New Members Form - Form - Beth Jacob Congregation

Join Beth Jacob Congregation and be a part of the largest Orthodox Shul west of the Mississippi. As a member of Beth Jacob, you will enjoy a warm community atmosphere, a wide variety of classes, great programming, wonderful youth events and programs in addition to our beautiful and spiritual davening.To become a member, please fill out and submit the form below. We also encourage you to contact Rabbi Topp (rabbitopp@bethjacob.org or 310-278-1911) to introduce yourself and to discuss life at the shul.

If you have any questions or if we can assist you in any way, please give us a call.

At Beth Jacob Congregation our membership year runs from July 1 to June 30. Please support Beth Jacob Congregation by pledging as suggested or, if possible, pledge more. If you have special circumstances, please contact our Executive Director, Robyn Lewis (310.278.1911 or r.lewis@bethjacob.org) for a confidential discussion.

Please choose a Membership Level:

Please choose a Pillar category below:

For a description of each category please click here.

Adult 1 - Title

Adult 1 - First Name

Adult 1 - Last Name

Adult 1 - Address

Adult 1 - City

Adult 1 - State

Adult 1 - Zip

Adult 1 - Home Phone

* Is this also the Billing Address?

Billing Street Address 1

Billing City

Billing Zip

Billing State

Adult 1 - Birth date

* Adult 1 - Email

* Adult 1 - Mobile Phone

* Adult 1 - Can we use your cell phone for texting services?

Adult 1 - Full Hebrew Name

Please use English letters

Adult 1 - Tribe

Adult 1 - Bar Mitzvah Parsha (if applicable)

Adult 1 - Marital Status

Adult 1 - Wedding Date

Adult 1 - Photo

You can upload a maximum of 1 files.

Adult 1 - Employer

Adult 1 - Occupation

Adult 1 - Work Email

Adult 1 - Work Phone

Adult 2 - Title

Adult 2 - First Name

Adult 2 - Last Name

Adult 2 - Birth date

Adult 2 - Email

Adult 2 - Mobile Phone

* Adult 2 - Can we use your cell phone for texting services?

Adult 2 - Full Hebrew Name

Please use English letters

Adult 2 - Tribe

Adult 2 - Bar Mitzvah Parsha (if applicable)

Adult 2 - Photo

You can upload a maximum of 1 files.

Adult 2 - Employer

Adult 2 - Occupation

Adult 2 - Work Email

Adult 2 - Work Phone

* Is home address for Adult 2 same as for Adult 1?

Adult 2 - Address

Adult 2 - City

Adult 2 - State

Adult 2 - Zip Code

Children under the age of 18 are included in your Membership. How many children live in the family home?

If you have more than 4 children please contact the office after submitting your new membership form.

Child 1 - First Name

Child 1 - Last Name

Child 1 - Gender

Child 1 - Email Address

Child 1 - Hebrew Name

Please enter in English

Child 1 - Date of Birth

Child 1 - School

Child 1 - Grade as of September 2021

Child 2 - First Name

Child 2 - Last Name

Child 2 - Gender

Child 2 - Email Address

Child 2 - Hebrew Name

Please enter in English

Child 2 - Date of Birth

Child 2 - School

Child 2 - Grade as of September 2021

Child 3 - First Name

Child 3 - Last Name

Child 3 - Gender

Child 3 - Email Address

Child 3 - Hebrew Name

Please enter in English

Child 3 - Date of Birth

Child 3 - School

Child 3 - Grade as of September 2021

Child 4 - First Name

Child 4 - Last Name

Child 4 - Gender

Child 4 - Email Address

Child 4 - Hebrew Name

Please enter in English

Child 4 - Date of Birth

Child 4 - School

Child 4 - Grade as of September 2021

The remembrance of the anniversary of the passing of a loved one.
Do you have loved ones you would like placed on our Yahrzeit list?

How many yahrzeit would you like to observe?

You will be able to add additional yahrzeits once you log into your new Temple account.

Deceased Title

Deceased First Name

Deceased Last Name

Deceased Full Hebrew Name

for example: First Name, ben/bat, Father’s Name

English Date of DeathMM/DD/YY

Hebrew Date of Death

(if known)

Related to:

Relationship:

Deceased Title

Deceased First Name

Deceased Last Name

Deceased Full Hebrew Name

for example: First Name, ben/bat, Father’s Name

English Date of Death

Hebrew Date of Death

(if known)

Related to:

Relationship:

Deceased Title

Deceased First Name

Deceased Last Name

Deceased Full Hebrew Name

for example: First Name, ben/bat, Father’s Name

English Date of Death

Hebrew Date of Death

(if known)

Related to:

Relationship:

Deceased Title

Deceased First Name

Deceased Last Name

Deceased Full Hebrew Name

for example: First Name, ben/bat, Father’s Name

English Date of Death

Hebrew Date of Death

(if known)

Related to:

Relationship:

How did you find us?

Mailings Should Be Addressed As? (i.e, Mr. Mrs. different last names)

Please select a seating location:

Member - Shapell

2 allowed at this price with payment of Family Membership

Additional - Shapell Seats @ $405/seat

Unlimited allowed to be purchased by the member after their allotment of 2

Member - Rubin Hall

2 allowed at this price with payment of Family Membership

Additional - Rubin Hall Seats @ $305/seat

Unlimited allowed to be purchased by the member after their allotment of 2

Member - Eisenstat

2 allowed at this price with payment of Family Membership

Additional - Eisenstat Seats @ $305/seat

Unlimited allowed to be purchased by the member after their allotment of 2

Member - Jacob’s Garden

2 allowed at this price with payment of Family Membership

Additional - Jacob’s Garden Seats @ $305/seat

Unlimited allowed to be purchased by the member after their allotment of 2

Do you wish to purchase seats in the Ives Youth Lounge for YP Services? If so, how many would you like to purchase @ $180/seat?

Seats are $180 each

Do you wish to purchase seats for Non-Members or Associate Members? If so, how many seats would you like to purchase @ $650/seat?

Seats are $650 each

Total Membership Commitment

As a member of Beth Jacob Congregation, I understand that I am making a full-year financial commitment to support the Congregation. I further understand that the Congregation depends on this commitment, and I pledge to fulfill my financial obligation on or before June 30, 2021. If I am unable to do so, I agree to contact the Executive Director to make alternative arrangements. I authorize Beth Jacob Congregation to charge my credit card when payment is due.