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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
Cohen
Levi
Yisrael
None Set
Hebrew Name
*
Birthday
Gender Identification
N/A or Unknown
Male
Female
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Wedding Anniversary
(If applicable)
Primary Address
City
State
--Select State--
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District of Columbia
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Hawaii
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Maryland
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Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Employer Name
Occupation/Job Title
Full-time
Part-time
Retired
Business Phone
Business Address
Jewish tradition in which Adult #1 was raised:
Reform
Conservative
Orthodox
Reconstructionist
Secular
Jew by Choice
Non-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
Living
Deceased
Mother's Hebrew Name (if known)
Yartzeit (English Date)
Adult #1 - Father's English Name
Living
Deceased
Father's Hebrew Name (if known)
Yartzeit (English Date)
Is there a second adult applying for Membership?
Please Select One
Yes
No
Adult #2 - Personal Information
*
First Name
Preferred Name/Nickname
*
Last Name
Maiden Name (if applicable)
Birthday
Gender Identification
N/A or Unknown
Male
Female
Tribe (if applicable)
Cohen
Levi
Yisrael
None Set
Hebrew Name (if applicable)
E-Mail Address
Preferred Phone Number
Employer
Occupation/Job Title
Full-time
Part-time
Retired
Business Phone
Business Address
Jewish tradition in which Adult #2 was raised:
Reform
Conservative
Orthodox
Reconstructionist
Secular
Jew by choice
Non-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
Living
Deceased
Mother's Hebrew Name (if known)
Yartzeit (English Date)
Adult #2 - Father's English Name
Living
Deceased
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?
Please Select One
None
One child
Two children
Three children
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
Attended
Will Attend
Currently 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
Attended
Will Attend
Currently 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
Attended
Will Attend
Currently 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
Sat, August 23 2025 29 Av 5785