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Micah Membership Form
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Congregation Micah is many things: a place of inspiring worship, creative and stimulating educational experiences, and spiritual and cultural activities. Micah is home for life-cycle observances as well as individual and communal expressions of our Jewish heritage and people. Micah is Reform Judaism that is inclusive, welcoming, and sensitive to the varied lives and needs of our congregants. Micah is a Temple dedicated to promoting Jewish values and teachings in a warm and approachable manner. Most of all, Micah is a community of wonderful people committed to the exciting challenges of a new and growing congregation.
At Micah, we welcome interfaith couples and have a thriving community of families. We can provide many resources for both interfaith couples and those who are looking to reconnect with their heritage.
We are pleased that you are interested in becoming a part of our congregational family. If you have any questions about this application form or the congregation in general, please do not hesitate to contact our Membership Director, Mindy Drongowski, at
membership@congregationmicah.org
. You may also find helpful information on our website at
www.congregationmicah.org
.
We hope you will join our Micah family and share our exciting journey into the future.
*
I/We understand that there is a financial commitment to being a member of Congregation Micah. Upon completion of this application, someone from the Annual Support Committee will contact me to discuss annual support in confidence.
I/We understand that there is a financial commitment to being a member of Congregation Micah. Upon completion of this application, someone from the Annual Support Committee will contact me to discuss annual support in confidence.
*
I/We understand that to be a member of Congregation Micah, one adult member must be Jewish.
I/We understand that to be a member of Congregation Micah, one adult member must be Jewish.
(Please Note: If you are in the process of converting, please contact
mindy@congregationmicah.org
for more information.)
Member A Information
Member A Title
(optional)
*
Member A First Name
Middle Name
(optional)
*
Member A Last Name
Member A Suffix
(optional)
*
Member A Name Tag Should Read:
*
Member A Sex:
Please Select One
Female
Male
Gender Neutral
Home Address
*
Address Line 1
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
*
Home Phone
Please include area code.
*
Member A Cell Phone
Please include area code.
Member A Work Phone
Please include area code.
*
Member A Email
*
Member A Date of Birth
*
Member A Occupation
Please Select One
Student
Retired
Not Currently Employed
Currently Employed
Name of Employer
Work Address 1
Work Address 2
Work City
Work State
Work Zip
Jewish History Background
*
Member A Jewish/Hebrew Background
Please Select One
Yes
No
Member A Hebrew Name
Member A Previous Synagogue Affiliation
Member A, Do You:
Read Hebrew
Speak Hebrew
Chant Hebrew
Areas of Interest
We are proud to have an active group of volunteers as well as several social and educational groups which make up our community. If you are interested in any of these or would like more information about ways to get involved please mark one or more groups/committees that would be of interest to you and someone will contact you.
Adult Education
Campus Maintenance
Security
Youth/Religious School Education
Service Greeters
Social Action Volunteering
Community Outreach
Micah Baking Team
Members Outreach
Music
Digital Media
Small Groups
Grief Support
Wellness Checks
Programming
General Volunteering
*
Would you like to add a second member on your form? (Spouse or Partner)
Please Select One
Yes
No
Member B Information
Member B Title
Member B First Name
Second Member Middle Name/Initial
Member B Last Name
Member B Suffix
Member B Name Tag Should Read:
*
Member B Sex:
Please Select One
Female
Male
Gender Neutral
*
Member B Cell Phone
Please include area code.
Member B Work Phone
Please include area code.
*
Member B Email
Member B Date of Birth
Anniversary Date
Member B Occupation
Please Select One
Student
Retired
Not Currently Employed
Currently Employed
Name of Employer
Work Address 1
Work Address 2
Work City
Work State
Work Zip
*
Member B Jewish/Hebrew Background
Please Select One
Yes
No
Member B Hebrew Name
Member B Previous Synagogue Affiliation
Member B, Do You:
Read Hebrew
Speak Hebrew
Chant Hebrew
Areas of Interest
We are proud to have an active group of volunteers as well as several social and educational groups which make up our community. If you are interested in any of these or would like more information about ways to get involved please mark one or more groups/committees that would be of interest to you and someone will contact you.
Adult Education
Campus Maintenance
Security
Youth/Religious School Education
Service Greeters
Social Action Volunteering
Community Outreach
Micah Baking Team
Members Outreach
Music
Digital Media
Small Groups
Grief Support
Wellness Checks
Programming
General Volunteering
Family Information: Children Living at Home
*
How many children do you have living at home?
Please choose one
0
1
2
3
4
5
Are you interested in enrolling one or more of your children in Religious School?
Please Select One
Yes
No
Child 1 First Name
Child 1 Middle Name
Optional
Child 1 Last Name
Child 1 Hebrew First Name
Child 1 Hebrew Last Name
Child 1 Name Tag Should Read:
Child 1 Sex
Please choose one
Female
Male
Gender Neutral
Child 1 Date of Birth
Child 1 Age
Child One School Name
Child 1 Grade Level (Secular School)
Child 2 First Name
Child 2 Middle Name
Optional
Child 2 Last Name
Child 2 Hebrew First Name
Child 2 Hebrew Last Name
Child 2 Name Tag Should Read:
Child 2 Sex
Please choose one
Female
Male
Gender Neutral
Child 2 Date of Birth
Child 2 Age
Child 2 School Name
Child 2 Grade Level (Secular School)
Child 3 First Name
Child 3 Middle Name
Optional
Child 3 Last Name
Child 3 Hebrew First Name
Child 3 Hebrew Last Name
Child 3 Name Tag Should Read:
Child 3 Sex
Please choose one
Female
Male
Gender Neutral
Child 3 Date of Birth
Child 3 Age
Child 3 School Name
Child 3 Grade Level (Secular School)
Child 4 First Name
Child 4 Middle Name
Optional
Child 4 Last Name
Child 4 Hebrew First Name
Child 4 Hebrew Last Name
Child 4 Name Tag Should Read:
Child 4 Sex
Please choose one
Female
Male
Gender Neutral
Child 4 Date of Birth
Child 4 Age
Child 4 School Name
Child 4 Grade Level (Secular School)
Child 5 First Name
Child 5 Middle Name
Optional
Child 5 Last Name
Child 5 Hebrew First Name
Child 5 Hebrew Last Name
Child 5 Last Name
Child 5 Sex
Please choose one
Female
Male
Gender Neutral
Child 5 Date of Birth
Child 5 Age
Child 5 School Name
Child 5 Grade Level (Secular School)
Children Living Away from Home
*
Do you have any children away from home?
Please choose one
Yes
No
*
How many children do you have living away from home?
Please choose one
1
2
3
4
5
Child 1 First Name
Child 1 Last Name
Child 1 Age
Child 2 First Name
Child 2 Last Name
Child 2 Age
Child 3 First Name
Child 3 Last Name
Child 3 Age
Child 4 First Name
Child 4 Last Name
Child 4 Age
Child 5 First Name
Child 5 Last Name
Child 5 Age
Miscellaneous
*
Are there any special needs in your family that we should be aware of?
*
Are you related to anyone at Micah? Please tell us who! How are you related?
Yahrzeit Information
Note: Most Micah members observe on the English date of death. If you would like to observe on the Hebrew date, please contact us. **Don't worry - more yahrzeits may be added after processing!**
How many observances would you like to add?
Please Select One
1
2
3
4
5
6
7
8
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Deceased Prefix
optional
Deceased First Name
Deceased Middle Name
optional
Deceased Last Name
Deceased Suffix
optional
Relative of Which Applicant
Relationship to Applicant
Date of Death
Key Facts Regarding Annual Support
As a member of our congregation, your annual support commitment helps provide the wealth of services to all of our congregants. As we continue to grow as a congregation, adding more services and programming for our members, our financial needs will also grow. This requires us - all of us - to establish a firm, predictable financial foundation that will assure the promise of Micah's future.
Everyone who requests membership at Congregation Micah is welcomed regardless of their financial ability. Our Pillars of Annual Support approach enables every member to be a "pillar" of our congregation based on their level of annual support.
Mindy Drongowski, our Membership Director, will receive this application. She will ensure that a member of our Annual Support Committee contacts you to thoroughly explain our Pillars of Annual Support in a confidential manner so you may make an informed decision regarding your annual support - one that meets your needs and supports Congregation Micah.
Signature(s)
*
I/we herewith apply for membership at Congregation Micah. I/we understand that the application is subject to approval by the Board of Trustees of Congregation Micah. If my/our application is approved, I/we agree to abide by the Constitution, By-laws, and all other regulations of Congregation Micah.
Fri, May 3 2024 25 Nisan 5784
