New Member Application

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Congregation Shirat Hayam
New Member Application

FAMILY INFORMATION

* Home Address

* City

* State

* Zip Code

Home Phone

if applicable

Snowbirds check here

If you are a Snowbird, please enter your secondary address below:

* Emergency Contact Name

* Emergency Contact Relationship

* Emergency Contact Mobile Phone

ADULT 1 INFORMATION

Adult - Title

* Adult - First Name

Adult - Middle Name

* Adult - Last Name

Adult - Informal Name/Nickname

Adult - Birthdate

* Adult - Email Address

* Adult - Mobile Phone

Adult - Religious Identity

Adult - Preferred Pronoun

Adult - Hebrew Name (if applicable)

Adult - Father’s Hebrew Name

Adult - Mother’s Hebrew name

Adult - Tribe

Adult - Occupation

(list previous one if retired)

Adult - Current Employer

Adult - Work Phone

ADDITIONAL ADULT MEMBER

* Is there a second Adult applying for Membership?

ADULT 2 INFORMATION

Adult - Title

* Adult - First Name

Adult - Middle Name

* Adult - Last Name

Adult - Informal Name/Nickname

Adult - Birthdate

* Adult - Email Address

* Adult - Mobile Phone

Adult - Religious Identity

Adult - Preferred Pronoun

Adult - Hebrew Name (if applicable)

Adult - Father’s Hebrew Name

Adult - Mother’s Hebrew name

Adult - Tribe

Adult - Occupation

(list previous one if retired)

Adult - Current Employer

Adult - Work Phone

Wedding anniversary (if applicable)

CHILDREN (under 26 or on Social Security Disability Insurance)

How many children under 26 or on SSDI live in your household?

* First Name

Nickname

* Last Name

* Birthdate

Gender

Preferred Pronouns

Religious Identity

This child will be joining the CJE program

YAHRZEIT

Notices are mailed on the anniversary and names will be read according to the Hebrew date of passing.

How many yahrzeits are observed in your household annually?

* Loved one’s name

* English Date of Passing

Hebrew date, if known

Before/After Sunset

* Observer Name

* Deceased relationship to observer:

Will send more information at a later date.

CEMETERY INFORMATION

Check here if you would like information about cemetery plots in the Shirat Hayam Cemetery on Lowell St., Peabody.

YOUR T'RUMOT HALEV COMMITMENT
Our voluntary dues membership model, called T’rumot HaLev (“Gift of the Heart”), reflects our core beliefs and commitment. The prophet Isaiah commands us to “clear a path and remove all obstacles from the road of my people” and that is what we have done. We know that every family, every individual member has unique needs and resources. Our membership requirements are structured to recognize these differences and include everyone. T’rumot HaLev allows our members to reflect on and quantify the value that Shirat Hayam brings to them, and to let their hearts set their financial contribution to their congregation.

Our giving levels are as follows:
$360       Welcome to Shirat Hayam!
$1800    Thank you!
$3000    Sustaining the community.
$5000    Ensuring our future and helping others.

Membership at Shirat Hayam includes the following:

High Holy Day seats for member adult/s and children under 26 or on Social Security DI
Clergy officiation at bris/baby naming, wedding, and funeral services
CJE enrollment and teen programming
Clergy counseling and well/sick visits
See Member Benefits Sheet for more details.

* Please select your giving level:

My household is pleased to offer a Gifts of the Heart pledge in the amount of:

Total T'rumot HaLev Commitment

After clicking SUBMIT, you will be asked to set up a password. This will be your password to this site going forward. Please do not skip this step.

Sat, July 27 2024 21 Tammuz 5784