Membership Application - Form - The Chatham Synagogue

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Membership Application

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MEMBERSHIP APPLICATION

Please complete the form below. You will be contacted by our membership committee soon after the application is received.

FAMILY INFORMATION:

Last Name:

First Name:

Email:

Occupation

Are you Jewish?

YesNo

Primary Phone Number:

Alternate Phone Number:

CO-APPLICANT

Last Name:

First Name:

Email:

Occupation:

Are You Jewish?

YesNo

Primary Phone:

Alternate Phone:

CHILDREN (under the age of 21)

Last Name:

First Name:

Birthdate:

Last Name:

First Name:

Birthdate:

Last Name:

First Name:

Birthdate:

ADDRESS

Primary Address: (for mail & billing)

City:

State:

Zipcode:

Secondary Address:

City:

State:

Zipcode:

INTERESTS

We are a volunteer organization and rely on our members to contribute their talents and time to the life of the synagogue and our community. This also enables us toe keep our membership dues affordable. We encourage your participation in one or more of the following committees. Please indicate your interests by checking as many as you like.

BuildingYoung FamiliesFinance

CemeteryCommunicationsDevelopment

MembershipInterfaith ActivitiesRitual

Social ActionProgramsChesedGeneral Volunteerism

How did you hear about us?

AGREEMENT

The undersigned hereby applies for membership in The Chatham Synagogue/Netivot Torah, and certifies that the information given is true. You will be contacted by our membership committee once the application is received.

Type Of Membership

Family Membership $600/YearIndividual Membership $375/Year

Digital Signature of Applicant: (type full name)

Digital Signature of Co-Applicant: (type full name)

Date:

Date:

Tue, December 5 2023 22 Kislev 5784

THE CHATHAM SYNAGOGUE

NETIVOT TORAH

Located in the hamlet of Chatham Center at:

1536 County Route 28

Valatie, NY 12184

Mailing Address:

PO Box 51 Chatham, NY 12037

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