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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+
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Primary Reason for Joining
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Moved to Atlanta
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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
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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
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Title
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Mr.
Mrs.
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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
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Hebrew Name
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Tribe
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Kohen
Levi
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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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Date of Marriage
Conversion Date
Conversion Rabbi & Affiliation
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Email Address
Home Phone Number
Mobile Phone
Facebook 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
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How Many Yahrzeit Listings?
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1
2
3
4
5
6
7
8
9
10
Yahrzeit Listing
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Name of Deceased
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Relationship
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Mother
Father
Grandmother
Grandfather
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Daughter / Daughter-in-Law
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Related to
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Head of Household
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Secular Yarzheit Date
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Pass After Sunset
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Hebrew Name
Sun, June 15 2025 19 Sivan 5785
