New Member Registration - Form - Temple Emek Shalom

Welcome to Temple Emek Shalom. We are excited that you are joining a vibrant and caring Jewish community. Please note that when you submit this form, your information will be added into our database, but you will not be a full member until you submit a Pledge Form and make your first Dues Payment. Please call or email the TES Office with any questions: 541-488-2909 or office@emekshalom.org.

Adult Member 1

Title

* First Name

* Last Name

* Phone Number

* Email

Gender

* Birth Date

Announce in monthly newsletter?

As a new member, we would like to introduce you and include your Member Directory information in the monthly newsletter that only goes to members.

Additional Information?

Where are you from? How did you hear about TES?

Is there another adult in your household?

Adult Member 2

Title

First Name

Last Name

Phone Number

Gender

Birth Date

Announce in monthly newsletter?

As a new member, we would like to introduce you and include your Member Directory information in the monthly newsletter that only goes to members.

Additional Information?

Where are you from? How did you hear about TES?

Anniversary Date

* Address

* City

* State

* ZIP code

Children Information

Do you have any children living at home?

How many children are living at home?

Child 1

First Name

Last Name

Birth Date

Pronouns

May we publish your child's....

First nameYear of BirthDo Not IncludeSee disclaimer below.

Announce in monthly newsletter?

May we publish the Member Directory information in the monthly newsletter?

Email Address (if you allow us to contact your child)

Phone Number (if you allow us to contact your child)

Child 2

First Name

Last Name

Birth Date

Pronouns

May we publish your child's....

First nameYear of BirthDo Not IncludeSee disclaimer below.

Announce in monthly newsletter?

May we publish the Member Directory information in the monthly newsletter?

Email Address (if you allow us to contact your child)

Phone Number (if you allow us to contact your child)

Child 3

First Name

Last Name

Birth Date

Pronouns

May we publish your child's...

First nameYear of BirthDo Not IncludeSee disclaimer below.

Announce in monthly newsletter?

May we publish the Member Directory information in the monthly newsletter?

Email Address (if you allow us to contact your child)

Phone Number (if you allow us to contact your child)

Child 4

First Name

Last Name

Birth Date

Pronouns

May we publish your child's....

First nameYear of BirthDo Not IncludeSee disclaimer below.

Announce in monthly newsletter?

May we publish the Member Directory information in the monthly newsletter?

Email Address (if you allow us to contact your child)

Phone Number (if you allow us to contact your child)

MEMBERSHIP DIRECTORY DISCLOSURE: The membership Directory is published every July. It is distributed to Members only. The front of the directory states:

"This Membership Directory is provided for
members of Temple Emek Shalom only.
Please do not give out information to non-members without permission."

I would like the following information included in the Membership Directory.

YAHRZEIT- Remembering the anniversary of a death.

Please list any family or friends you want to acknowledge.
Do you have anyone you would like to remember?

This information will be used to honor loved ones in our newsletters. This information will not be available for any other reason.

How many people would you like to list?

Name

Relationship

Date of Death