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Demographic Update Form
Member Information
Required
Name:
*
Required
Address:
*
Required
City:
*
Required
State:
*
Required
Please enter a 5-digit ZIP code or a 9-digit ZIP code with a hyphen after the first 5 digits.
Zip Code:
*
Required
Please enter a valid email address with the format youraddress@yourdomain.
Email
*
Please complete the following form to add a spouse, partner, and/or child(ren) to your Temple membership.
*
Spouse / Partner Information
Required
Title:
<Select>
Mr.
Ms.
Mrs.
Dr.
<Enter your own value>
*
This field is required.
This value is not unique.
Enter your own value
*
Required
First Name:
*
Required
Nickname:
*
Required
Middle Name:
*
Required
Last Name:
*
Required
Please enter a date with the format M/D/YYYY.
Marriage Date:
*
Click to view help for this field.
M/D/YYYY
Required
Please enter a date with the format M/D/YYYY.
Date of Birth:
*
Click to view help for this field.
M/D/YYYY
Required
Birthplace (Optional):
*
Required
Please enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.
Cell Phone:
*
Required
Please enter a valid email address with the format youraddress@yourdomain.
Email:
*
Required
Religious Affiliation:
<Select>
Jewish
Non-Jewish
<Enter your own value>
*
This field is required.
This value is not unique.
Enter your own value
*
Required
Conversion Date and Location:
*
Required
Hebrew Name:
*
Required
Employer:
*
Required
Occupation/Title:
*
Required
Please enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.
Business Phone:
*
Required
Please enter a valid email address with the format youraddress@yourdomain.
Business Email:
*
Child(ren) Information
Required
First Name
*
Required
Nickname
*
Required
Middle Name
*
Required
Last Name
*
Required
Gender
<Select>
Male
Female
*
Required
Please enter a date with the format M/D/YYYY.
Date of Birth
*
Click to view help for this field.
M/D/YYYY
Required
Marital Status (optional)
<Select>
Single
Married
*
Is this child being raised in the Jewish faith?
*
Required
Yes
No
*
Required
Add another child?
Yes
No
*
Child 2 Information
Required
First Name
*
Required
Nickname
*
Required
Middle Name
*
Required
Last Name
*
Required
Gender
<Select>
Male
Female
*
Required
Please enter a date with the format M/D/YYYY.
Date of Birth
*
Click to view help for this field.
M/D/YYYY
Required
Marital Status (optional)
<Select>
Single
Married
*
Is this child being raised in the Jewish faith?
*
Required
Yes
No
*
Required
Add another child?
Yes
No
*
Child 3 Information
Required
First Name
*
Required
Nickname
*
Required
Middle Name
*
Required
Last Name
*
Required
Gender
<Select>
Male
Female
*
Required
Please enter a date with the format M/D/YYYY.
Date of Birth
*
Click to view help for this field.
M/D/YYYY
Required
Marital Status (optional)
<Select>
Single
Married
*
Is this child being raised in the Jewish faith?
*
Required
Yes
No
*