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ONLINE Member Application FORM

Island Synagogue
8685 SE 47th Street, Mercer Island, WA 98040-4314
(206) 275-1539
membership@islandsynagogue.org

Membership Application

Please print in English - Transliterate Hebrew

Complete one application per household.  
If there is a spouse, please provide their information as the second applicant.

Please print in English - Transliterate Hebrew

Please print in English - Transliterate Hebrew

Please print in English - Transliterate Hebrew

Please print in English - Transliterate Hebrew

Please print in English - Transliterate Hebrew

Please print in English - Transliterate Hebrew

Please print in English - Transliterate Hebrew

Please print in English - Transliterate Hebrew

Please provide details of these additional members, starting each person on a separate line. Include their English and Hebrew names, their English date of birth and their relationship to you.

Please print in English - Transliterate Hebrew

Please start each yahrzeit on a separate line and provide the following: 

Full English name of deceased, full Hebrew name of deceased, including their father's Hebrew first name, (their mother's Hebrew first name if for Meldados), English date of passing (mm/dd/yyyy), Hebrew date of passing (dd/mm/yyyy), English name of person observing the yahrzeit, relationship to the observer.

Please print in English - Transliterate Hebrew

All full memberships are assessed an additional $110 security fee.

During the second year of your membership you will be invited to contribute to our building fund.

Enter the amount of Annual Dues that you are able to pay.

All Associate memberships are assessed an additional $25 security fee.

During the second year of your membership you will be invited to contribute to our building fund.

Enter the amount of Annual Dues that you are able to pay

Please do not submit any payments for membership until your application has been approved and you have been notified.

In accordance with Island Synagogue's by-laws, all applicants must be approved by Rabbi Yechezkel Kornfeld and the Board of Directors.

I hereby am requesting membership in Island Synagogue and as a member will notify the Board of Directors should any of the above information or conditions of membership change.

I hereby am requesting membership in Island Synagogue and as a member will notify the Board of Directors should any of the above information or conditions of membership change.

 

Tue, July 25 2017 2 Av 5777