Membership

Membership Application

Congregation Shaarei Shamayim

1810 Briarcliff Rd. N.E.
Atlanta, GA 30329
404-417-0472
404-417-0473:Fax

Full Name

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Spouse Full Name

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Hebrew Name

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Are you a Cohen or a Levi?

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Home Address

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Home Telephone Number

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His Work Telephone Number

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Her Work Telephone Number

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His E-mail address

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Her E-mail address

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His Date of Birth

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Her Date of Birth

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Children

1st Childs Name

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1st Childs Hebrew Name

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1st Childs Age

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1st Childs School and Grade

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2nd Childs Name

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2nd Childs Hebrew Name

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2nd Childs Age

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2nd Childs School and Grade

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3rd Childs Name

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3rd Childs Hebrew Name

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3rd Childs Age

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3rd Childs School and Grade

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His Parents

His Mothers Name

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His Mothers Hebrew Name

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His Mothers Age / Yartzeit

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Fathers Name

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Fathers Hebrew Name

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Fathers Age / Yartzeit

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Her Parents

Her Mothers Name

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Her Mothers Hebrew Name

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Her Mothers Age / Yartzeit

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Is / was your mother Jewish?

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Have you been married previously?

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Dues You Agree to Pay/Initial Donation

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Membership Categories
Family:$1400/year
Family Single Parent:$950/year
Single:$750/year
Single(<35):$500/year
Senior Citizen:(if requested):$750
Associate Members:$500/year

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Comments or Questions

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Security Code

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