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Membership Application

Kindly contact our Administrator, Mark Wiesel if you have any questions about filling out this form.  This includes requiring more fields for certain information.                     Admin@ShomreiTorahWCC.org  or  973.696.2500 x12.

Contact  Information

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FAMILY BACKGROUND INFORMATION

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Member  # 2

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FAMILY INFORMATION

CHILDREN AT HOME (or in College):

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CHILDREN LIVING INDEPENDENTLY:

INDEPENDENT CHILD # 1

INDEPENDENT CHILD # 2

INDEPENDENT CHILD # 3

INDEPENDENT CHILD # 4


OTHER ADULTS IN YOUR HOUSEHOLD


YAHRZEIT RECORDS

DECEASED  # 1

DECEASED  # 2

DECEASED  # 3

DECEASED  # 4

DECEASED  # 5


CONGREGATIONAL ACTIVITIES & INVOLVEMENT

What programs would you like more information about and/or interest you as a participant?

Check all those which might interest you and your family.

 

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Thu, April 25 2024 17 Nisan 5784