Calendar Year 2017-18

I /WE _____________________________________________________________________are of the Jewish faith

(Jewish mother or have been converted)
and hereby apply for membership in Congregation B’nai Zion of Key West, Florida, Inc.
I/We agree to abide by its by-laws (revised 2008) and the Articles of Incorporation.
A minimum of six month’s dues ($400.) is enclosed with this application. Annual dues are $800.

Name (s)_______________________________________________________________________


Hebrew Name ____________________________________________________________________


Birthday _________________________________________________________________________


Spouse Name _____________________________________________________________________


Hebrew Name _____________________________________________________________________


Birthday (Spouse/Partner)__________________________ Anniversary _______________________


Member – Kohen__________ Levi__________ Spouse/Partner – Kohen___________ Levi_______


Spouse/Partner Jewish? Yes ______ No_______ I/we came to the Keys from___________________


Keys Address_________________________City____________________ State______ Zip_______


Mailing Address______________________ City____________________ State_____ Zip__________


Home Telephone___________________Business ___________________Cell__________________


Email Address-1 __________________________________________________________________


Email Address-2 __________________________________________________________________


Web Site:________________________________________________________________________


Member’s Occupation_______________________Spouse/Partner Occupation__________________


Paid Amount______________________Check Number _______________ Today’s Date__________


Signature: _________________________________________________________________________


Page 1

Please Print this Application at 98% to Fit





Do you have a Cemetery Plot? _____________


If no, would you like more information to reserve one with CBZ?_____________________________


Emergency Contact1_________________________Tel______________Relationship______________


Emergency Contact2_________________________Tel______________Relationship______________


Children(s) Name-1 ________________Hebrew Name ______________________Birthday__________


Children(s) Name-2 ________________Hebrew Name______________________Birthday__________


Children(s) Name-3 _______________ Hebrew Name_______________________Birthday__________


Please include additional Yahrzeit information on the back of this application.


Name of Deceased ____________________________________ Relationship ____________________


Date of Death____________________________________________________ Am _____ PM ______


Name of Deceased ____________________________________ Relationship ____________________


Date of Death____________________________________________________ Am ______ PM _____

Do You want to receive Yahrzeit notices on Hebrew ______ or English ______ date of death?

Yes, I/We are interested in serving on a Committee/Volunteer activity… (Please check)


____ Kiddush, ____ Fundraising, ____ Finance, ____ Ritual, ____ Building & Grounds,


____ Social & Cultural,___ Chorus____Monthly Newsletter,____ Membership , ____ Cemetery,


____ Gift Shop, ____ Library, ____ Family Learning Center


For information regarding the CBZ Family Learning Center,

Contact: Rabbi Shimon Dudai at 305-294-3414.


The Board of Directors for CBZ is elected by the members in good standing at the Annual Meeting.
Anyone who has been a member in good standing for four or more years may be elected to the Board.

Please return this form and your check payable to Congregation B’nai Zion to the attention of the
Board’s President, Dr. Fred Covan at 750 United Street, Key West, Florida 33040.


Revised:  December 2016

Page 2