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HSOSC Membership Application

Please verify reCaptcha before submitting the form.

Membership Application

Today's Date

Adult #1 - Personal Information

* First Name

Preferred Name/Nickname

* Last Name

Maiden Name

(If applicable)

* Primary E-Mail Address

Preferred Phone Number

Tribe

Hebrew Name

* Birthday

Gender Identification

Marital Status

Wedding Anniversary

(If applicable)

Primary Address

City

State

Zip Code

Employer Name

Occupation/Job Title

Full-timePart-timeRetired

Business Phone

Business Address

Jewish tradition in which Adult #1 was raised:

ReformConservativeOrthodoxReconstructionistSecularJew by ChoiceNon-Jew/Other Religion

Adult #1 Conversion Performed By:

(If applicable)

Adult #1 B'nai Mitzvah Date

(If applicable)

Adult #1 Confirmation Date

(If applicable)

Adult #1 - Other previous synagogue affiliation

Adult #1 - Parent Information

Adult #1 - Mother's English Name

LivingDeceased

Mother's Hebrew Name (if known)

Yartzeit (English Date)

Adult #1 - Father's English Name

LivingDeceased

Father's Hebrew Name (if known)

Yartzeit (English Date)

Is there a second adult applying for Membership?

Adult #2 - Personal Information

* First Name

Preferred Name/Nickname

* Last Name

Maiden Name (if applicable)

Birthday

Gender Identification

Tribe (if applicable)

Hebrew Name (if applicable)

E-Mail Address

Preferred Phone Number

Employer

Occupation/Job Title

Full-timePart-timeRetired

Business Phone

Business Address

Jewish tradition in which Adult #2 was raised:

ReformConservativeOrthodoxReconstructionistSecularJew by choiceNon-Jew/Other Religion

Adult #2 Conversion Performed By:

(If applicable)

Adult #2 B'nai Mitzvah Date

(If applicable)

Adult #2 Confirmation Date

(If applicable)

Adult #2 - Other previous synagogue affiliation

Adult #2 - Parent Information

Adult #2 - Mother's English Name

LivingDeceased

Mother's Hebrew Name (if known)

Yartzeit (English Date)

Adult #2 - Father's English Name

LivingDeceased

Father's Hebrew Name (if known)

Yartzeit (English Date)

Children's Information

For those with children who live at home and are still enrolled in a full-time education program.

How many children live in the family home?

Child #1

Name: First & Middle

Preferred Name/Nickname

Last Name

If different from yours

Hebrew Name

Date of Birth

Preferred phone

If different from yours

Pre-School Name

Hebrew School

AttendedWill AttendCurrently Attending

B'nai Mitzvah Date

If applicable

Confirmation Date

If applicable

Public/Private School Name

Grade

High School Class Of

Year

Child #2

Name: First & Middle

Preferred Name/Nickname

Last Name

If different from yours

Hebrew Name

Date of Birth

Preferred Phone

If different from yours

Pre-School Name

Hebrew School

AttendedWill AttendCurrently Attending

B'nai Mitzvah Date

If applicable

Confirmation Date

If applicable

Public/Private School Name

Grade

High School Class Of

Year

Child #3

Name: First & Middle

Preferred Name/Nickname

Last Name

If different from yours

Hebrew Name

Date of Birth

Preferred Phone

If different from yours

Pre-School Name

Hebrew School

AttendedWill AttendCurrently Attending

B'nai Mitzvah Date

If applicable

Confirmation Date

If applicable

Public/Private School Name

Grade

High School Class Of

Year

Additional Information

Are you interested in joining Temple committees?

Yes, I'm ready!Not right now

Please email Interim Executive Director, Amy Mallor (amy.mallor@hsosc-baltimore.org) if you are interested in learning more about Temple committees.

By signing this application, I/We understand that I/We are responsible for all financial obligations I/We incur with Har Sinai-Oheb Shalom Congregation (HSOSC).

Signature of Adult #1

Date

Signature of Adult #2

Date

Wed, May 18 2022 17 Iyar 5782

410-358-0105 • info@hsosc-baltimore.org • 7310 Park Heights Ave., Baltimore, MD, 21208 (map link)
Email: Rabbi Rachel Sabath Beit-Halachmi, Ph. D. Inaugural Senior Rabbi • Cantor Alexandra S. Fox, Inaugural Cantor

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