New Members: Membership Form

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Name: Contemplative Shabbat service
Start: 2023-03-28T08:30:00-04:00
End: 2023-03-28T09:30:00-04:00

We are so happy you would like to become a member of Tikkun v’Or! We look forward to having you be part of our congregation.

Please complete the membership form below. The final page contains dues information and online payment through PayPal. You are welcome to pay dues by mailing a check as well.

All information provided is private and will not be shared with anyone without your written permission

We are so grateful for your membership. Please complete this information to the best of your ability. A member of the Welcoming Committee will contact you to answer any questions you may have. Thank you for being part of our TVO community.
Adult 1
Full Name
Nickname
Hebrew/Yiddish Name (If you have one)
Address
Home Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
E-Mail Address
Date of Birth
MM slash DD slash YYYY
Occupation/Profession

Adult 2 (Regardless of membership status)
Full Name
Nickname
Hebrew/Yiddish Name (If you have one)
Address
Home Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
E-Mail Address
Date of Birth
MM slash DD slash YYYY
Occupation/Profession

If there are no children in your home, please scroll down to the bottom of the page and click "Next."
Child 1
First Name
Middle Name
Surname if different
Hebrew Name
Birthdate
MM slash DD slash YYYY
If student, name of school/current grade
Child 2
First Name
Middle Name
Surname if different
Hebrew Name
Birthdate
MM slash DD slash YYYY
If student, name of school/current grade
Child 3
First Name
Middle Name
Surname if different
Hebrew Name
Birthdate
MM slash DD slash YYYY
If student, name of school/current grade
Child 4
First Name
Middle Name
Surname if different
Hebrew Name
Birthdate
MM slash DD slash YYYY
If student, name of school/current grade
Thank you for completing the Membership Information! After you submit this form, please continue to the Dues Payment page if you would like to pay dues online through PayPal. If you would prefer to pay by check, please send your check to: Congregation Tikkun v'Or PO Box 3981 Ithaca NY 14852. Please note “ Membership Dues” in the memo.

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