Membership Form

Contact Information

Name to be used for mailing label(Required)

Home Phone

Primary Email(Required)

Adult #1

Adult #1 - Nickname (preferred name)

Adult #1 - Marital Status

Adult #1 - Anniversary Date

Adult #1 - Birthdate(Required)

Adult #1 - Email(Required)

(for directory and newsletter)

Adult #1 - Cell Phone

Adult #1 - Hebrew Name (in English)

Adult #1 - Father's Hebrew Name

Adult #1 - Mother's Hebrew Name

Adult #1 - Religion

Adult #1 - Previous synagogue affiliation, number of years

Adult #1 - Occupation

Adult #1 - Area of Specialization

Adult #1 - Interests/Skills

(such as Art, Computers, Photography, Cooking, Music, History, Financial, Education, etc.)

How did you hear about Congregation Beth Jacob?

Please let us know which qualities/programs you are looking for in a synagogue so that we may try to meet your needs:

Adult #2

Adult #2 - Nickname (preferred name)

Adult #2 - Marital Status

Adult #2 - Anniversary Date

Adult #2 - Birthdate

Adult #2 - Email

(for directory and newsletter)

Adult #2 - Cell Phone

Adult #2 - Hebrew Name (in English)

Adult #2 - Father's Hebrew Name

Adult #2 - Mother's Hebrew Name

Adult #2 - Religion

Adult #2 - Previous synagogue affiliation, number of years

Adult #2 - Occupation

Adult #2 - Area of Specialization

Adult #2 - Interests/Skills

(such as Art, Computers, Photography, Cooking, Music, History, Financial, Education, etc.)

Dependent Children

Rabbi Contact

Rabbi Mills is a valuable resource for all members of the Beth Jacob Community. She is available to answer any questions or concerns you may have as a new member. If you would like to have her call you, please indicate the best time and phone number at which she may reach you:

Best Time to call you:

Yahrzeits (Memorials)

Please provide us with yahrzeit names if you want us to include them in our publications and to announce them in services. We will be happy to mail reminders to you on a timely basis, if you request postal notification.

Cemetery Information

Please provide name and location:

Please describe other arrangements made for the occasion of my/our death.

Membership Rates

2025-2026 Membership Rates(Required)

My/Our TOTAL annual dues commitment will be:(Required)

Other Payment Plan Details

Please make your check payable to "Congregation Beth Jacob" and mail it to the following address:

Congregation Beth Jacob
ATTN: Membership
P.O. Box 3284
Plymouth, MA 02361

MUST COMPLETE IF PAYING BY CREDIT CARD - If paying in full right now, how much do you want to pay?

MUST COMPLETE IF PAYING BY CREDIT CARD - If paying quarterly, how much do you want each payment to be for?

MUST COMPLETE IF PAYING BY CREDIT CARD - If paying monthly, how much do you want each payment to be for?

Additional contribution to cover the credit card convenience fee

Price: $0.00

Total

Signature - Head of Household(Required)

Signature - Spouse/Partner

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Please note that upon submission, you will be taken to PayPal's website in order to enter your credit card information.