Synagogue Membership Application Form ✡ Israel Center of Conservative Judaism

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user id

You are viewing the singles' version of this form. Enter a name for "Adult 2" and the form will add various questions about your spouse/partner.

Birthdate 1: (Required)

Birthdate 2: (Required)

Website Login Credentials: Adult 1 ( )

Select a username and password for your ICCJ Website account. If you already have an account, you should login first before filling out this form, as duplicate accounts with the same username or email will not be registered.

Username: Adult 1 ( )(Required)

Website Login Credentials: Adult 2 ( )

(Omit this section if already has an ICCJ Website Account)

Username: Adult 2 ( )

should maintain their own ICCJ website account. If you choose a Username for here, upon submitting this form an email will be sent to them at the email you indicate for them below (), asking them to choose their password and activate their membership.

can also apply for a website account later, at https://www.iccj2004.org/register .

If already has an ICCJ Website account you can leave this blank.

Contact Information

Cell Phone 1: (Required)

Cell Phone 2:

Email Address 1: (Required)

Email Address 2:

Home Phone

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Seasonal Home Phone

Personal Information

Occupation 1:

Occupation 2:

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Military Service/Branch 1:

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Military Service/Branch 2:

Anniversary Date

Emergency Contact

Name(Required)

Relationship(Required)

Cell Phone Number(Required)

Family Record Information

Jewish Status 1: (Required)

Jewish Status 2:

Hebrew Name 1:

Father's Hebrew 1:

Tribe 1:

Mother's Hebrew 1:

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Adult 1 and

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Adult 1 He

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Adult 1 She

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Adult 1 They

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Full Hebrew Name 1

Hebrew Name 2:

Father's Hebrew Name 2:

Tribe 2:

Mother's Hebrew Name 2:

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Adult 2 and

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Adult 2 He

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Adult 2 She

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Adult 2 They

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Full Hebrew Name 2

Children

Yahrzeit Observances

Synagogue Interests

☞ Congregations thrive on participation and volunteerism. Please indicate the auxiliaries/committees/interest groups that may interest you:

Special Talents/Interests/Skills 1:

Please list any special talents, interests & skills, e.g. Torah reading, Haftarah chanting, leading services, singing, playing an instrument, computer use, graphic design, writing/editing, grant writing, photography, advertising, etc.

Special Talents/Interests/Skills 2:

Please list any special talents, interests & skills, e.g. Torah reading, Haftarah chanting, leading services, singing, playing an instrument, computer use, graphic design, writing/editing, grant writing, photography, advertising, etc.

How did you hear about ICCJ?

Photo Consent and Release

We live in a digital-cyber era in which digital photography and film is constantly created and shared, for both personal and advertising purposes. Synagogue communities use digital content as a tool for both member engagement and new member attraction.

We strive to respect everyone's wishes when it comes to photographs and video of themselves. As such, we request that you choose the option below that best suits your needs. Depending on your selection, an option to specify details may open up below.

Photo consent

We live in a digital-cyber era in which digital photography and film is constantly created and shared, for both personal and advertising purposes. Synagogue communities use digital content as a tool for both member engagement and new member attraction.

We strive to respect everyone's wishes when it comes to photographs and video of themselves. As such, we request that you choose the option below that best suits your needs. Depending on your selection, an option to specify details may open up below.

Partial photo consent

We live in a digital-cyber era in which digital photography and film is constantly created and shared, for both personal and advertising purposes. Synagogue communities use digital content as a tool for both member engagement and new member attraction.

We strive to respect everyone's wishes when it comes to photographs and video of themselves. As such, we request that you choose the option below that best suits your needs. Depending on your selection, an option to specify details may open up below.

No photo consent

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Photo Consent - Fine Print

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Partial Photo Consent - Fine Print

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No Photo Consent - Fine Print

I/we grant to Israel Center of Conservative Judaism (ICCJ) and all subsidiary groups (Yedidya Academy, Sports Clinic, etc) the right to take photographs of me/us and my/our family in connection with any official ICCJ and partnered functions or events.
I/we authorize the ICCJ, its assigns and transferees to copyright, use and publish the same in print and/or electronically for purposes including ICCJ's social media (Facebook, Instagram, Youtube, Tiktok, Twitter), website and newsletter. ICCJ may use such photographs/videos of me/us with or without my/our name, for any lawful purpose.

Subject to the conditions and limitations which I will specify below, I/we grant to Israel Center of Conservative Judaism (ICCJ) and all subsidiary groups (Yedidya Academy, Sports Clinic, etc) the right to take photographs of me/us and my/our family in connection with any official ICCJ and partnered functions or events.
I/we authorize the ICCJ, its assigns and transferees to copyright, use and publish the same in print and/or electronically for purposes including ICCJ's social media (Facebook, Instagram, Youtube, Tiktok, Twitter), website and newsletter. ICCJ may use such photographs/videos of me/us with or without my/our name, for any lawful purpose.

I/we DO NOT grant to Israel Center of Conservative Judaism (ICCJ) or any of its subsidiary groups (Yedidya Academy, Sports Clinic, etc) the right to take photographs of me/us and my/our family in connection with any official ICCJ and partnered functions or events, unless I/we grant explicit permission for that particular photo/video/function/event.
I/we DO NOT authorize the ICCJ, its assigns and transferees to use or publish the same in print and/or electronically for purposes including ICCJ's social media (Facebook, Instagram, Youtube, Tiktok, Twitter), website and newsletter.

Partial photo consent - please specify your preferences:(Required)

If you notice photos/videos of you/your family and have concerns, please contact ICCJ via this email.