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SEPHARDIC TEMPLE TIFERETH ISRAEL
Membership Application
10500 Wilshire Blvd.
Los Angeles, CA 90024
(310) 475-7000 | FAX (310) 470-9238
PRIMARY MEMBER INFORMATION
*
Title
*
First Name
Middle Name
*
Last Name
Hebrew Name
*
Were you born Jewish?
Please Select One
Yes
No
*
Was your Mother born Jewish?
Please Select One
Yes
No
*
Date of Birth
Mobile Phone
*
Email
Occupation
Firm Name
Business Address
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
Business Phone
Business Fax
Type of Business
Job Title
We encourage all members of the congregation to take an active part in Temple Life. We would very much like you to choose one or more areas in which you might have an interest.
Family/Adult Programs
Parent Association
Membership
Sisterhood
Purim Carnival
Ad Book/Bulletin
*
What is your Marital Status?
Please Select One
Single
Married
Divorced
Widowed
*
Anniversary Date
*
Do you have a second member to add?
Please Select One
Yes
No
SECONDARY MEMBER INFORMATION
*
Title
*
First Name
Middle Name
*
Last Name
Hebrew Name
*
Were you born Jewish?
Please Select One
Yes
No
*
Was your Mother born Jewish?
Please Select One
Yes
No
*
Date of Birth
Mobile Phone
Email
Occupation
Firm Name
Business Address
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
Business Phone
Business Fax
Type of Business
Job Title
We encourage all members of the congregation to take an active part in Temple Life. We would very much like you to choose one or more areas in which you might have an interest.
Family/Adult Programs
Parent Association
Membership
Sisterhood
Purim Carnival
Ad Book/Bulletin
CONTACT INFORMATION
*
Address
*
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
Home Phone
Fax Number
*
All mail will be sent to residence unless otherwise specified.
Please Select One
Yes, send to the home
No, send elsewhere
*
How would you like it sent?
PREVIOUS AFFILIATION INFORMATION
*
Previous Membership or Affiliation in Jewish Organization of Synagogue: (If Any)
*
Were you connected with any Rabbi prior to this current application?
*
Have you been active in Temple Life?
Please Select One
Yes
No
*
In what capacity have you been active?
RELATIVES WHO ARE MEMBERS OF SEPHARDIC TEMPLE TIFERETH ISRAEL
Name
Relationship
Name
Relationship
CHILDREN (Up to 15 Years Old)
*
Do you have Children 15 and Under?
Please Select One
Yes
No
*
How many Children?
Please Select One
1
2
3
4
*
Child 1 - First Name
Child 1 - Middle Name
*
Child 1 - Last Name
Child 1 - Hebrew Name
*
Child 1 - Sex
*
Child 1 - Date of Birth
Email
Cell Number
*
School Enrollment (If Any)
Please Select One
Yes
No
*
What Grade?
*
Child 2 - First Name
Child 2 - Middle Name
*
Child 2 - Last Name
Child 2 - Hebrew Name
*
Child 2 - Sex
*
Child 2 - Date of Birth
Email
Cell Number
*
School Enrollment (If Any)
Please Select One
Yes
No
*
What Grade?
Child 3 - First Name
Child 3 - Middle Name
Child 3 - Last Name
Child 3 - Hebrew Name
Child 3 - Sex
Child 3 - Date of Birth
Email
Cell Number
School Enrollment (If Any)
Please Select One
Yes
No
What Grade?
Child 4 - First Name
Child 4 - Middle Name
Child 4 - Last Name
Child 4 - Hebrew Name
Child 4 - Sex
Child 4 - Date of Birth
Email
Cell Number
School Enrollment (If Any)
Please Select One
Yes
No
What Grade?
ADULT CHILDREN (16 Years and Older)
Do you have Adult Children 16 and Older?
Please Select One
Yes
No
How many Children?
Please Select One
1
2
3
4
Adult Child 1 - Name
Adult Child 1 - Birth Date
Email
Cell Number
*
Live at the home address?
Please Select One
Yes
No
Adult Child 1 - Address
Married?
Please Select One
Yes
No
Adult Child 1 - Spouse Name
Adult Child 1 - Spouse Birth Date
Adult Child 2 - Name
Adult Child 2 - Birth Date
Email
Cell Number
*
Live at the home address?
Please Select One
Yes
No
Adult Child 2 - Address
Married?
Please Select One
Yes
No
Adult Child 2 - Spouse Name
Adult Child 2 - Spouse Birth Date
Adult Child 3 - Name
Adult Child 3 - Birth Date
Email
Cell Number
*
Live at the home address?
Please Select One
Yes
No
Adult Child 3 - Address
Married?
Please Select One
Yes
No
Adult Child 3 - Spouse Name
Adult Child 3 - Spouse Birth Date
Adult Child 4 - Name
Adult Child 4 - Birth Date
Email
Cell Number
*
Live at the home address?
Please Select One
Yes
No
Adult Child 4 - Address
Married?
Please Select One
Yes
No
Adult Child 4 - Spouse Name
Adult Child 4 - Spouse Birth Date
LIST OF DEPARTED FOR ANIOS (YAHRZEIT) NOTIFICATION
Do you have Yahrzeits you would like to add?
Please Select One
Yes
No
How many would you like to add?
Please Select One
1
2
3
4
Name of Deceased
Hebrew Name of Deceased
Date of Death
Relationship
Which member?
Name of Deceased
Hebrew Name of Deceased
Date of Death
Relationship
Which member?
Name of Deceased
Hebrew Name of Deceased
Date of Death
Relationship
Which member?
Name of Deceased
Hebrew Name of Deceased
Date of Death
Relationship
Which member?
MEMBERSHIP
*** MEMBERSHIP WILL REMAIN IN EFFECT UNLESS NOTIFIED IN WRITING ***
Please note that dues are billed AUTOMATICALLY on a yearly basis
For Membership Year
2023
to
2024
Sephardic Temple Tifereth Israel membership is based on a Fiscal year from July 1st through June 30. Any person joining the Temple between January 1st and June 30th will pay the FULL MEMBERSHIP DUES AND THE BUILDING FUND for the calendar year that they join the Temple. On the 1st of July of the following year, the member(s) will be billed for ½ OF THEIR MEMBERSHIP DUES and THE FULL BUILDING FUND for the New Year. Therefore, after the first 1½ year of Membership Dues, the member(s) will have paid 1½ years of membership and 2 years of the Building Fund. (The Temple does not prorate the Building Fund.)
*
Select your Married Membership Age Level
Please Select One
18-20 years old
21-25 years old
26-33 years old
34-39 years old
40-69 years old
70 years old & over
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
BUILDING FEE APPLICABLE
BUILDING FEE APPLICABLE
*
Select your Single Membership Age Level
Please Select One
16-20 years old
21-25 years old
26-33 years old
34-39 years old
40-69 years old
70 years old & over
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
BUILDING FEE APPLICABLE
BUILDING FEE APPLICABLE
*
Would you like to add single membership for dependent adult child/children?
Please Select One
No
Yes, 1
Yes, 2
Yes, 3
Yes, 4
*
Single Membership Age Level - Adult Child 1
Please Select One
16-20 years old
21-25 years old
26-33 years old
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
Single Membership Age Level - Adult Child 2
Please Select One
16-20 years old
21-25 years old
26-33 years old
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
Single Membership Age Level - Adult Child 3
Please Select One
16-20 years old
21-25 years old
26-33 years old
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
Single Membership Age Level - Adult Child 4
Please Select One
16-20 years old
21-25 years old
26-33 years old
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
*
SECURITY FEE APPLICABLE
SECURITY FEE APPLICABLE
MEMBER AGREEMENT
I hereby subscribe to the purposes of Sephardic Temple Tifereth Israel as stated in the Temple’s By-Laws, namely, to worship God in accordance with the Jewish Faith, to promote the cultural and spiritual welfare of its members as Jews and as members of the general community, and to advance the Jewish tradition. I agree to abide by the Constitution, By-laws, Rules and Regulations of this Organization.
Signature of Applicant
Signature of Applicant
Date
Mon, January 27 2025 27 Tevet 5785
