Membership Application

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How many adult Members are part of this membership?

* Member 1 - First Name

* Member 1 - Middle Name

* Member 1 - Last Name

* Member 1 - Date of Birth

Member 1 - Hebrew Name

* Member 1 - Home Address

* Member 1 - Home City

* Member 1 - Home State

* Member 1 - Home ZIP

* Member 1 - Mobile Phone

* Member 1 - Email

* Member 1 - Gender

Member 1 - Occupation

Member 1 - Employer

Member 1 - Work Phone

Interest or skills?

Do you play a musical instrument? if so, what instrument?

Member 2 - First Name

Member 2 - Middle Name

Member 2 - Last Name

Member 2 - Date of Birth

Member 2 - Hebtrew Name

Member 2 - Mobile Phone

Member 2 - Email

Member 2 - Gender

Member 2 - Occupation

Member 2 - Employer

Member 2 - Work Phone

Interest or skills?

Do you play a musical instrument? if so, what instrument?

Does Member 2 live at the same address?

Member 2 - Home Address

Member 2 - Home City

Member 2 - Home State

Member 2 - Home ZIP

Member 2 - Home Phone

How many children live in your home?

First Name

Last Name

Gender

Date of Birth

School Grade

Name of School

Will attend:

Gan Shalom Nursery School Synagogue SchoolTeen Programming

First Name

Last Name

Gender

Date of Birth

School Grade

Name of School

Will attend:

Gan Shalom Nursery School Synagogue SchoolTeen Programming

First Name

Last Name

Gender

Date of Birth

School Grade

School Name

First Name

Last Name

Gender

Date of Birth

School Grade

School Name

Will attend:

Gan Shalom Nursery School Synagogue SchoolTeen Programming

First Name

Last Name

Gender

Date of Birth

School Grade

School Name

Will attend:

Gan Shalom Nursery School Synagogue SchoolTeen Programming

First Name

Last Name

Gender

Date of Birth

School Grade

School Name

Will attend:

Gan Shalom Nursery School Synagogue SchoolTeen Programming

Are there other adults living in the same household?

Please list any adult children or grandchildren that are members of your household.

If you want a notice sent to you as a reminder of an upcoming yahrzeit, please click the + button to add each yahrzeit.

Name of Deceased

Relationship

English Date of Death

Send letter on:

How or from what source did you learn about the Reconstructionist Synagogue of North Shore

Are there any comments you would like to include?

**If you are eligible for gift membership, contact the office at info@rsns.org or call 516.627.6274.**

* Please select your annual membership support level

Every person is valued at RSNS and we would never turn anyone away due to a financial hardship. If you need financial assistance, please choose 'I am requesting dues adjustment" in the dropdown menu above and contact Liza Wilson at ExecutiveDirector@rsns.org or call 516.627.6274.

* To further the work of RSNS and for capital improvement, members agree to pay a one-time fee of $1815 to RSNS (for its Building Fund) payable:

Total:

Sun, June 15 2025 19 Sivan 5785

Reconstructionist Synagogue of the North Shore

1001 Plandome Road

Plandome, NY 11030

516-627-6274

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