Membership Renewal 2024-2025 / 5785

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Adat Shalom Membership Renewal Application
2024-2025 / 5785

Thank you for your continuous and generous support as a renewing member of Adat Shalom. Your membership enables our ongoing spiritual and educational programs while strengthening our community for generations to come.

For the best user experience and to easily auto-populate your existing account information:
1. Please log in to your Adat Shalom member account
2. Type your name in the box just above that says "Enter a Name"

If you don't have a login, or forgot your password, please contact the office at (310) 475-4985, or e-mail Erin Goldstein to have your login access rest.

Family Address

* Family Home Address

* City

* State

* ZIP

* Home Phone #:

Date of Anniversary (if applicable)

Date Joined (if date on profile is incorrect)

Please Select Number of Adults on the Family Account

Member #1 Information

* First Name

* Last Name

* E-mail

* Cell Phone #:

Hebrew Name (please include Father's and Mother's name. Please write in transliterated English)

What tribe of Israel do you belong to?

Bar/Bat Mitzvah Date

Parshah

* Date of Birth (MM/DD/YYY):

Profession / Special Skill

Business Phone #:

Member #2 Information

* First Name

* Last Name

* E-mail

* Cell Phone #:

Hebrew Name (please include Father's and Mother's name. Please write in transliterated English)

What tribe of Israel do you belong to?

Bar/Bat Mitzvah Date

Parshah

* Date of Birth (MM/DD/YYY):

Profession / Special Skill

Business Phone #:

Primary Emergency Contact Information

* First Name

* Last Name

E-mail

* Phone #:

* Relationship with Emergency Contact

Secondary Emergency Contact Information

First Name

Last Name

E-mail

Phone #:

Relationship with Emergency Contact

Family Information

* Information for Children

* English Name of Child One

Hebrew Name of Child One (English transliteration is ok)

* D.O.B. of Child One (MM/DD/YYYY):

If birth mother is not Jewish, was child converted?

* English Name of Child Two

Hebrew Name of Child Two (English transliteration is ok)

* D.O.B. of Child Two (MM/DD/YYYY):

If birth mother is not Jewish, was child converted?

* English Name of Child Three

Hebrew Name of Child Three (English transliteration is ok)

* D.O.B. of Child Three (MM/DD/YYYY):

If birth mother is not Jewish, was child converted?

* English Name of Child Four

Hebrew Name of Child Four (English transliteration is ok)

* D.O.B. of Child Four (MM/DD/YYYY):

If birth mother is not Jewish, was child converted?

Membership Directory

We publish a Membership Directory annually for members. Please note this is for personal use only and not to be shared or used for business purposes. Please review your information so it is accurate and up to date.

If you don't want your personal contact information in the directory, and only want your name listed, please make sure to select the checkbox below.

If you don't want to be included in the directory at all please contact the office at (310)475-4985 or email the office.

I do not want my contact information listed in the directory, please only list my name

Yahrzeit Information

Renewing Members: We have your loved ones yahrzeit information on file. Please provide only new yahrzeit information below.
New Members: Please provide yahrzeit information for loved ones below.

We send reminders to active members prior to your loved one's yahrzeit date. Names will be read during the morning Shabbat service prior to the yahrzeit.

* Yahrzeit Information

* English Name

Hebrew Name (if known)

* Relationship / To Whom