Step 1 of 2

Member Information - #1
Title
First Name & Initial **
Last Name **
*
Date of Birth*
Month
Day
Year
Marital Status **
Wedding Anniversary
Month
Day
Year
Address *
Street Address Address Line 2 City State ZIP Code
Home Phone Number
Cell Phone Number
Email Address **
Job Title/Occupation
Business Name
Business Address
Business Phone Number
Have You Chanted a Haftorah?
If yes, date last read
Month
Day
Year
Have You Read From the Torah?
If yes, date last read
Month
Day
Year
Hebrew Name (may be transliterated)
Ben/Bat (Son of -or- Daughter of) (Father’s name) (Mother’s name)
Do you wish to add your spouse as a member?
Member Information - #2
Title
First Name & Initial **
Last Name **
*
Date of Birth*
Month
Day
Year
Marital Status **
Wedding Anniversary
Month
Day
Year
Address *
Street Address Address Line 2 City State ZIP Code
Home Phone Number
Cell Phone Number
Email Address **
Job Title/Occupation
Business Name
Business Address
Business Phone Number
Have You Chanted a Haftorah?
If yes, date last read
Month
Day
Year
Have You Read From the Torah?
If yes, date last read
Month
Day
Year
Hebrew Name (may be transliterated)
Ben/Bat (Son of -or- Daughter of) (Father’s name) (Mother’s name)
Hidden
How many dependent children do you have?*
Dependent Child - #1
Name
First Last
Date of Birth*
Month
Day
Year
Hebrew Name
Address
Current Grade
Dependent Child - #2
Name
First Last
Date of Birth*
Month
Day
Year
Hebrew Name
Address
Current Grade
Dependent Child - #3
Name
First Last
Date of Birth*
Month
Day
Year
Hebrew Name
Address
Current Grade
Dependent Child - #4
Name
First Last
Date of Birth*
Month
Day
Year
Hebrew Name
Address
Current Grade
Hidden
Do you have any Yahrzeit Record's would you like to enter, if so how many?
Yahrzeit Record - #1
Name of Deceased
Hebrew Name of Deceased
Which Member was the Deceased Related to?
Deceased Relationship to Member
English Date of Death*
Month
Day
Year
Hebrew Date of Death
Month
Day
Year
Yahrzeit Record - #2
Name of Deceased
Hebrew Name of Deceased
Which Member was the Deceased Related to?
Deceased Relationship to Member
English Date of Death*
Month
Day
Year
Hebrew Date of Death
Month
Day
Year
Yahrzeit Record - #3
Name of Deceased
Hebrew Name of Deceased
Which Member was the Deceased Related to?
Deceased Relationship to Member
English Date of Death*
Month
Day
Year
Hebrew Date of Death
Month
Day
Year
Yahrzeit Record - #4
Name of Deceased
Hebrew Name of Deceased
Which Member was the Deceased Related to?
Deceased Relationship to Member
English Date of Death
Month
Day
Year
Hebrew Date of Death
Month
Day
Year
Date*
Month
Day
Year
Signature*

Events

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Services

Fri 20

Kabbalat Shabbat

September 20 @ 5:30 pm - 6:30 pm

Sat 21

Shabbat Service

September 21 @ 9:00 am - 11:30 am

Fri 27

Kabbalat Shabbat

September 27 @ 5:30 pm - 6:30 pm

Sat 28

Selichot

September 28 @ 10:00 pm - 11:00 pm

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School Events

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Congregation Beth David

Located at: 102 Kingstown Road, Narragansett, RI 02882
Mail to: PO Box 3299, Narragansett, RI 02882

Phone: (401) 789-3437

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Step 1 of 2

Member Information - #1

Member Information - #2

Dependent Child - #1

Dependent Child - #2

Dependent Child - #3

Dependent Child - #4

Yahrzeit Record - #1

Yahrzeit Record - #2

Yahrzeit Record - #3

Yahrzeit Record - #4

Membership Choices

Events

Services

Kabbalat Shabbat

Shabbat Service

Kabbalat Shabbat

Selichot

School Events

Congregation Beth David

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