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2025-2026 New Member Application
Please verify reCaptcha before submitting the form.
*
How did you become interested in Sukkat Shalom?
*
Family Name
Address
Address 2
City
State
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Zip code
*
Primary Phone Number
*
Cell Phone Number, Adult 1
Cell Phone Number, Adult 2
I/we give permission to print HOME e-mail addresses in Congregation Directory
I/we give permission to print HOME e-mail addresses in Congregation Directory
Adult #1
*
Adult 1 First Name
*
Adult 1 Last Name
*
Adult 1 Email
Adult 1 Date of Birth
Occupation
Business Name
Business Phone Number
Business Email
I/we give permission to print BUSINESS e-mail address in Congregation Directory
I/we give permission to print BUSINESS e-mail address in Congregation Directory
Preferred Pronouns (optional)
Adult #2
Secondary Contact First Name
Secondary Contact Last Name
Secondary Contact Email
Secondary Contact Date of Birth
Occupation
Business Name
Business Phone Number
Business Email
I/we give permission to print BUSINESS e-mail address in Congregation Directory
I/we give permission to print BUSINESS e-mail address in Congregation Directory
Preferred Pronouns (optional)
Children
Child 1 First Name
Child 1 Last Name
Child 1 Birthdate
Gender (select one)
Select below
Male
Female
Nonbinary
Prefer not to answer
Child 2 First Name
Child 2 Last Name
Child 2 Birthdate
Gender (select one)
Select below
Male
Female
Nonbinary
Prefer not to answer
Child 3 First Name
Child 3 Last Name
Child 3 Birthdate
Gender (select one)
Select below
Male
Female
Nonbinary
Prefer not to answer
Child 4 First Name
Child 4 Last Name
Child 4 Birthdate
Gender (select one)
Select below
Male
Female
Nonbinary
Prefer not to answer
*
Annual Membership Commitment
Please Select One
Please select an option
$3,600
$4,500
$6,000
$7,500
Other amount meaningful to you
If "Other amount" was selected, please note annual commitment amount
Security Fund
Please consider making an additional contribution to our Security Fund to help us cover the costs of our armed security guards.
We ask you to consider a donation of at least $180 per household. Thank you for your generous support.
Please note contribution amount here
Thank you for filling out this form! Please be on the lookout for a welcome message from the Sukkat Shalom staff shortly.
Questions? 847-251-2675; snelson@sukkatshalom.org
Sat, May 24 2025 26 Iyar 5785