New Member Information

New Member Information

Welcome to Congregation Beth Israel (CBI). We are delighted you have chosen to become part of this community. Please feel free to call upon the clergy, staff, and lay leaders whenever we can help enrich your experience as part of the CBI family.

Adult 1:

* First Name

* Last Name

Nickname

Hebrew Name

Occupation/Title

Employer

Personal Pronouns (she, he, they, ze, etc.)

(Learn more about personal pronouns.)

* Date of Birth

* Relationship Status

Adult 2:

First Name

Last Name

Nickname

Hebrew Name

Occupation/Title

Employer

Personal Pronouns (she, he, they, ze, etc.)

(Learn more about personal pronouns.)

Date of Birth

Special Accommodations Needed (mobility concerns, physical limitation). If yes, please describe your needs:

Adult 1 (accommodations needed):

Adult 2 (accommodations needed):

Please list any relatives who are affiliated with CBI:

Mailing & Contact Information

* Home Address

* City

* State

* Zip

Home Phone

Adult 1

* Cell Phone

Work Phone

* Email

Adult 2

* Cell Phone

Work Phone

* I/we give permission to share my/our contact information with other CBI members in the online membership directory.

YesNo

Religious Background

Adult 1

Reform

Conservative

Orthodox

Jewish - Unaffiliated

Other

Adult 2

Reform

Conservative

Orthodox

Jewish - Unaffiliated

Other

Previous Synagogue Attended, if any:

Children

Child 1:

First Name

Last Name

Hebrew Name

Personal Pronouns (she, he, they, ze, etc.)

Date of Birth

Current Grade

Living at home?

YesNo

Will this child be attending Religious School (grade K-12)?

YesNo

Child 2:

First Name

Last Name

Hebrew Name

Personal Pronouns (she, he, they, ze, etc.)

Date of Birth

Current Grade

Living at home?

YesNo

Will this child be attending Religious School (grade K-12)?

YesNo

Child 3:

First Name

Last Name

Hebrew Name

Personal Pronouns (he, she, they, ze, etc.)

Date of Birth

Current Grade

Living at home?

YesNo

Will this child be attending Religious School (grade K-12)?

YesNo

If you have more than three children, please let us know so we can collect their information.

Emergency Contact

Emergency Contact - Name

Relationship

Phone number

Yahrzeits

The names of your deceased loved ones can be read in services the Shabbat before the Yahrzeit date (the anniversary of death).

1. Deceased - Full Name

Relationship

Hebrew Name

Date of Death

Observed by:

Adult 1Adult 2

Observe:

Hebrew Date orSecular Date

2. Deceased - Full Name

Relationship

Hebrew Name

Date of Death

Observed by:

Adult 1Adult 2

Observe:

Hebrew DateSecular Date

3. Deceased - Full Name

Relationship

Hebrew Name

Date of Death

Observed by:

Adult 1Adult 2

Observe:

Hebrew DateSecular Date

If you have more yahrzeits to observe, please let us know.

Member Interests

CBI is an active community and there are many ways to get involved!
We'd love to learn more about your interests and skills. If you indicate interest in joining a committee, your contact information will be given to the chairperson.
Please use Column 1 for Adult 1 and Column 2 for Adult 2 (if applicable).

ADULT 1 - Please use this space if you would like to tell us more about your interests & skills.

ADULT 2 - Please use this space if you would like to tell us more about your interests & skills.

One way CBI helps congregants get connected is by including a short biography of new members in our weekly e-announcements. If you would like to be included in this, please use this space below to share your story (e.g. reason for moving to Charlottesville area, career, hometown, what you look forward to participating in at CBI...).

Biography (to be shared in e-news)

* Would you prefer to be contacted by our Director of Communications to help write your bio?

YesNo

I/we wish to participate in Congregation Beth Israel, making a personal and financial commitment to the support and continuation of this community.

* Initial here to indicate your digital signature.

* Date

After submitting this form, please go back to our Membership page and complete the Financial Support Commitment.

Please contact Raya at office@cbicville.org or 434-295-6382 if you have questions or need help with this process.

Be sure to click SUBMIT at the bottom when you have completed this form.

Open Hearts. Open Minds. Strong Values.