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Application

Adult #1 - Name(Required)

Adult #1 - Hebrew Name(Required)

Adult #1 - Address

Street Address Address Line 2 City State ZIP Code

Adult #1 - Cell Phone(Required)

Adult #1 - Home Phone

Adult #1 - Email(Required)

Adult #1 - Occupation

Adult #1 - Date of Birth

(to celebrate life cycle events)

Adult #2 - Name

Adult #2 - Hebrew Name

Adult #2 - Address

(if different from Adult #1)

Street Address Address Line 2 City State ZIP Code

Adult #2 - Cell Phone

Adult #2 - Home Phone

Adult #2 - Email

Adult #2 - Occupation

Adult #2 - Date of Birth

(to celebrate life cycle events)

Anniversary Date, if applicable

(to celebrate life cycle events)

Child(ren)

Name

Date of Birth

Hebrew Name

Grade

School

Are you new to the area?(Required)

Yes

No

If so, where do you live?

What programs are you interested in at Melville Jewish Center? Check all that apply.

Early Childhood

Religious School

Youth Group

Torah Study

Ritual

Davening

Men's Club

Sisterhood

Adult Education

Social Action

Social Activities

The Village (55+)

Email Notifications

We regularly send out e-notices to the congregation. Do you both want to receive them, or just one of you?

Adult #1 only

Adult #2 only

Both

Chat Discussion Group

We have a chat discussion group. Do both of you want to be a part of it, just one, or neither of you?

Adult #1 only

Adult #2 only

Both

Neither

Finances should never be a barrier to membership. If you are interested in membership but need financial assistance, please be in touch with our office at (631) 421-3224. Any such conversations will be held in the strictest confidence.

Yahrzeit Information

Yahrzeit List

We invite you to share information about loves ones for whom you would like to receive Yahrzeit notifications.

Full Name of Deceased

Hebrew Name

Relationship and to which member

Date of Death

Time of Death (before or after sunset)

Help Us Grow!

Additional Names

We would appreciate it if you would please provide names of friends, neighbors or relatives who might be interested in learning more about the Melville Jewish Center, or would like to receive our email updates of events. Also, do you know families with children? Help us grow our Early Childhood and Religious School programs.

Name

Email

Phone

Acknowledgements

I/we hereby apply for membership in the Melville Jewish Center and agree to abide by the by-laws, rules and regulations of the congregation.

Adult #1 - Signature(Required)

Adult #2 - Signature

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2600 New York Avenue, Melville, NY 11747|631-421-3224|office@melvillejc.org

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