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Membership Form
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Have you or a member of your family been a member of WJC previously?
Please Select One
Yes
No
Who was the member?
When were you/they last members?
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First Name
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Last Name
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Email
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Mobile Phone Number
Secondary Phone or Landline
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Primary Address, Line 1
Primary Address City
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Primary Address 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
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Primary Address Zip
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Date of Birth
Hebrew Name (if known)
B-Mitzvah Date
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Adult One Faith Background. Did you grow up:
Please Select One
Reconstructionist
Reform
Conservative
Orthodox
Unaffiliated
Not Jewish
Have you belonged to a synagogue previously? If so, is there anything you would like us to know about that experience?
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Will there be a second adult?
Please Select One
No
Yes
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First Name (Adult Two)
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Last Name (Adult Two)
Date of Birth (Adult Two)
Mobile Phone, Adult Two
Email, Adult Two
Adult Two Faith Background. Did you grow up:
Reconstructionist
Reform
Conservative
Orthodox
Non Jewish
Wedding Anniversary (If Applicable)
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Do you have children? (even if they are adults)
Please Select One
Yes
No
Child One First and Last Names
Child One Date of Birth
Child One Hebrew Name
Child Two First and Last Names
Child Two Date of Birth
Child Two Hebrew Name
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship
Deceased Loved Ones for Our Yahrzeit Records. Please list names, date of death, and relationship to member.
What three words best describe your ideal congregation?
What services, events, and other programs interest you?
Are there any other skills or services you would be interested in sharing with the Congregation?
Interests and skills I/we would be interested in learning about and/or possibly joining
Shabbat Hosting
Children's Programming
Caring Support
Ritual
Help out in the office
Plan Holidays
Hebrew reading/chanting
Fundraising
Gardening
Choir
Computer/Technology
Music
Marketing/PR
Grant Writing
Finance
Home Repair
Hebrew/Yiddish/Ladino
Art
Other
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Type of Membership
Please Select One
2 Adult Household
1 Adult Household
1 Young Adult (18 - 29)
Adjusted Membership Commitment
A value of the WJC is that finances should not be a barrier to joining the WJC. If you need your membership commitment adjusted please share that below.
Wed, 15 January 2025
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Wed, 15 January 2025
