Membership

Membership Application

Congregation Shaarei Shamayim

1600 Mount Mariah
Atlanta, GA 30329
404-417-0472: Phone
404-417-0472: Fax

His Full Name

Invalid Input

Her Full Name

Invalid Input

His Hebrew Name

Invalid Input

Is he a Cohen or a Levi?

Invalid Input

Home Address

Invalid Input

City

Invalid Input

State

Invalid Input

Zip

Invalid Input

Home Telephone Number

Invalid Input

His Cell Telephone Number

Invalid Input

Her Cell Telephone Number

Invalid Input

His E-mail address

Invalid Input

Her E-mail address

Invalid Input

His Date of Birth (mm/dd/yyyy)

Invalid Input

Her Date of Birth (mm/dd/yyyy)

Invalid Input

Date of Marriage (mm/dd/yyyy)

Invalid Input

Children

1st Childs Full Name

Invalid Input

1st Childs Hebrew Name

Invalid Input

1st Childs Date of Birth (mm/dd/yyyy)

Invalid Input

1st Childs School and Grade

Invalid Input

2nd Childs Full Name

Invalid Input

2nd Childs Hebrew Name

Invalid Input

2nd Childs Date of Birth (mm/dd/yyyy)

Invalid Input

2nd Childs School and Grade

Invalid Input

3rd Childs Full Name

Invalid Input

3rd Childs Hebrew Name

Invalid Input

3rd Childs Date of Birth (mm/dd/yyyy)

Invalid Input

3rd Childs School and Grade

Invalid Input

His Parents

His Mothers Name

Invalid Input

His Mothers Hebrew Name (Eng/Heb)

Invalid Input

His Mothers Age / Yartzeit (Eng/Heb)

Invalid Input

Fathers Name

Invalid Input

Fathers Hebrew Name (Eng/Heb)

Invalid Input

Fathers Age / Yartzeit (Eng/Heb)

Invalid Input

Her Parents

Her Mothers Full Name

Invalid Input

Her Mothers Hebrew Name

Invalid Input

Her Mothers Age / Yartzeit (Eng/Heb)

Invalid Input

Is / was your mother Jewish?

Invalid Input

Her Father's Full Name

Invalid Input

Her Father’s Hebrew Name (Eng/Heb)

Invalid Input

Her Father’s Age / Yahrzeit (Eng/Heb)

Invalid Input

Have you been married previously?

Invalid Input

Dues You Agree to Pay/Initial Donation

Invalid Input

All Charges are deductible and begin Jan 1 each year

Please CHECK One

Membership Categories

Family:$1500/year
Family Single Parent:$950/year
Young Married (under 30) $550
Seniors Married (one over 64): $750
Single (Over 29): $750
Single (24-29): $360
College Single (18-23 w/ID): No Charge
Newlyweds Married by Rabbi Kunis: Remaining 1st YR: No Charge
Associated Member (MUST be a member of another Shul): $500
Invalid Input
Adjustments of these charges is at the discretion of the Rabbi or Treasurer

Comments or Questions

Invalid Input

Security(*)

Invalid Input

Shaarei Shamayim
1600 Mount Mariah
Atlanta, GA 30329
(404) 417-0472

Membership Application

Contact Info

Amazon Smile

Dresslers

Tobin Law

Helpful Links

Search