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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: _________________________________________________________________________

 

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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

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