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Membership Form

APPLICATION FOR MEMBERSHIP
Temple Emanuel
1163 Persinger Rd. S.W.
Roanoke, VA 24015
(540) 342-3378
We (I) do hereby apply for membership in Temple Emanuel, a congregation dedicated to the principles of Reform Judaism. Our primary goals are the enhancement of our religious experience and the continuing education of our members and their children.
FAMILY RECORD
Please enter your first name
Please enter your last name
Please indicate the Marital Status of the Primary Member
Please enter the date of your marriage
Please enter the Street Address
Please enter Second Line for the Address (if applicable)
Please enter the City for the Primary Member
Please enter the State of Residence for the Primary Member
Please the Zip Code for the Primary Member
Please enter a Primary Phone Number for the Primary Member
Please enter a Mobile Phone for the Primary Member
Please enter a family email address (if your family has one)
Please enter your previous community or congregation you were affiliated with
PRIMARY MEMBER
MEMBER 2
Please enter the First Name of the Primary Member
Please enter the First Name of the Secondary member
Please enter the Middle Name of the Primary Member
Please enter the Middle Name of Member 2
Please enter the Last Name of the Primary Member
Please enter the Last Name for Member 2
Please enter the Hebrew First Name of the Primary Member
Please enter the Hebrew First Name of Member 2
Please enter the Hebrew Father's Name for the Primary Member
Please enter the Hebrew Father's Name for Member 2
Please enter the Hebrew Mother's Name for the Primary Member
Please enter the Hebrew Mother's Name for Member 2
Please enter the Occupation for the Primary Member
Please enter the Occupation for Member 2
Please enter the Business Name for the Primary Member
Please enter the Business Name for Member 2
Please enter the Business Address for the Primary Member
Please enter the Business Address for Member 2
Please enter the Business City and State for the Primary Member
Please enter the Business City and State for Member 2
Please enter the Business Zip Code for the Primary Member
Please enter the Business Zip Code for Member 2
Please enter the Email Address for the Primary Member
Please enter the Email Address for Member 2
Please indicate the Religious Background for the Primary Member
Please enter the Religious Affiliation for Member 2
Please enter a Conversion Date for the Primary Member (if applicable)
Please enter a Conversion Date for Member 2 (if applicable)
Please select the date for the Bar or Bat Mitzvah for the Primary Member (if applicable)
Please enter the Bar or Bat Mitzvah Date for Member 2 (if applicable)
Please enter the Confirmation Date for the Primary Member (if applicable)
Please enter the Confirmation Date for Member 2 (if applicable)
DEPENDENT CHILDREN
CHILDREN NOT LIVING AT HOME
MEMORIALS
Family Relationship
Last Name
First Name and Initial
Date of Death
Primary Mother
Please enter the Last Name of the Primary Member's Mother
Please enter the First Name and Initial of the Primary Member's Mother
Please select the Date of Death for the Primary Member's Mother
Primary Father
Please enter the Last Name of the Primary Member's Father
Please enter the First Name and Initial of the Primary Member's Father
Please enter the Date of Death for the Primary Member's Father
Member 2 Mother
Please enter the Last Name of Member 2's Mother
Please enter the First Name and Initial of Member 2's Mother
Please enter the Date of Death for Member 2's Mother
Member 2 Father
Please enter the Last Name of Member 2's Father
Please enter the First Name and Initial for Member 2's Father
Please enter the Date of Death for Member 2's Father
Please indicate where the family plot is located (if applicable)
I am interested in information regarding Temple Emanuel Cemetery
COMMITTEES
I would like to be involved in the following Committee(s)
PRIMARY
MEMBER 2
Please indicate which Committee(s) the Primary Member is interested in
Please indicate which Committee(s) Member 2 is interested in
Please list any other special talents or interests (i.e., sing, play instrument, drama, writing, photography, etc.)
Please list any other special talents or interests (i.e., sing, play instrument, drama, writing, photography, etc.)
I hereby apply for membership in Temple Emanuel, a congregation dedicated to promoting the fundamental and enduring principles of Judaism; to ensuring the continuity of the Jewish people; to enabling its members to develop a relationship with God through communal worship, study of Torah, and assembly; and to apply the principles of Reform Judaism to the values and conduct of the individual, the family and the society in which we live. We/I agree to conform to Temple Emanuel's by-laws and to honor all monetary obligations to the congregation.
Applicant(s) signature:
PRIMARY MEMBER
Please type your name. Please note that you are consenting to sign and agree to Temple Emanuel's by-laws and financial obligations electronically. Your typed name will be be considered as valid and binding as your signature. For any questions regarding the application process, please contact the Temple Office at (540) 342-3378 or office@teroanoke.org.
Please enter a date for when this form was signed
MEMBER 2
Please type your name. Please note that you are consenting to sign and agree to Temple Emanuel's by-laws and financial obligations electronically. Your typed name will be be considered as valid and binding as your signature. For any questions regarding the application process, please contact the Temple Office at (540) 342-3378 or office@teroanoke.org.
Please enter a date for when this form was signed
Thu, September 21 2023 6 Tishrei 5784