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Temple Israel Portsmouth Membership Application
Please verify reCaptcha before submitting the form.
Thank you for your interest in Temple Israel Portsmouth!
Please fill out the Membership Application below. Visit our website for more information about
Membership benefits
or
School and Membership Fees
. If you have any questions please email the
Temple Office
or our
Membership Committee
. We look forward to having you as an active member of Temple Israel!
Applicant Information
I am applying as for the following membership category:
Please select membership category:
Young Adult (Age 21-29, single or married, no children)
Single (Age 30 and over, no spouse, no children)
Single with child(ren) (Parents who are single, or who have a non-Jewish spouse who is not a member)
Couple (Two adults with no children under age 21)
Family (Two adults with children under age 21)
Lack of ability to pay the full dues should never be a barrier to becoming a Temple Israel member. To request a dues reduction, please check the appropriate box on the bottom of this Membership Application. Confidentiality will be honored.
Contact Information
*
First Name
*
Last Name
Birthday
Phone Number
Cell Phone
Email Address
Home Address Line 1
Home Address Line 2
*
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 Code
Occupation (Current or Former)
Contact Info: Spouse / Partner
First Name
Last Name
Birthday
Phone Number
Cell Phone
Email Address
Address Line 1
Address Line 2
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 Code
Occupation (current or former)
For Children Under 21
Name
Birthday
School Grade / College
Name
Birthday
School Grade / College
Name
Birthday
School Grade / College
I would like to receive information about:
Preschool
Religious School
To help you connect with other members, may we publish your family members’ names, children’s ages, town you live in and town you are from in our temple newsletter?
Yes
No
Town(s) you are from:
Please select if any of these apply to you:
I am interested in joining Sisterhood. I understand annual dues are $25.00.
I am interested in joining Brotherhood. I understand annual dues are $25.00.
I would like to receive the Doorpost newsletter by mail (in addition to email) for an annual $25.00 fee.
I would like to be contacted confidentially to discuss a dues and/or tuition reduction.
I would like to be contacted confidentially to discuss a dues and/or tuition reduction.
Please do not let a lack of ability to pay the full dues or tuition be a barrier to becoming a Temple Israel member or sending your children to our school. We offer dues and tuition reductions based on need.
Additional notes or questions:
Wed, May 31 2023 11 Sivan 5783