Membership Interest Form CBI New Member Information Today's Date MM slash DD slash YYYY Today's DateAdult 1Adult 1 Name(Required) Dr.MissMr.Mrs.Ms.Prof.RabbiCantor Title First Name Nickname Last Name Adult 1 Primary Phone NumberCell Phone NumberAdult 1 Email Email AddressAdult 1 Birthday MM slash DD slash YYYY Date of BirthAdult 1 Hebrew NamesPlease enter Hebrew names, if known, using English transliteration: Hebrew Name Father's Hebrew Name Mother's Hebrew Name Adult 1 TribePlease select one: Kohen Levi Yisrael Adult 1 Occupation OccupationIs there a second adult?(Required) Yes No Adult 2Adult 2(Required) Dr.MissMr.Mrs.Ms.Prof.RabbiCantor Title FIrst Name Nickname Last Name Adult 2 Primary Phone NumberCell NumberAdult 2 Email Address Email AddressAdult 2 Birthday MM slash DD slash YYYY BirthdayAdult 2 Hebrew namesPlease enter Hebrew names, if known, using English transliteration: Hebrew Name Father's Hebrew Name Mother's Hebrew Name Adult 2 TribePlease select one: Kohen Levi Yisrael Adult 2 Occupation OccupationHousehold InformationHome Address Street Address City State / Province / Region ZIP / Postal Code Home PhoneLandlineMarital Status Single Married Partnered Divorced Widowed Other Wedding Anniversary MM slash DD slash YYYY ChildrenDo you have a child under 26 living in your household: Yes No Enter children's information. Click on the plus sign to add additional children.First NameMiddle NameLast NameHebrew NameBirthdayGender Add RemoveGeneral InformationHow did you hear about CBI?What are you looking for in a synagogue?Prior synagogue affiliation?Are you new to Orange County? Yes No InterestsWhich opportunities are you interested in at CBI? (Check all that apply) Lifelong learning Young Professionals/singles Attending Services Torah reading/service leading Social Action Volunteering/Committee Member Youth Activities (Religious School & USY) Men’s /Women’s Club Preschool/Young family Programming Comfort Committee Book Club Please list other interests, and enter anything else you would like to tell usYahrzeitsCBI would like to help you remember to observe your yahrzeits.Do you have Yahrzeit to add? Yes No Enter Yahrzeit information. Click on the plus sign to add additional Yahrzeits.Full NameRelationshipRelated toHebrew and/or English date of death Add Remove
