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Membership Application
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Membership Type
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30 and Under
Single 31-35
Family 31-35
Single 36+
Family 36+
Associate (requires concurrent synagogue affiliation)
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Primary Reason for Joining
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Moved to Atlanta
Transferring Primary Affiliation
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Referral Name
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Head of Household First Name
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Head of Household Last Name
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Email for Confirmation
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Primary Household Address
Primary Household Address Line 2
Primary Household City
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Primary State
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Primary Zip Code
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How Many Family Members (including yourself)
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1
2
3
4
5
6
7
8
9
10
Family Details
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Role in Family
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Head of Household
Spouse
Child
Sibling
Other Relative
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Title
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Mr.
Mrs.
Ms.
Dr.
Rabbi
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First Name
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Last Name
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Jewish Status
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Born Jewish
Converted to Judaism
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Hebrew Name
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Tribe
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Kohen
Levi
Yisroel
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Birth Date
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Born After Sunset
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No
Yes
Date of Bar/Bat Mitzvah
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Marital Status
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Single
Married
Not Applicable
Date of Marriage
Conversion Date
Conversion Rabbi & Affiliation
Conversion Location
Email Address
Home Phone Number
Mobile Phone
Facebook Name/Handle
Instagram Name/Handle
LinkedIn Name/Handle
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Former Synagogue Affiliation
Concurrent Synagogue Affiliation
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Father's English Name
Father's Hebrew Name
Father's Tribe
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Kohen
Levi
Yisroel
Unknown
*
Mother's English Name
Mother's Hebrew Name
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Mother's Jewish Status
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Born Jewish
Converted to Judaism
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How Many Yahrzeit Listings?
0
1
2
3
4
5
6
7
8
9
10
Yahrzeit Listing
*
Name of Deceased
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Relationship
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Mother
Father
Grandmother
Grandfather
Sister
Brother
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Daughter / Daughter-in-Law
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Related to
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Head of Household
Spouse
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Secular Yarzheit Date
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Pass After Sunset
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Yes
No
Hebrew Name
Sat, March 15 2025 15 Adar 5785
