Hebrew Tabernacle Membership Form

To join us, please fill in this form and return  to:
HEBREW TABERNACLE CONGREGATION
551 Fort Washington Avenue New York, NY 10033
office@hebrewtabernacle.org / (212) 568-8304
Adult 1:								Adult 2:
Mr./Ms./Mrs./Dr.								Mr./Ms./Mrs./Dr.
		Name     (First, Middle, Last)								Name     (First, Middle, Last)
Hebrew Name								Hebrew Name
Date of Birth								Date of Birth
Address (please include apartment #)								Address (please include apartment #)
City, State, ZIP code								City, State, ZIP code
Home Phone					Cell Phone			Home Phone		Cell Phone
Work +/or Other Phone								Work +/or Other Phone
E-mail Address								E-mail Address
preferred method of contact								preferred method of contact
We are interested in the following type(s) of programming (please check all that apply):
		Worship services		Family Programs		Holiday Celebrations
		Social Action		Children's Programs		Interfaith Events
		Hebrew School		Social Programs		Exercise Classes
		Adult Education		Art, Music & Culture		Other (please specify)
		Torah Study		Israel		Other (please specify)
Child 1:							Child 2:
		Name (First, Middle, Last)						Name (First, Middle, Last)
		Hebrew Name						Hebrew Name
		Date of Birth						Date of Birth
Child 3:							Child 4:
		Name (First, Middle, Last)						Name (First, Middle, Last)
		Hebrew Name						Hebrew Name
		Date of Birth						Date of Birth
Date