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Membership Application Page
Membership Application Page
Household Information
*
Family Last Name(s)
This is how mail will be addressed to your household. You can use formats such as: Kohan Family, Kohan Garber Family, or Kohan-Garber Family.
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Address 1
Address Line 2
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City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
Neighborhood/Development
Subdivision
*
Home Phone
If you do not have a home phone number, please enter the primary cell phone number for your family.
*
Marital Status
Please Select One
Single
Engaged
Married
Partnered
Separated
Divorced
Widowed
*
Wedding Anniversary Date
*
Have you (or your partner/spouse) recently been affiliated with any other synagogues?
Please Select One
Yes
No
If you have been a KKBE member before, please select Yes, and write in the years of your previous membership.
*
Name of Synagogue
*
Location of Synagogue
*
Date(s) of previous membership(s)
Were you active in synagogue life?
Yes
No
*
Do you (or your partner/spouse) have friends or relatives who are current KKBE members?
Please Select One
Yes
No
*
Name
*
What is your relationship to this person?
Name
What is your relationship to this person?
Name
What is your relationship to this person?
Adult 1 Information
*
First Name
*
Last Name
*
Nickname
How would you like to be addressed?
*
Email
*
Cell Phone
*
Date of Birth
Gender
N/A or Unknown
Male
Female
Pronouns
*
Occupation (now or before retirement)
*
Business Name or Employer
Are you retired or planning on retiring in the next year?
Business Address
Business Phone
Other volunteer organizations and/or affiliations?
Are you a veteran or currently serving in our military?
Air Force
Navy
Coast Guard
Army
Marines
Currently Active Duty
*
Were you raised in the Jewish faith?
Please Select One
Yes
No
In what faith were you raised?
*
Please choose one from the following list
Please Select One
Reform
Conservative
Orthodox
Reconstructionist
Traditional
Cultural
Have you had a Bar/Bat Mitzvah?
Please Select One
Yes
No
Please enter the name of the institution, date, and location of your Bar/Bat Mitzvah
If you know the month/day/year of your Bat/Bar Mitzvah, please enter it here. If you are unsure of the exact date, please leave this blank for now.
*
How do you currently identify? (Reform, Reconstructionist, Traditional, etc.)
If you converted to Judaism, please enter the date, name, and location of your conversion ceremony, and feel free to describe your experience. If you are in the process of converting or may want to convert in the future, please note that as well.
Additional Family Members
*
Is there another adult in your household?
Please Select One
Yes
No
*
Do you have children under the age of 25?
Please Select One
Yes
No
*
Do you have children over the age of 25?
Please Select One
Yes
No
Adult 2 Information
*
First Name
*
Last Name
*
Nickname
How would you you like to be addressed?
*
Email
*
Cell Phone
*
Date of Birth
Gender
N/A or Unknown
Male
Female
Pronouns
*
Occupation (currently or before retirement)
*
Business Name or Employer
Business Address
Business Phone
Are you retired or planning on retiring in the next year?
Other volunteer organizations and/or affiliations?
Are you a veteran or currently serving in our military?
Air Force
Navy
Coast Guard
Army
Marines
Currently Active Duty
*
Were you raised in the Jewish faith?
Please Select One
Yes
No
In what faith were you raised?
*
Please choose one from the following list
Please Select One
Reform
Conservative
Orthodox
Reconstructionist
Traditional
Cultural
Have you had a Bar/Bat Mitzvah?
Please Select One
Yes
No
Please enter the name of the institution, date, and location of your Bar/Bat Mitzvah
If you know the month/day/year of your Bat/Bar Mitzvah, please enter it here. If you are unsure of the exact date, please leave this blank for now.
If you converted to Judaism, please enter the date, name, and location of your conversion ceremony, and feel free to describe your experience. If you are in the process of converting or may want to convert in the future, please note that as well.
Child 1 Information (Under 25)
*
Child 1 First Name
*
Child 1 Last Name
Child 1 Gender
N/A or Unknown
Male
Female
Child 1 Pronouns
*
Child 1 Date of Birth
What is your child's grade as of September 2024?
Please Select One
Younger than Pre-K
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Will your child attend Religious School?
Please Select One
Yes
No
Maybe
*
Has your child had (or will your child have) a Bar/Bat Mitzvah?
Please Select One
Yes
No
Maybe
Child 1 Hebrew Name
*
What school does your child attend?
*
Does your child live at home with you full-time?
Please Select One
Yes
No
*
Do you have a second child under the age of 25?
Please Select One
Yes
No
Child 2 Information (Under 25)
*
Child 2 First Name
*
Child 2 Last Name
Child 2 Gender
N/A or Unknown
Male
Female
Child 2 Pronouns
*
Child 2 Date of Birth
What is your child's grade as of September 2024?
Please Select One
Younger than Pre-K
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Will your child attend Religious School?
Please Select One
Yes
No
Maybe
*
Has your child had (or will your child have) a Bar/Bat Mitzvah?
Please Select One
Yes
No
Maybe
Child 2 Hebrew Name
*
What school does your child attend?
*
Does your child live at home with you full-time?
Please Select One
Yes
No
Do you have a third child under the age of 25?
Please Select One
Yes
No
Child 3 Information (Under 25)
*
Child 3 First Name
*
Child 3 Last Name
Child 3 Gender
N/A or Unknown
Male
Female
Child 3 Pronouns
*
Child 3 Date of Birth
What is your child's grade as of September 2024?
Please Select One
Younger than Pre-K
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Will your child attend Religious School?
Please Select One
Yes
No
Maybe
*
Has your child had (or will your child have) a Bar/Bat Mitzvah?
Please Select One
Yes
No
Maybe
Child 3 Hebrew Name
*
What school does your child attend?
*
Does your child live at home with you full-time?
Please Select One
Yes
No
Do you have a fourth child under the age of 25?
Please Select One
Yes
No
Child 4 Information (Under 25)
*
Child 4 First Name
*
Child 4 Last Name
Child 4 Gender
N/A or Unknown
Male
Female
Child 4 Pronouns
*
Child 4 Date of Birth
What is your child's grade as of September 2024?
Please Select One
Younger than Pre-K
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
*
Will your child attend Religious School?
Please Select One
Yes
No
Maybe
*
Has your child had (or will your child have) a Bar/Bat Mitzvah?
Please Select One
Yes
No
Maybe
Child 4 Hebrew Name
*
What school does your child attend?
*
Does your child live at home with you full-time?
Please Select One
Yes
No
Child 1 Information (Over 25)
Child 1 First Name
Child 1 Last Name
Child 1 Gender
N/A or Unknown
Male
Female
Child 1 Pronouns
My child is:
Please Select One
Single
Engaged
Married
In a domestic partnership
Prefer not to say
Does your child live at home with you full-time?
Please Select One
Yes
No
*
Do you have a second child over the age of 25?
Please Select One
Yes
No
Child 2 Information (Over 25)
Child 2 First Name
Child 2 Last Name
Child 2 Gender
N/A or Unknown
Male
Female
Child 2 Pronouns
My child is:
Please Select One
Single
Engaged
Married
In a domestic partnership
Prefer not to say
Does your child live at home with you full-time?
Please Select One
Yes
No
*
Do you have a third child over the age of 25?
Please Select One
Yes
No
Child 3 Information (Over 25)
Child 3 First Name
Child 3 Last Name
Child 3 Gender
N/A or Unknown
Male
Female
Child 3 Pronouns
My child is:
Please Select One
Single
Engaged
Married
In a domestic partnership
Prefer not to say
Does your child live at home with you full-time?
Please Select One
Yes
No
*
Do you have a fourth child over the age of 25?
Please Select One
Yes
No
Child 4 Information (Over 25)
Child 4 First Name
Child 4 Last Name
Child 4 Gender
N/A or Unknown
Male
Female
Child 4 Pronouns
My child is:
Please Select One
Single
Engaged
Married
In a domestic partnership
Prefer not to say
Does your child live at home with you full-time?
Please Select One
Yes
No
Yahrzeit Information
*
Do you have a loved one whose name you would like to be placed on our Kaddish list (they do not need to have been Jewish)?
Please Select One
Yes
No
Yes but I dont have their information at this time. I will get back to you.
There will be an opportunity to add additional names.
*
Name of Loved One
First and Last Name
*
Relationship to Loved One
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother
Date of Death
If you know the exact date (month/day/year) of your loved one's death, please enter it above.
If you are unsure of the exact date, please leave this blank and email Caitlin at shalom@kkbe.org when you are able to confirm the date for remembrance.
Hebrew Date
*
Would you like Yahrzeit observed according to the Gregorian calendar or Hebrew calendar?
Please Select One
Hebrew
Gregorian
I have no preference (will be observed based on the Gregorian calendar)
Do you have additional loved ones whose names you would like to be placed on our Kaddish list?
Please Select One
Yes
No
*
Name of Loved One
First and Last Name
*
Relationship to Loved One
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother
Date of Death
If you know the exact date (month/day/year) of your loved one's death, please enter it above.
If you are unsure of the exact date, please leave this blank and email
Caitlin at shalom@kkbe.org
when you are able to confirm the date for remembrance.
Hebrew Date
*
Would you like Yahrzeit observed according to the Gregorian calendar or Hebrew calendar?
Please Select One
Hebrew
Gregorian
I have no preference (will be observed based on the Gregorian calendar)
Do you have additional loved ones whose names you would like to be placed on our Kaddish list?
Please Select One
Yes
No
*
Name of Loved One
First and Last Name
*
Relationship to Loved One
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother
Date of Death
If you know the exact date (month/day/year) of your loved one's death, please enter it above.
If you are unsure of the exact date, please leave this blank and
email
Caitlin at shalom@kkbe.org
when you are able to confirm the date for remembrance.
Hebrew Date
*
Would you like Yahrzeit observed according to the Gregorian calendar or Hebrew calendar?
Please Select One
Hebrew
Gregorian
I have no preference (will be observed based on the Gregorian calendar)
Do you have additional loved ones whose names you would like to be placed on our Kaddish list?
Please Select One
Yes
No
*
Name of Loved One
First and Last Name
*
Relationship to Loved One
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother
Date of Death
If you know the exact date (month/day/year) of your loved one's death, please enter it above.
If you are unsure of the exact date, please leave this blank and email
Caitlin at shalom@kkbe.org
when you are able to confirm the date for remembrance.
Hebrew Date
*
Would you like Yahrzeit observed according to the Gregorian calendar or Hebrew calendar?
Please Select One
Hebrew
Gregorian
I have no preference (will be observed based on the Gregorian calendar)
Additional Information
*
Please tell us a little bit about why you are joining KKBE.
*
Which of these events and opportunities are of interest to your family? Please select all that apply.
Lifelong Learning/Adult Education
Sunday Torah Study
Caring Community (ie home visits to housebound members)
Event Volunteer
Interfaith Family Events
Shabbat Services
Shabbat Dinners
Social Justice Volunteering
Communications
Docent for tours at KKBE or Coming Street
Gift Shop Volunteer
Event Volunteer
Sisterhood
Brotherhood
Mahjong
Bridge
Youth Programming
Not sure at this time
Is there anything else you would like to share with us (such as special interests or areas of expertise)?
*
Would you like your information listed in the upcoming printing of the KKBE Blue Book?
Please Select One
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Thu, March 13 2025 13 Adar 5785
