Midbar Kodesh Temple Membership Form - Form

Thanks for checking out Midbar Kodesh Temple. Choosing where to worship, learn and celebrate is a big decision. There's no better way to learn more about us than joining us for a Friday night service or Shabbat morning service, a class with the Rabbi or Cantor, or another upcoming event.

How many adults are part of this application?

How many children will be included in your Membership/Registration?

Children 25 and under are included in your membership. Children 26 and older must apply for membership on their own.

Are you interested in the Gift Membership? This is only available for first-time members.

YESNO

All memberships will be offered at a 50% discount for the first year of a new member.
The discount membership will include high holiday tickets.
Those new members age 18-25 will be given a free membership their first year.
All memberships whether discounted or free will include a security fee annually.
After your first year, there will be a cost of membership.

How did you hear about us?

Who referred you to Midbar Kodesh Temple?

PERSONAL INFORMATION

Adult 1 Information

* First Name

Middle Name

* Last Name

* Home Phone Number

* Address

City/Town

* Province

* Postal Code

* Email Address

Cell Phone Number

Birth date

Occupation

Hobbies

Your Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

I was raised (select one)

Please Select One

Did you convert to Judaism?

Conversion Date

Conversion Place

Name of Rabbi for Conversion

Current/other Congregational Affiliation

Membership in other Jewish Organizations

Bar/Bat Mitzvah Date

Date You Moved to Las Vegas/Henderson?

Where did you move from?

Adult 2 Information

First Name

Middle Name

Last Name

* Email Address

* Address

* City/Town

* Province

* Postal Code

Cell Phone Number

Date of Birth

Occupation

Hobbies/Interests

Your Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

I was raised (select one)

Please Select One

Did you convert to Judaism?

Conversion Date

Conversion Place

Name of Rabbi for Conversion

Current/other Congregational Affiliation

Membership in other Jewish Organizations

Occupation

Date You Moved to Las Vegas/Henderson?

Where did you move from?

Wedding Anniversary

COMMUNITY INVOLVEMENT

CHILD/CHILDREN INFORMATION

Child 1

First Name

Middle Name

Last Name

Hebrew Name

Was the mother Jewish when the child was born?

Did the child convert?

Conversion Date

Conversion Place

Name of Rabbi

Date of Birth

Name of school entering in Fall, 2024

Grade entering in Fall, 2024

Child 2

First Name

Middle Name

Last Name

Hebrew Name

Date of Birth

Name of school entering in Fall, 2024

Grade Entering in Fall, 2024

Child 3

Child 3 First Name

Child 3 Middle Name

Child 3 Last Name

Hebrew Name

Date of Birth

Name of School Entering in Fall, 2024

Grade Entering in Fall, 2024

Child 4

First Name

Middle Name

Last Name

Hebrew Name

Date of Birth

Name of School Entering in Fall, 2024

Grade Entering in Fall, 2024

YAHRZEIT INFORMATION

How many yahrzeit's would you like to record?

YAHRZEIT #1

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #2

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #3

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #4

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #5

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #6

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #7

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #8

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #9

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)

YAHRZEIT #10

First Name of Deceased

Last Name of Deceased

Hebrew Name of Deceased

English Date of Death

After Sunset?

YesNo

Deceased is (member name)

Relationship (to member)