Young Israel of East Brunswick Membership Application 
FORM A 
General information on form A will be shared, as necessary,...
Job Information: 
Applicant 1 Applicant 2/Spouse 
Occupation: 
Address: 
Phone: 
Shul Activity: Please identify with H (hu...
Young Israel of East Brunswick Membership Application 
FORM B 
This form will be reviewed by the Rabbi only. 
All informat...
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YIEB membership forms a and b new as of 2014

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YIEB membership forms a and b new as of 2014

  1. 1. Young Israel of East Brunswick Membership Application FORM A General information on form A will be shared, as necessary, only with those related to managing shul records. Form B is strictly for the Rabbi. Both forms must be completed. See Form B for more information. Membership Categories: Family ($1,250.00) Senior ($650.00) Individual ($650.00) Associate Member ($250.00) Current Synagogue Membership Building fund assessment is $600 annually for the first 6 years of membership ($3,600 total). Applicant 1: Last name: First name: Hebrew name: Father’s Hebrew name: Mother’s Hebrew name: Bar Mitzvah Parsha: Date of Birth Applicant 2/ Spouse: Last name: First name: Hebrew name: Father’s Hebrew name: Mother’s Hebrew name: Anniversary Date: Date of Birth Home Address: Home Phone: Cell Phone: Applicant 1: Applicant 2: Email: Applicant 1: Applicant 2: Children: Kohen Levi Yisrael English name Hebrew name M/F Date of birth School and Grade 1. 2. 3. 4. 5.
  2. 2. Job Information: Applicant 1 Applicant 2/Spouse Occupation: Address: Phone: Shul Activity: Please identify with H (husband) or W (wife) any of the following activities of interest: Layning Religious Affairs Publicity Youth Haftorah Adult Education House Affairs Mikvah Davening Fundraising Sisterhood Recruiting Catering How did you hear about the Young Israel of East Brunswick? ____________________________________________ If you are experiencing financial hardships, please contact on a confidential basis our Special Circumstances Chair, Judy Silber, at 732-390-6596. If you have any questions regarding this application, please call the Shul office at (732) 254-1860 or email membership@yieb.org. Please return your completed application to: Young Israel of East Brunswick 193 Dunhams Corner Road East Brunswick, NJ 08816 Attn: Bertin Lefkovic, Office Manager or e-mail to officemanager@yieb.org. ____________________________ _____________________________ __________________ Signature (Applicant 1) Signature (Applicant2/Spouse) Date (03-2014) Young Israel of East Brunswick
  3. 3. Young Israel of East Brunswick Membership Application FORM B This form will be reviewed by the Rabbi only. All information submitted on this form will be kept strictly confidential. Applicant 1: Last name: First name: Date of birth: Applicant 2: Last name: First name: Date of birth Marital Status: Single Divorced Widowed Married Date of Marriage If divorced, please submit a copy of the get along with this form. Any conversions within the family? No Yes If yes: Self Spouse Child(ren) Parent Grandparent If yes, please submit a copy of the conversion certificate along with this form. Current/Prior Synagogue Affiliation: Name: Address: Membership Status: Please return this completed form to: Young Israel of East Brunswick 193 Dunhams Corner Road East Brunswick, NJ 08816 Attn: Rabbi Jay Weinstein You may submit this form separately or along with Form A. The YIEB Office Manager will forward this form only to the Rabbi if submitted together. Membership will not be considered unless both forms are completed. If you have any questions regarding this application, please call the shul office at (732) 254-1860 or email rabbiweinstein@yieb.org. ____________________________ _____________________________ ________________ Signature (Applicant 1) Signature (Applicant2/Spouse) Date (03-2014) Young Israel of East Brunswick

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