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Kol Nidre Campaign 2023 / 5784
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Membership Record 2024
Please verify reCaptcha before submitting the form.
Join Date
Member A
Martial Status
Single
Married
Divorced
Separated
Widowed
Partner
Wedding Anniversary Date
Prefix
Mr.
Mrs.
Ms.
Dr.
Pronouns
Full Name
Nickname
Date of birth
Address
Address 2
City
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Subdivision
Zip Code
Home Phone
Cell Number
Email
Instagram
LinkedIn
Facebook
Occupation
Business Name
Work Phone
Work Email
Years in Atlanta
0
1
2
3
4
5
6
7
8
9
10
Hometown
Prior Synagogue, Location, Date of Membership, and Positions Held
Hebrew Name
Bar/Bat Mitzvah
Yes
No
Bar/Bat Mitzvah Date
Mother's Hebrew Name
Father's Hebrew Name
Tribe
Kohen
Levite
Israelite
Were you born Jewish?
Yes
No
If Converted, date, by whom, and where
Can you read Hebrew
Yes
No
Do you have any relatives at Etz Chaim
Yes
No
If so, please list with relationship
Member B
Prefix
Mr.
Mrs.
Ms.
Dr.
Pronouns
Full Name
Nickname
Date of Birth
Email
Cell Number
Instagram
LinkedIn
Facebook
Occupation
Business Name
Work Phone
Work Email
Years in Atlanta
0
1
2
3
4
5
6
7
8
9
10
Hometown
Prior Synagogue, Location, Date of Membership, and Position Held
Hebrew Name
Bar/Bat Mitzvah
Yes
No
Bar/Bat Mitzvah Date
Mother's Hebrew Name
Father's Hebrew Name
Tribe
Kohen
Levite
Israelite
Were you born Jewish
Yes
No
If Converted, date, by whom, and where
Can you read Hebrew
Yes
NO
Do you have an relatives at Etz Chaim
Yes
No
If so, please list with relationship
How many children
0
1
2
3
4
5
6
Child(ren) Name
Sex
Female
Male
Date of Birth
Adopted
Yes
No
School Grade
Jewish Day School
Yes
No
Hebrew Name
Bar/Bat Mitzvah Date
Yahrzeits Observed
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Full Name of Deceased
Relationship to Deceased
Mourner of Deceased
Member A
Member B
Both
Secular Date of Death (MM/DD/YY) Before or After Sunset
Would you like to be a "featured new member" in our monthly newsletter, the Voice of Chaim? (someone from our membership committee will reach out to you.)
Yes
No
What would like to get from Etz Chaim?
What would you like to give to Etz Chaim?
What areas of interest would like more information on?
Area of Interest
Budget/Financials
Chavurot/Friendship Group
Chesed/Caring Committee
Chevrah Kaddisha/Burial Society
College Connection
Fundraising
Inclusion Committee
Interfaith Family Programs
Lead Services
Library
Areas of Interest
Lilmode/Adult Education
Men's Club
Minyannaires/Ritual Committee
Preschool (Teacher/Volunteer)
Pride Alliance (LGBTQIA)
Religious School (Teacher/Volunteer)
Roots Group (Interest Based Small Groups)
Social Action
Synagogue Office Volunteer
Sisterhood
Areas of Interest
Social Event Programming
The Prime Timers (50s and up)
Torah/Haftarah Readers
Young Adults
Young Family Programming
Youth Commission
We look forward to receiving your information. If you have any questions, please contact us at (770) 973-0137.
Wed, July 2 2025 6 Tammuz 5785
