM SEPHARDIC CONGREGATION, and we/I hereby agree to be bound by the rules and by-laws of the Congregation.

 

 

First Name:
 
Middle Name:
 
Last Name:
Hebrew Name:
Ben/Bat Father:
(mother)
Date of Birth:
Birthplace:

 

Civil Status    
If married, maiden name of spouse:  
Spouse Hebrew Name:
Ben/Bat Father:
(mother)
Spouse Date of Birth:
Birthplace:
Date of Marriage:
Rabbi:

 

 

 

Current Address:
City:
State:
Zip:
Address Line 2
Phone:
Email:
How long have you lived in Indianapolis?  
0-1 Year  2-5 Years   5 or More Years   I Don't Live in Indianapolis
Previous synagogue affiliation:
If other, please explain:
Name of Congregation:
Dates:
City, State:
 
 
 
 
Business or Profession:
Applicant Employer:
Phone:
Employer Address:
City, State
Spouse Business or Profession:
Spouse Employer:
Phone:
Spouse Employer Address:
City, State

 

Please list names of children and their spouses.
Name:                                              Address:
 
Name:                                              Address:
 
Name:                                              Address:
 
Name:                                              Address:
 

 

Please list all Anos /Yahrzeits that you observe and their relationship.
If you do not have the Hebrew date, please use the standard calender date.
Name:
Relatioinship:
Date:
Name:
Relatioinship:
Date:
Name:
Relatioinship:
Date:
Name:
Relatioinship:
Date:

 

 

Print and Mail Completed form to:
Etz Chaim Sephardic Congregation
P.O. Box 80004
Indianapolis, IN 46280

 

Etz Chaim Sephardic Congregation