Engagement Interest Form

We are excited you desire to be a part of the incredible community of Temple Beth-El! We want to know how to serve you best and how we can connect you to the community so please take a few moments and complete the information below.

Once you complete this form, you will be contacted by our Executive Director, Gerri Madenberg, who will go over all-things-engagement at TBE. While we do have a Recommended Engagement Commitment, membership will not be denied based on economic ability. Please be comfortable to speak confidentially with Gerri regarding any financial concerns you may have.

Personal Information

* How many adults would be joining in your household?

Member 1

Member 2

Member 1 - Title

Member 2 - Title

* Member 1 - First Name

Member 2 - First Name

Member 1 - Nickname

Member 2 - Nickname

* Member 1 - Last Name

Member 2 - Last Name

* Member 1 - Date of Birth

Member 2 - Date of Birth

Member 1 - Hebrew Name (if applicable)

Member 2 - Hebrew Name (if applicable)

* Member 1 - Marital Status

Member 2 - Marital Status

* Member 1 - Email Address

Member 2 - Email Address

* Member 1 - Mobile Phone

Member 2 - Mobile Phone

* Member 1 - Type of Occupation (or Specialty)

Member 2 - Type of Occupation (or Specialty)

Member 1 - Business Telephone

Member 2 - Business Telephone

Member 1 - Where do/did you work?

Member 2 - Where do/did you work?

Member 2 - Special Needs

Date of Marriage (if applicable)

I/We are related to the following Temple Beth-El members: (please list relationship)

* Emergency Contact (EC) Name #1

Not in your household

* EC #1 Phone

* EC #1 Relationship to you

Emergency Contact Name #2

Not in your household

EC #2 Phone

EC #2 Relationship to you

Address Information

Address

Please include number of your apartment, lot, condo, etc. if applicable

City

State

Zip Code

Home Phone Number

If no home number exists, please enter primary contact number

Children Information

Still living at home.

* How many children are living at home?

1st Child

2nd Child

3rd Child

4th Child

Child 1 - Last Name

Child 2 - Last Name

Child 3 - Last Name

Child 4 - Last Name

Child 1 - First Name

Child 2 - First Name

Child 3 - First Name

Child 4 - First Name

Child 1 - Birth Date

Child 2 - Birth Date

Child 3 - Birth Date

Child 4 - Birth Date

Child 1 - Gender

Child 2 - Gender

Child 3 - Gender

Child 4 - Gender

Child 1 - Email

Child 2 - Email

Child 3 - Email

Child 4 - Email

Child 1 - Hebrew Name

Child 2 - Hebrew Name

Child 3 - Hebrew Name

Child 4 - Hebrew Name

Child 1 - Secular School Name

Child 2 - Secular School Name

Child 3 - Secular School Name

Child 4 - Secular School Name

Child 1 - Post HS - Living at home?

Child 2 - Post HS - Living at home?

Child 3 - Post HS - Living at home?

Child 4 - Post HS - Living at home?

Child 1 - College Student?

Child 2 - College Student?

Child 3 - College Student?

Child 4 - College Student?

Child 1 - College Name

Child 2 - College Name

Child 3 - College Name

Child 4 - College Name

Other Adults in Your Household

Not your children

How many other adults are in your household?

1st Adult

2nd Adult

Other Adult 1 - Name

Other Adult 2 - Name

Other Adult 1 - Birth Date

Other Adult 2 - Birth Date

Other Adult 1 - Relationship

Other Adult 2 - Relationship

Yahrzeit Information

Please list the names of loved ones for whom you wish to receive Yahrzeit notices.

I/We choose to observe Yahrzeits on the:

English DateHebrew Date

* How many yahrzeits would you like to enter information for today?

Name of Deceased

Relationship

Which member is this for?

Date of Death (Secular)

Name of Deceased

Relationship

Which member is this for?

Date of Death (Secular)

Name of Deceased

Relationship

Which member is this for?

Date of Death (Secular)

Name of Deceased

Relationship

Which member is this for?

Date of Death (Secular)

Name of Deceased

Relationship

Which member is this for?

Date of Death (Secular)

Judaic Information

* How many adults would be joining in your household?

Member 1

Member 2

Member 1 - If you grew up Jewish, when was your Bar/Bat Mitzvah? (mm/dd/yyyy)

Member 2 - If you grew up Jewish, when was your Bar/Bat Mitzvah? (mm/dd/yyyy)

Member 1 - If you converted, what city and with which Rabbi did you work?

Member 2 - If you converted, what city and with which Rabbi did you work?

Miscellaneous Information

Did you, or do you currently belong to a congregation prior to Temple Beth-El?

Please list your former temple name, city, state & reason for leaving

* How did you hear about Temple Beth-El?

* What made you decide to pursue active membership at Temple Beth-El?

Tell us about your passions!

* How many adults would be joining in your household?

Member 1

Member 2

Other Ways to Become Engaged in our Community

Checking an interest box shows you're interested in receiving more information, but it is not a commitment.

* How many adults would be joining in your household?

Member 1

Member 2

Member 1 - I would to receive more information about serving with:

Member 2 - I would to receive more information about serving with:

Please let us know anything we missed or feel free to comment as you wish in the space provided below.

We are excited you desire to be a part of the incredible community of Temple Beth-El! We want to know how to serve you best and how we can connect you to the community so please take a few moments and complete the information below.

Personal Information

Member 1

Member 2

Address Information

Children Information

1st Child

2nd Child

3rd Child

4th Child

Other Adults in Your Household

1st Adult

2nd Adult

Yahrzeit Information

Judaic Information

Member 1

Member 2

Miscellaneous Information

Tell us about your passions!

Member 1

Member 2

Other Ways to Become Engaged in our Community

Member 1

Member 2

Once submitted, you will be contacted by someone in the next few days to get to know you a bit more and walk you through your next steps.