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Membership Application FY22
Please verify reCaptcha before submitting the form.
2021-2022 Membership Application Form
*
What type of household?
Please Select One
Single Adult Household
Two Adult Household
*
New or Returning Member?
Please Select One
New Member
Returning Member
*
New or Returning Member?
Please Select One
New Member
Returning Member
*
Do you have any children?
Please Select One
No
Yes
*
Do you have any children?
Please Select One
No
Yes
How many?
Please Select One
1
2
3
4
5
How many?
Please Select One
1
2
3
4
5
Adult 1: Personal Information
*
Title
Please Select One
Mr.
Mrs.
Ms.
Dr.
Rabbi
*
First Name
Middle Name
*
Last Name
*
Home 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
Mailing Address (if different)
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
*
Date of Birth
*
Cell Phone Number
Home Phone Number
Work Phone Number
*
Email Address
Employer/Occupation
*
Jewish Status
Please Select One
Born Jewish
Jew by Choice
Not Jewish
Hebrew Name & Names of Parents
Tribe
Please Select One
Kohen
Levi
Yisroel
Bar/Bat Mitzvah Parsha
*
Marital Status
Please Select One
Single
Married
Divorced
Widowed
Anniversary Date
Conversion Date
Place
Rabbi and Affiliation
Adult 2: Personal Information
*
Title
Please Select One
Mr.
Mrs.
Ms.
Dr.
Rabbi
First Name
Middle Name
Last Name
Date of Birth
Cell Phone Number
Cell Phone Number
Work Phone Number
Email Address
Employer/Occupation
Jewish Status
Please Select One
Born Jewish
Jew by Choice
Not Jewish
Hebrew Name & Names of Parents
Tribe
Please Select One
Kohen
Levi
Yisroel
Bar/Bat Mitzvah Parsha
Conversion Date
Place
Rabbi and Affiliation
Synagogue Affiliation
Adult 1 - Former
Adult 1 - Concurrent
Adult 2 - Former
Adult 2 - Concurrent
Children
Child 1
Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Parsha
Bar/Bat Mitzvah Date
Email Address
Jewish Status
Please Select One
Born-Jewish
Jew by Choice
Not Jewish
Conversion Date
Place
Rabbi and Affiliation
Relationship to Adult 1
Child
Step-child
Other
Relationship to Adult 2
Child
Step-child
Other
Child 2
Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Parsha
Bar/Bat Mitzvah Date
Email Address
Jewish Status
Please Select One
Born Jewish
Jew by Choice
Not Jewish
Conversion Date
Place
Rabbi and Affiliation
Relationship to Adult 1
Child
Step-child
Other
Relationship to Adult 2
Child
Step-child
Other
Child 3
Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Parsha
Bar/Bat Mitzvah Date
Email Address
Jewish Status
Please Select One
Born Jewish
Jew by Choice
Not Jewish
Conversion Date
Place
Rabbi and Affiliation
Relationship to Adult 1
Child
Step-child
Other
Relationship to Adult 2
Child
Step-child
Other
Child 4
Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Parsha
Bar/Bat Mitzvah Date
Email Address
Jewish Status
Please Select One
Born Jewish
Jew by Choice
Not Jewish
Conversion Date
Place
Rabbi and Affiliation
Relationship to Adult 1
Child
Step-child
Other
Relationship to Adult 2
Child
Step-child
Other
Child 5
Name
Hebrew Name
Date of Birth
Bar/Bat Mitzvah Parsha
Bar/Bat Mitzvah Date
Email Address
Jewish Status
Please Select One
Born Jewish
Jew by Choice
Not Jewish
Conversion Date
Place
Rabbi and Affiliation
Relationship to Adult 1
Child
Step-child
Other
Relationship to Adult 2
Child
Step-child
Other
About Tifereth Israel
*
How did you learn about TI?
Please Select One
TI's Website
Word of Mouth
A TI Member
A Jewish Publication
Social Media
Other
Please Describe
TI Member's Name?
What do you like about TI?
Membership Type & Dues
Membership Category
Single Adult Household
Two Adult Household
New member
Regular
New member
Regular
Age 30 and Over
$788
$1,575
$1,575
$3,150
Under Age 30
1, 5
$90
$90
$180
$180
Over 79
1
$591
$1,182
$1,182
$2,363
Out-of-Town
2
$150
$300
$150
$300
Split Membership
3
$591
$1,182
$1,182
$2,363
Newlyweds
4
N/A
Complimentary
The following options are required fees.
*
Select Membership Type - New Member, Single Adult
Please Select One
Age 30+
Under Age 30
Over 79
Out-of-Town
Split Membership
*
Select Membership Type - New Member, Two Adults
Please Select One
Age 30+
Under Age 30
Over 79
Out-of-Town
Split Membership
Newlyweds
*
Select Membership Type - Returning Member, Single Adult
Please Select One
Age 30+
Under Age 30
Over 79
Out-of-Town
Split Membership
*
Select Membership Type - Returning Member, Two Adults
Please Select One
Age 30+
Under Age 30
Over 79
Out-of-Town
Split Membership
Newlyweds
*
George Greenberg Building Preservation Fund*
George Greenberg Building Preservation Fund*
*These fees are not charged to Out of Town members, Newlyweds or members under 30.
*
George Greenberg Building Preservation Fund
George Greenberg Building Preservation Fund
*These fees are not charged to Out of Town members, Newlyweds or members under 30.
*
Annual Security Fee
Annual Security Fee
*These fees are not charged to Out of Town members, Newlyweds or members under 30.
*
Annual Security Fee
Annual Security Fee
*These fees are not charged to Out of Town members, Newlyweds or members under 30.
Dues amount:
Tue, April 23 2024 15 Nisan 5784
