Membership Application 2019/2020 – Congregation Micah of NJ

Membership (chose individual unless you are listing your spouse or kids) *

Household
Individual

Primary Member Name *

First

Last

Email *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Phone *

Preferred Phone Type *

Cell Phone - you may text me
Cell Phone - please don't text me
Business Phone
Land Line

Book of Remembrance Changes *

There is NO CHARGE for BofR entries. A link to last year's BofR is on our website. Please indicate any BofR changes above (or say no change).

Secondary Address

Address Line 1

Address Line 2

City

State

Zip Code

Secondary Address Dates (dates you're there) or type (business)

Secondary Phone

Secondary Phone type

Cell Phone - you may text me
Cell Phone - please don't text me
Business Phone
Land Line

Do you have additional people in your household (please fill out information on them on the last page) *

I certify that I and the members of my household wish to be members of Congregation Micah of NJ.

Date Signed and Exception

Just type in name of person who filled out form & Note other membership exception if you want to

CONGREGATION PARTICIPATION

Committees

I am willing to serve on the following committees:

Services (High Holy Day Planning)
Membership
Fundraising (Charitable Giving)

Dues

We encourage members of Congregation Micah to donate whatever you have been contributing to any former congregation, or as much as you are comfortable with, although there is a suggested minimum of $500.* Dues will support the operation of the congregation (administrative costs, insurance, supplies), Cantor Janine Schwartz, and High Holy Services including technical broadcast help and rental of the audio studio and meeting space. Rabbi Bemporad receives no remuneration for his services. Suggested fees for specific lifecycle events are paid to the officiant and are not part of the operation of the Congregation. *Those wishing to join Congregation Micah who find themselves in financial need will not be turned away.

Household Members

2-Name (change household to individual if you're finished) *

First

Last

2-Relationship: *

Spouse
Minor Child
Adult Child
Parent
Dependant

2-Birthday

2-Anniversary

2-Email

2-Phone

2-Phone Type

Cell Phone - you may text
Cell Phone - please don't text
Business Phone
Land Line

2-More Members?

Yes
No, Finished

3-Name (change previous more members if you're finished) *

First

Last

3-Relationship:

Minor Child
Adult Child
Parent
Dependant

3-Birthday

3-Email

3-Phone

3-Phone Type *

Cell Phone - you may text
Cell Phone - please don't text
Business Phone
Land Line

3-More Members?

Yes
No, Finished

4-Name (change previous more members if you're finished)

First

Last

4-Relationship: *

Minor Child
Adult Child
Parent
Dependant

4-Birthday

4-Email

4-Phone

4-Phone Type *

Cell Phone - you may text
Cell Phone - please don't text
Business Phone
Land Line

4-More Members?

Yes
No, Finished

Additional Household Members

Please tell us their names, Birthdays, relationship, and, if they are not minors or dependants, their contact info. Thks.