YAD New Member Application

Personal Information

First Name

Last Name

Hebrew Name

Date of Birth

Primary Email

Mobile Phone

Home Phone

Primary Street

Primary City

Primary Post Code

Primary County

Membership Selection

High Holy Seating Venue

Blum Community Hall: Seating is in the round, inviting all who are present to lend their voices to our service, led by a Rabbi Dror Chankin Gould and Cantor Liz Berke with a professional choir.Malkov Chapel: A lay-led egalitarian minyan grounded in the traditional Hebrew liturgy.Sanctuary-Balcony: The Sanctuary High Holy Day service, led by Hazzan Alberto Mizrahi, Rabbi Siegel and a professional choir but with seating in the Balcony of the main Sanctuary.* (Not wheelchair accessible)Sanctuary-Main Floor: The Sanctuary High Holy Day service, led by Hazzan Alberto Mizrahi, Rabbi Siegel and a professional choir but with seating on the main level of the Sanctuary.*

Would you like to add a Yahrzeit?

Yahrzeit Information

Deceased First Name

Deceased Last Name

Deceased Hebrew Name

Gregorian Date of Death

Time of Day

Hebrew Date of Death

Yahrzeit Observed By

Deceased's Relationship to Observer

Yahrzeit Information 2

Deceased First Name

Deceased Last Name

Deceased Hebrew Name

Gregorian Date of Death

Time of Day

Yahrzeit Observed By

Contact 1

Deceased Relationship to you

Synagogue Life

We would like to get to know what your interests might be so we can make sure your synagogue experience is the most meaningful it can be.

Please indicate if any of these are of interest to you:

Payment Options

Please select one of the three options below:

A. Please charge me a monthly amount of:

$25$50$80

B. Please charge me a one-time amount of:

$300$600$960

C. Please charge me a different monthly amount:

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Credit Card Payment Information

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Last Name on Card

Credit Card Number

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YYYY

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ACH/eCheck Information

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Bank Account Number

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Bank Name

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Click SUBMIT only once to avoid being charged multiple times.

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