Am Echad Membership Form

* Family Name

Spouse Last Name (if different)

* Home Phone

* Address 1

Address 2

* City

* State

* Zip

* Member type

Please Select OneFull - Family - $1500Full - Single - $1000Associate - Family - $900Associate - Single - $625Student/Unemployed - $250

No one will be turned away for lack of funds. Please inquire about special cases.

NOTE: Associate membership is available to those who are members of other synagogues, but wish to support Am Echad. Associate membership does not include the right to vote at Congregation meetings. If Am Echad decides to assign seats for High Holy days then Associate Members would be assigned seats after Full Members are assigned seats, if seats are available. In all cases, High Holy days are open to Associate Members.

* Family tribe

Please Select OneCohenLeviYisroel

* Title

* Spouse Title

* First name

* Spouse first name

* Gender

Please Select OneMaleFemale

* Spouse gender

Please Select OneMaleFemale

* Hebrew name (no parent name)

* Spouse Hebrew name (no parent name)

* Father's Hebrew name

* Spouse father's Hebrew name

* Mother's Hebrew name

* Spouse mother's Hebrew name

Spouse email

* Email

Cell phone

Spouse cell phone

Birth date

Spouse birth date

Wedding anniversary

Children?

Children (English and Hebrew names; English and Hebrew date of birth). Start each on a blank line.

Observe Yahrzeit(s)?

Yahrzeits [Full English name of deceased; full Hebrew name of deceased; English date of passing; Hebrew date of passing; Name of person observing; Relationship to observer]. Start each on a blank line.

Other information (if needed)

I hereby submit my application for membership of Congregation Am Echad. I understand that my membership will not be valid until approved by Rabbi Menachem Levine and by the Am Echad executive board.