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Beth Shalom Progressive Jewish Congregation Membership Application
The following application for membership at Beth Shalom Progressive Synagogue is Confidential
PART 1: Details for first applicant
Persons name
*
First name
Last name
Hebrew Name
*
Gender
Female
Male
Non-binary/Gender diverse
I identify as:
Please share your pronouns if you wish
Relationship Status
Married/Partnered
Single
Marriage/Civil Union date (if applicable)
Best phone number to reach you
*
Email address
*
Household Address
*
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Place of Birth
Date of Birth
Occupation
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Part 2. Details for second applicant (if applicable)
Add Partner's details (if applicable)
Persons name
First name
Last name
Hebrew Name
Gender
Female
Male
Non-binary/Gender diverse
Please share your pronouns if you wish
Marital Status
Married/Partnered
Single
Marriage/Civil Union Date (if applicable)
Best phone number to reach you
Email address
Person or Household Address
Same as primary
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Place of Birth
Date of Birth
Occupation
+ Add another
- Remove
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Part 3. Details of dependent children living at home (if applicable)
Add child (if applicable)
Childs name
First name
Last name
Hebrew Name
Gender
Female
Male
Non-binary/Gender diverse
Please share your child's pronouns if you wish
Place of Birth
Date of Birth
School (if applicable)
Bar/Bat mitzvah date (if applicable)
**If your child is over 16 years, please provide their contact details so we may categorise their membership as a Young Adult
Email address
Phone
+ Add another child
- Remove
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Part 4. Tell us about yourself and your journey
We want to hear your story. Tell us why you are joining Beth Shalom?
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PART 5: Jewish status and identity of primary applicant
Please select below as applicable and upload confirmation documents or scan/email to office@bethshalom.org.nz
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Brit Milah or Baby naming
Bar or Bat Mitzvah
Bar/Bat Mitzvah Date (if applicable)
Conversion to Judaism
Previous membership at a Jewish Synagogue or congregation
If applicable, name of Synagogue, location, years of membership, name of Rabbi, etc.
None of the above
PART 6: Jewish status and identity of secondary applicant (if applicable)
Add details of secondary applicant
Please select below as applicable and upload confirmation documents or scan/email to office@bethshalom.org.nz
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Brit Milah or Baby naming
Bar or Bat Mitzvah
Bar/Bat Mitzvah Date (if applicable)
Conversion to Judaism
Previous membership at a Jewish Synagogue or congregation
If applicable, name of Synagogue, location, years of membership, name of Rabbi, etc.
None of the above
+ Add another
- Remove
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PART 7: Referees
Please provide the names and contact details of two members of the community who could provide a personal reference.
Reference 1
Reference 2
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PART 8: Yahrzeit
If you would like us to add someone to our list of Yahrzeits, please provide their name, date of their death, and relationship to Applicant
Yahrzeit 1
Name
Date of Death
Relationship to the applicant
Add another Yahrzeit
Name
Date of Death
Relationship to the applicant
+ Add another Yahrzeit
- Remove
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PART 9: Introduction to the Community
Can we contact you to introduce you to the congregation, either through Teruah or from the Bimah?
Yes
No
Maybe
Part 10: Allergy information
Does anyone in your family have any significant allergies you would like us to be aware of?
Yes
No
If yes, please describe
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PART 11: Services available to members
Please tick below if you are interested in finding out more about the following, and someone will be in touch:
Burial and Benevolent Society (Requires separate application)
Tamar - for young adults ages 18-35 – "the global movement looking to build and strengthen Progressive Jewish connections and communities"
All members receive weekly newsletter and monthly Teruah via email - please email the office if you prefer to opt-out
PART 12: Becoming involved in the community
I would like to get involved in the following ways:
Community Care
Community Care committee
Community Care lunches
Home visits to congregants
Social programmes/Community events
Education
Adult Jewish education
Introduction to Judaism course
Jewish Education – student at Yachad (Age 7 - 12)
Jewish Education - student age 13-15
Jewish Education - Teacher at Yachad
Education Committee
Tutor for Bar/Bat Mitzvah
Governance
Board/Leadership
Finances (Treasurer/Accounting/Book-keeping)
Ritual
Ritual committee
Service Leader
Shammash/E-Shammash
Erev Shabbat Potluck dinners (monthly for all members)
Interests and special skills
Community Security Group (CSG) volunteers
Crafty Club
Garden Club
Catering/Baking
Maintenance/Building/Renovations
Library/archives
Music
Audiovisuals
Communications (Advertising/Website/Posters/Social media)
Editing/Contributing to the Weekly newsletter or monthly Teruah
Fundraising (Events/Grant writing)
Tikkun Olam (social action)
LGBTQ+
Other Jewish interest groups
Habonim Dror youth movement - Email auckland@habo.org.nz
Australasian Union of Jewish Students (AUJS) (for University students) - Follow on Facebook or Instagram
Jewish Auckland/AJCC - Go to https://jewishauckland.co.nz
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