Membership Form

Membership Application

* Family Name

* Today's Date

* First Name

* Birthdate

* Address

* City

* State

* Zip Code

* Cell Phone

Home Phone

* E-mail Address

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Tribe

* Occupation

Business Phone

Business E-mail

Anniversary Date

SPOUSE

Name

Birthdate

Cell Phone

E-mail Address

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Tribe

Occupation

Business Phone

Business E-mail

CHILD / CHILDREN INFORMATION

Name

Birthdate

Hebrew Name

E-mail Address

Name

Birthdate

Hebrew Name

E-mail Address

Name

E-mail Address

YAHRZEIT INFORMATION

English Name

Relationship

Date of Death

Time

English Name

Relationship

Date of Death

Time

English Name

Relationship

Date of Death

Time

English Name

Relationship

Date of Death

Time

Thank you for completing this membership form. Someone from our New Member Committee will follow up with you soon. WELCOME!

Wed, April 30 2025 2 Iyyar 5785

330 S. Oyster Bay Road, Syosset, NY 11791
(516) 938-8390 • office@mjc.org

regular prayer service schedule

Sunday Minyan at 9 am and 8 pm
Monday - Friday Morning Minyan, 6:30 am
Monday - Thursday Evening Minyan, 6:15 pm

Shabbat

Kabbalat Shabbat on Fridays at 6:15 pm
Shabbat on Saturdays at 9:00 am

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