New Member Questionnaire

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Adult (partner one, P1)

Adult (partner two, P2)

Prefix

First Name

Middle Name

Last Name

Suffix (if applicable)

Nickname

Current Employer

Job Title

Email Address

Home Phone

Address

City/State/Zip

Birth Date

Current Marital Status

Marriage Anniversary Date

Religious tradition in which you were raised

For ritual purposes, I am

Bar/Bat Mitzvah Date

Do you read Hebrew? How well?

How did you hear about Rodeph Sholom?

Synagogue you attended last? City? State?

Do you have relatives or friends at Rodeph Sholom?

If so, name and relationship

Sun, October 26 2025 4 Cheshvan 5786