New Member Form

* Adult 1 - Title

* Adult 1 - First Name

* Adult 1 - Middle Name

* Adult 1 - Last Name

Adult 1 - Former Name

Adult 1 - Hebrew Name

Adult 1 - Gender

* Adult 1 - Address

* Adult 1 - City

* Adult 1 - State

* Adult 1 - Zip

Adult 1 - Home Phone

Adult 1 - Unlisted?

* Adult 1 - Cell Phone

* Adult 1 - Email

* Adult 1 - Birthdate

* Adult 1 - Marital Status

Adult 1 - Anniversary Date

if applicable

Adult 1 - How long have you lived in Omaha?

* Adult 1 - Religious Status

* Adult 1 - Jewish Background

* Adult 1 - Name of Previous Congregation

* Adult 1 - Location of Previous Congregation

* Adult 1 - Do you presently belong to another religious institution?

* Adult 1 - Name of other Congregation

* Adult 1 - Location of other Congregation

Adult 1 - Please check all that apply to you and fill in date

B'nai MitzvahConfirmationJewish Day SchoolHigh School/College Jewish Studies

Adult 1 - B'nai Mitzvah Date

Adult 1 - Confirmation Date

Adult 1 - Jewish Day School

Date range

Adult 1 - High School/College Jewish Studies

Date range

* Adult 1 - University/College Degree obtained

* Adult 1 - Discipline of Degree

* Adult 1 - Occupation

* Adult 1 - Name of Business

* Adult 1 - Business Phone

* Adult 1 - Business Address

* Adult 1 - Business City

* Adult 1 - Business State

* Adult 1 - Business Zip Code

* Adult 1 - Retired?

* Is there a second Adult applying for membership?

* Adult 2 - Title

* Adult 2 - First Name

* Adult 2 - Middle Name

* Adult 2 - Last Name

* Adult 2 - Maiden Name

Adult 2 - Hebrew Name

Adult 2 - Gender

Does Adult 2 live at the same address as Adult 1?

* Adult 2 - Address

* Adult 2 - City

* Adult 2 - State

* Adult 2 - Zip

Adult 2 - Home Phone

Adult 2 - Unlisted?

* Adult 2 - Cell Phone

* Adult 2 - Email

* Adult 2 - Birthdate

* Adult 2 - Marital Status

Adult 2 - Anniversary Date

if applicable

Adult 2 - How long have you lived in Omaha?

* Adult 2 - Religious Status

* Adult 2 - Jewish Background

* Adult 2 - Name of Previous Congregation

* Adult 2 - Location of Previous Congregation

* Adult 2 - Do you presently belong to another religious institution?

* Adult 2 - Name of other Congregation

* Adult 2 - Location of other Congregation

* Adult 2 - Please check all that apply to you and fill in date

B'nai MitzvahConfirmationJewish Day SchoolHigh School/College Jewish Studies

Adult 2 - B'nai Mitzvah Date

Adult 2 - Confirmation Date

Adult 2 - Jewish Day School

Date range

Adult 2 - High School/College Jewish Studies

Date range

* Adult 2 - University/College Degree obtained

* Adult 2 - Discipline of Degree

* Adult 2 - Occupation

* Adult 2 - Name of Business

* Adult 2 - Business Phone

* Adult 2 - Business Address

* Adult 2 - Business City

* Adult 2 - Business State

* Adult 2 - Business Zip Code

* Adult 2 - Retired?

Please include Adult children.

* How many children do you have?

Child 1 - First Name

Child 1 - Middle Name

Child 1 - Last Name

Child 1 - Gender Pronoun

Child 1 - Email

Child 1 - Date of Birth

Child 1 - Hebrew Name

Child 1 - Bar/Bat Mitzvah Date

Child 1 - Confirmation Year

Child 1 - Living at Home

Child 1 - Religious School Grade

Child 1 - School District

Child 1 - Public School Grade

Child 1 - Year in College

Child 1 - Cell Phone

Projected High School Graduation Year

Child 2 - First Name

Child 2 - Middle Name

Child 2 - Last Name

Child 2 - Gender Pronoun

Child 2 - Email

Child 2 - Date of Birth

Child 2 - Hebrew Name

Child 2 - Bar/Bat Mitzvah Date

Child 2 - Confirmation Year

Child 2 - Living at Home

Child 2 - Religious School Grade

Child 2 - School District

Child 2 - Public School Grade

Child 2 - Year in College

Child 2 - Cell Phone

Projected High School Graduation Year

Child 3 - First Name

Child 3 - Middle Name

Child 3 - Last Name

Child 3 - Gender Pronoun

Child 3 - Email

Child 3 - Date of Birth

Child 3 - Hebrew Name

Child 3 - Bar/Bat Mitzvah Date

Child 3 - Confirmation Year

Child 3 - Living at Home

Child 3 - Religious School Grade

Child 3 - School District

Child 3 - Public School Grade

Child 3 - Year in College

Child 3 - Cell Phone

Projected High School Graduation Year

Child 4 - First Name

Child 4 - Middle Name

Child 4 - Last Name

Child 4 - Gender Pronoun

Child 4 - Email

Child 4 - Date of Birth

Child 4 - Hebrew Name

Child 4 - Bar/Bat Mitzvah Date

Child 4 - Confirmation Year

Child 4 - Living at Home

Child 4 - Religious School Grade

Child 4 - School District

Child 4 - Public School Grade

Child 4 - Year in College

Child 4 - Cell Phone

Projected High School Graduation Year

Please list the names of any relatives who are members of Temple Israel. List Relative and Relationship to (which) member

Yahrzeit names listed for which there is a Temple Israel memorial plaque will automatically be read on the appropriate date; you will receive a postcard a week prior to the date. For names listed above with no memorial plaque, please contact the Temple Israel office each year, 402-556-6536, to have the name read. If you would like to inquire about purchasing a memorial plaque, please contact the office.

How many relatives would you like to add to our Yahrzeit list

Full Name

Relationship to (which) member

English Date of Death

Temple Plaque? Y or N

Full Name

Relationship to (which) member

English Date of Death

Temple Plaque? Y or N

Full Name

Relationship to (which) member

English Date of Death

Temple Plaque? Y or N

Full Name

Relationship to (which) member

English Date of Death

Temple Plaque? Y or N

1. Where are you/your spouse from? How long ago did you move to Omaha (if you haven’t lived here all your life) and what brought you here?

2. What's something especially interesting about you and your spouse or family such as a hobby, past-time, what you like to do in your spare time, something about where you've lived or your career, pets?

Wed, September 17 2025 24 Elul 5785

Temple Israel
13111 Sterling Ridge Drive, Omaha, NE 68144
402-556-6536 | templeisrael@templeisraelomaha.com

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