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Membership Application

If you have any questions about Membership or the application, please contact Angela Siegel at [email protected] or (216) 371-2244, ext. 121

Type of Membership

Member 1 Information:

Contact Information

Prefix

* First Name

* Last Name

* Preferred Name

* Street Address

* City, State, Zip

Home Phone

Work Phone & Ext.

Cell Phone

Preferred Phone Contact

* Email Address

* Park Synagogue Information via Email

Personal Information

* Date of Birth

Occupation

Employer

Marital Status (optional)

Date of Wedding Anniversary (month/date/year)

Religious Information

Hebrew Name (in English)

Mother's Hebrew Name

Father's Hebrew Name

Bar/Bat Mitzvah Date (month/date/year)

Confirmation (month/date/year)

Lineage

Member 2 Information

Prefix

First Name

Last Name

Preferred Name

Street Address

City, State, Zip

Home Phone

Cell Phone

Work Phone & Ext.

Preferred Phone Contact

Email Address

Park Synagogue Information via Email

Personal Information

Date of Birth

Occupation

Employer

Religious Information

Hebrew Name (in English)

Mother's Hebrew Name

Father's Hebrew Name

Bar/Bat Mitzvah Date (month/date/year)

Confirmation (month/date/year)

Lineage

Children (if applicable)

** Include if your child has a different last name and/or address than yours. If your child is an adult, simply list the location of their residence (ex., New York). Please also note: To include your child(ren) in Bar/Bat Mitzvah scheduling, please email Natalie Prior, [email protected] to register your child(ren) in our education database.

Child 1

Name

Hebrew Name

Date of Birth

Gender

School

Grade

Address**

Single/Married (if adult)

Child 2

Name

Hebrew Name

Date of Birth

Gender

School

Grade

Address**

Single/Married (if adult)

Child 3

Name

Hebrew Name

Date of Birth

Gender

School

Grade

Address**

Single/Married (if adult)

Member 1 Family & Yahrzheit Information

Relatives who are Park Members (Name and relationship)

Yahrzheit Information (Deceased immediate family members)

Name of Deceased, Relationship, Date of Death, Hebrew Date (if known)

Member 2 Family & Yahrzheit Information

Relatives who are Park Members (Name and relationship)

Yahrzheit Information (Deceased immediate family members)

Name of Deceased, Relationship, Date of Death, Hebrew Date (if known)

Programs & Groups at Park Synagogue

We provide our members a wide range of programs and groups for every age group to get involved, meet new people and give back to the community. Please let us know which programs or groups you would like to participate in at Park Synagogue. (See “Park Synagogue Groups and Committees” for more information.)

Other Interests:

Comments

New Member Questionnaire

(Please also send in a recent photo of your family with your application)

Please tell us a little about you and your family (how long you have lived in the Cleveland area, where you grew up, occupations, hobbies and interests of adults and kids):

What made you decide to join Park Synagogue?

What activities/services/events/groups have you been able to experience at Park?

What are your personal or family goals for being a Park member? In what ways will being a Park member make a difference in your life/lives? In what ways do you want to get more involved now or in the future?

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total:

	Adult Education ( Prayerbook Hebrew, Peer Torah Study, Torah Chanting)
	Book Club
	Choir
	Gesher
	Park Family Connection
	Hosting Shabbat Dinner
	Keruv Connection
	Men's Club
	Minyan (Morning or Evening)
	Neshama
	Park Day Camp
	Park Synagogue Wolf Religious School
	Purim Carnival Committee
	Senior Adult Activities
	Shabbat Participation (Usher, Read Torah or Haftorah, Hakafot, Hagbah, Gelilah, and Gabbai)
	Shabbaton
	Sisterhood
	Social Action Projects
	Summer Member Event
	Volunteer Projects
	Women's Rosh Chodesh
	Youth Activities ( Chaverim- formally Jr Kadima & Youth Gesher - formally USY)

	Adult Education ( Prayerbook Hebrew, Peer Torah Study, Torah Chanting)
	Book Club
	Choir
	Gesher
	Park Family Connection
	Hosting Shabbat Dinner
	Keruv Connection
	Men's Club
	Minyan (Morning or Evening)
	Neshama
	Park Day Camp
	Park Synagogue Wolf Religious School
	Purim Carnival Committee
	Senior Adult Activities
	Shabbat Participation (Usher, Read Torah or Haftorah, Hakafot, Hagbah, Gelilah, and Gabbai)
	Shabbaton
	Sisterhood
	Social Action Projects
	Summer Member Event
	Volunteer Projects
	Women's Rosh Chodesh
	Youth Activities ( Chaverim- formally Jr Kadima & Youth Gesher - formally USY)

Membership Application

Member 1 Information:

Member 2 Information

Children (if applicable)

Member 1 Family & Yahrzheit Information

Member 2 Family & Yahrzheit Information

Programs & Groups at Park Synagogue

New Member Questionnaire

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Membership Application

Member 1 Information:

Member 2 Information

Children (if applicable)

Member 1 Family & Yahrzheit Information

Member 2 Family & Yahrzheit Information

Programs & Groups at Park Synagogue

New Member Questionnaire

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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