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Membership Application Page

Household Information
This is how mail will be addressed to your household. You can use formats such as: Kohan Family, Kohan Garber Family, or Kohan-Garber Family. 
If you do not have a home phone number, please enter the primary cell phone number for your family.
If you have been a KKBE member before, please select Yes, and write in the years of your previous membership. 

Adult 1 Information
How would you like to be addressed?
If you know the month/day/year of your Bat/Bar Mitzvah, please enter it here. If you are unsure of the exact date, please leave this blank for now.

Additional Family Members
 

Adult 2 Information
 
How would you you like to be addressed?
If you know the month/day/year of your Bat/Bar Mitzvah, please enter it here. If you are unsure of the exact date, please leave this blank for now.

Child 1 Information (Under 25)
 

Child 2 Information (Under 25)
 

Child 3 Information (Under 25)
 

Child 4 Information (Under 25)
 

Child 1 Information (Over 25)
 

Child 2 Information (Over 25)
 

Child 3 Information (Over 25)
 

Child 4 Information (Over 25)

Yahrzeit Information
 
There will be an opportunity to add additional names.
First and Last Name
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother 
If you know the exact date (month/day/year) of your loved one's death, please enter it above.  If you are unsure of the exact date, please leave this blank and email irene@kkbe.org when you are able to confirm the date for remembrance.
First and Last Name
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother 
If you know the exact date (month/day/year) of your loved one's death, please enter it above. If you are unsure of the exact date, please leave this blank and email irene@kkbe.org when you are able to confirm the date for remembrance.
First and Last Name
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother 
If you know the exact date (month/day/year) of your loved one's death, please enter it above. If you are unsure of the exact date, please leave this blank and email irene@kkbe.org when you are able to confirm the date for remembrance.
First and Last Name
Ex: if the deceased were my grandmother, I would write in: Arielle Kohan's Grandmother 
If you know the exact date (month/day/year) of your loved one's death, please enter it above. If you are unsure of the exact date, please leave this blank and email irene@kkbe.org when you are able to confirm the date for remembrance.

Additional Information
 

 

Sun, September 27 2020 9 Tishrei 5781