CONGREGATION HAVURAH SHALOM




MEMBERSHIP APPLICATION


Please enter the information below and submit the form to go to part two of the application. Then mail your check for $18.00 per member payable to Congregation Havurah Shalom to: Congregation Havurah Shalom, 1530 Sun City Blvd.,Suite 120, PMB 406, Georgetown, TX 78633.

Date
Last Name
 First Name
 Birth Month and Day
(First Member)
Last Name
 First Name
 Birth Month and Day
(Additional Member)
Current Address
 City
 State
 Zip Code
Email Address
 Additional Email Address
Telephone
 Wedding Anniversary
YAHRZEITS:
Name
 Secular Date
 Name
 Secular Date
Name
 Secular Date
 Name
 Secular Date
Name
 Secular Date
 Name
 Secular Date
Name
 Secular Date
 Name
 Secular Date
Name
 Secular Date
 Name
 Secular Date


NOTE: Yahrzeit Announcements will be included in the monthly services and CHS Newsletter of the secular date.


Please Note that when you click submit you will be directed to part two of the Membership Application, the Mini Bio Form, to complete and submit.