TBS Membership Application

“Do not separate yourself from the community.” —Talmud Temple Beth Shalom opens its membership to anyone whose heart so moves them to express themselves Jewishly.

Family Information

* Family Name

Please enter as last name(s) followed by first name(s).

* Home Street Address

* Home City/State/Zip

* Home Phone Number

* Marital Status

Single
Married (see below)
Divorced
Widowed

Anniversary Date

If married only. Please provide day/month/year!

Adult #1 Details

Title

Mr.
Mrs.
Ms.
Miss
Dr.

* Last Name

* First Name

* Date Of Birth

* Occupation

Business Name

Business Phone Number

Mobile Phone Number

* Email Address

Religious Background

Jewish
Jew by Choice
Not Jewish
Raised in "no faith"

Hebrew Name

If any. Please transliterate!

Adult #2 Details

Title

Mr.
Mrs.
Ms.
Miss
Dr.

Last Name

First Name

Date of Birth

Occupation

Business Name

Business Phone Number

Mobile Phone Number

Email Address

Religious Background

Jewish
Jew By Choice
Not Jewish
Raised in "no faith"

Hebrew Name

If any. Please transliterate!

Other Congregation Affiliation(s)

No Label

Prior Affiliation
Current Affiliation
No Other Affiliation(s)

Congregation Name

Congregation Location

Child(ren)

Child #1

Last Name

First Name

Hebrew Name

Please transliterate!

Birth Date

Sex

M
F

Lives at Home

Yes
No

Child #2

Last Name

First Name

Hebrew Name

Please transliterate!

Birth Date

Sex

M
F

Lives at Home

Yes
No

Child #3

Last Name

First Name

Hebrew Name

Please transliterate!

Birth Date

Sex

M
F

Lives at Home

Yes
No

Child #4

Last Name

First Name

Hebrew Name

Please transliterate!

Birth Date

Sex

M
F

Lives At Home

Yes
No

Child #5

Last Name

First Name

Hebrew Name

Please transliterate!

Birth Date

Sex

M
F

Lives at Home

Yes
No

Yahrzeits / Anniversaries of Death

Yahrzeit #1

Name of Departed

Observed by

Adult #1
Adult #2
Both

Relationship to Observer

Date of Decease

Please include day, month, and year.

Observe on which date?

English/Gregorian
Hebrew

Yahrzeit #2

Name of Departed

Observed by

Adult #1
Adult #2
Both

Relationship to Observer

Date of Decease

Please include day, month, and year.

Observe on which date?

English/Gregorian
Hebrew

Yahrzeit #3

Name of Departed

Observed by

Adult #1
Adult #2
Both

Relationship to Observer

Date of Decease

Please include day, month, and year.

Observe on which date?

English/Gregorian
Hebrew

Yahrzeit #4

Name of Departed

Observed by

Adult #1
Adult #2
Both

Relationship to Observer

Date of Decease

Please include day, month, and year.

Observe on which date?

English/Gregorian
Hebrew

Yahrzeit #5

Name of Departed

Observed by

Adult #1
Adult #2
Both

Relationship to Observer

Date of Decease

Please include day, month, and year.

Observe on which date?

English/Gregorian
Hebrew

Volunteer Opportunities

Get Involved! Temple Beth Shalom has many volunteer opportunities for new members. To get involved in Temple activities, programs, and policy development, please indicate below those opportunities that might interest you. You will be contacted with more information.

Adult Education

Adult #1
Adult #2

Archives Management

Adult #1
Adult #2

Budget & Finance

Adult #1
Adult #2

Caring Community

Adult #1
Adult #2

Choir (Sharyonim)

Adult #1
Adult #2

Early Childhood Activities

Adult #1
Adult #2

Fundraising

Adult #1
Adult #2

Interior Furnishings

Adult #1
Adult #2

Information Technology

Adult #1
Adult #2

Landscaping / Yard Work

Adult #1
Adult #2

Library Management

Adult #1
Adult #2

Marketing & PR

Adult #1
Adult #2

Membership Development

Adult #1
Adult #2

Membership Integration

Adult #1
Adult #2

Men's Club

Adult #1
Adult #2

Newsletter / The Window

Adult #1
Adult #2

Office Work

Adult #1
Adult #2

Oneg Preparation

Adult #1
Adult #2

Religious Practices

Adult #1
Adult #2

Religious School

Adult #1
Adult #2

Scrip Program

Adult #1
Adult #2

Social Action

Adult #1
Adult #2

Strategic Planning

Adult #1
Adult #2

Website

Adult #1
Adult #2

Women of Beth Shalom (WRJ)

Adult #1
Adult #2

Youth Activities

Adult #1
Adult #2

Membership Directory and Temple Contact Preferences

Temple Beth Shalom publishes a membership directory annually (this is a member-only publication). Please indicate your contact preferences below.

Home Address

Please do not publish in the directory
Please do not contact me/us this way

Home Phone Number

Please do not publish in the directory
Please do not contact me/us this way

Adult #1 Business Phone Number

Please do not publish in the directory
Please do not contact me/us this way

Adult #1 Mobile Phone Number

Please do not publish in the directory
Please do not contact me/us this way

Adult #1 Email Address

Please do not publish in the directory
Please do not contact me/us this way

Adult #2 Business Phone Number

Please do not publish in the directory
Please do not contact me/us this way

Adult #2 Mobile Phone Number

Please do not publish in the directory
Please do not contact me/us this way

Adult #2 Email Address

Please do not publish in the directory
Please do not contact me/us this way

No Label

I/We do not want to appear at all in the Temple Membership Directory.

Email Preferences

By default, Temple Beth Shalom will send you our monthly bulletin ("The Window") by postal mail and our weekly e-bulletin ("The eWindow") by email. You may also opt to receive an electronic copy of "The Window".

I wish to receive an emailed copy of the monthly bulletin, "The Window"

Adult #1
Adult #2
I/We do not need a paper copy of "The Window".

I do NOT wish to receive the TBS weekly email bulletin, "The eWindow"

Adult #1
Adult #2

You will be able to change your email preferences with us at any time by visiting the Temple Beth Shalom website.

Annual Support Commitment

Joining Temple Beth Shalom creates a covenant between the member and the congregation. As part of this covenant, the members and the congregation support each other. The members’ most ubiquitous expression of support for the congregation is through the pledge of the Annual Support Commitment (or “Dues”).

Information about suggested Annual Support Commitment amounts, including our Standard Annual Support Commitment levels, is available at:

tbsohio.org/joining/asc.pdf

After sending in this application, you will be contacted by the Temple Beth Shalom office to help establish an Annual Support Commitment rate that is acceptable to you and/or your family.

If you'd like to make a suggested pledge in advance, please enter it here.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

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Total:

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