Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Log in
Log in
Home
Donations
Calendar
Join
Contact Us
Livestreaming
About Us
Contact Us
Clergy and Staff
Officers and Board of Trustees
Young Family Programming
Hebrew Young Mens Cemetery
All Are Welcome
Interfaith Families
Our Inclusivity
Pray
Shabbat Services
Minyan Services and Resources for Mourners
Learn With Us
Religious School
Religious School Registration 2024-25
Adult Education
Cantor Apt Recordings
Connect
Groups and Clubs
Men's Club
Sisterhood
Social Action
Youth Groups
Donations
Home
Donations
Calendar
Join
Contact Us
Livestreaming
BSC Membership Application
Please verify reCaptcha before submitting the form.
HOUSEHOLD INFORMATION:
*
Address 1
Address Line 2
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
*
Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Wedding Anniversary Date (If Applicable)
Have you or your partner/spouse ever been a member of BSC?
Please Select One
YES
NO
*
Have you or your partner/spouse been recently been affiliated with any other synagogues?
Please Select One
Yes
No
*
Name of Synagogue
*
Years of previous membership(s)
*
Do you have friends or relatives who are current BSC members?
Please Select One
Yes
No
*
Name of Member?
*
Relationship to you?
Adult 1 Information
*
First Name
*
Last Name
*
Nickname
How would you like to be addressed?
*
Email
*
Cell Phone
*
Date of Birth
*
Gender
Please Select One
Female
Male
Non-Binary
other
*
Pronouns
*
Occupation
*
Business Name or Employer
*
Were you raised in the Jewish faith?
Please Select One
Yes
No
*
In what faith were you raised?
*
Growing up, how did your family identify?
Please Select One
Reform
Conservative
Orthodox
Reconstructionist
Traditional
Cultural
*
Which of your parents were Jewish?
Please Select One
mother
father
Have you had a Bar/Bat Mitzvah?
Please Select One
Yes
No
Hebrew Name
Please provide your Hebrew name in the following format:
First name, middle name ben/bat father's Hebrew name v'Mother's Hebrew name
ie: Yakov ben Yitzhak v'Rivkah
*
Please enter the name of the institution and location of your Bar/Bat Mitzvah
Bar/Bat Mitzvah Date
If you know the month/day/year of your Bat/Bar Mitzvah, please enter it here. If you are unsure of the exact date, please leave this blank for now.
Are you interested in a bar/bat Mitzvah?
YES
NO
Did you convert to Judaism?
Please Select One
YES
NO
Are you currently converting to Judaism or are you interested in converting in the near future?
YES
NO
If you converted to Judaism, please enter the date, name, and location of your conversion ceremony. If you are in the process of converting or may want to convert in the future, please note that as well.
ADDITIONAL FAMILY MEMBERS:
*
Is there another adult in your household?
Please Select One
No
Yes
ADULT 2 INFORMATION
*
First Name
*
Last Name
*
Nickname
How would you you like to be addressed?
*
Email
*
Cell Phone
*
Date of Birth
*
Gender
Please Select One
Female
Male
Non-Binary
other
*
Pronouns
*
Occupation
*
Business Name or Employer
*
Were you raised in the Jewish faith?
Please Select One
Yes
No
*
In what faith were you raised?
*
Growing up, how did your family identify?
Please Select One
Reform
Conservative
Orthodox
Reconstructionist
Traditional
Cultural
*
Which of your parents were Jewish?
Please Select One
mother
father
Have you had a Bar/Bat Mitzvah?
Please Select One
Yes
No
*
What is your Hebrew name?
Hebrew first name, Hebrew middle name ben/bat father's Hebrew name v'mother's Hebrew name
ie: Yakov ben Yitzhak v'Rivkah
Please enter the name of the institution and location of your Bar/Bat Mitzvah
Bar/Bat Mitzvah Date
If you know the month/day/year of your Bat/Bar Mitzvah, please enter it here. If you are unsure of the exact date, please leave this blank for now.
Are you interested in a bar/bat Mitzvah?
YES
NO
Did you convert to Judaism?
Please Select One
YES
NO
Are you currently converting to Judaism or are you interested in converting in the near future?
Please Select One
YES
NO
If you converted to Judaism, please enter the date, name, and location of your conversion ceremony. If you are in the process of converting or may want to convert in the future, please note that as well.
How do you currently identify?
Please Select One
Reform
Conservative
Orthodox
Reconstructionist
Traditional
Cultural
*
Do you have children aged 25 or younger?
Please Select One
Yes
No
List on separate lines your children under the aged 25 and younger
Include: Name; Gender, Date of birth and Hebrew name
Children aged 25 and younger are considered members and are included within your membership dues.
*
Do you have children that are ages 26 or older?
Please Select One
Yes
No
List on separate lines your children ages 26 or older.
Include: Name; Gender, Date of birth and Hebrew name
Adult children aged 26 and older will need to have their own membership in order to receive High Holiday tickets.
Additional Information
Do you have deceased loved ones for whom you would like to receive yahrzeit reminders?
Please Select One
No
Yes
Yahrzeit Information:
Please list each loved one on a separate line and include:
the deceased's name
English date of death and whether it was before sunset
relationship
Hebrew name if known. (Hebrew first name, Hebrew middle name, ben/bat their father's Hebrew name v'their mother's Hebrew name)
*
Which of these events and opportunities are of interest to your family? Please select all that apply.
Adult-Education
Holidays
Israel
Sisterhood
Men’s-Club
Social-Action
Religious School
Torah or Haftarah Reading
Is there anything else you would like to share with us (such as special interests or areas of expertise)?
Membership Category:
In which membership category do you and your partner/spouse belong?
Financial obligation is never an obstacle to membership at Beth Shalom. Membership rate discounts are offered to those in their first and second year of membership at Beth Shalom. Either the Synagogue Administrator or the Membership Committee Chair will be in touch to discuss the rates.
Quick summary of dues based on member category:
Young Professional (ages 26-30)
Regular (ages 31- 64)
Senior (65 & over)
Please note that if you have two adults in your household, select the age category based on the older person.
*
Membership Category
Please Select One
Individual/Single Young Professional: Introductory, Ages 26-30
Dual Young Professional membership Ages 26-30
Individual/Single Regular Membership Ages 31-64
Dual Regular Membership Ages 31-64
Individual/Single Senior Membership Ages 65 and older
Dual Senior Membership Ages 65 and older
Wed, April 16 2025 18 Nisan 5785
