2009-2010

I /WE _____________________________________are of the Jewish faith (Jewish mother or have been converted)
and hereby apply for membership in Congregation B’nai Zion of Key West, Florida, Inc.
I/We agree to abide by its by-laws (revised 2008)and the Articles of Incorporation.
A minimum of six month’s dues ($375.) is enclosed with this application. Annual dues are $750.

Name ___________________________________________________________________________

Hebrew Name ____________________________________________________________________

Birthday _________________________________________________________________________

Spouse Name _____________________________________________________________________

Hebrew Name _____________________________________________________________________

Birthday (Spouse/Partner)__________________________ Anniversary _______________________

Member – Kohen__________ Levi__________ Spouse/Partner – Kohen___________ Levi_______

Spouse/Partner Jewish? Yes ______ No_______ I/we came to the Keys from___________________

Keys Address_________________________City____________________ State______ Zip_______

Mailing Address______________________ City____________________ State_____ Zip__________

Home Telephone___________________Business ___________________Cell__________________

Email Address-1 __________________________________________________________________

Email Address-2 __________________________________________________________________

Web Site:________________________________________________________________________

Member’s Occupation_______________________Spouse/Partner Occupation__________________

Paid Amount______________________Check Number _______________ Today’s Date__________

Signature: _________________________________________________________________________

Page 1

Please Print this Application at 95% to Fit

Yes, I/We are interested in serving on a Committee/Volunteer activity… (Please check)

___ Kiddush, ___ Fundraising, ___ Finance, ___ Ritual, ___ Building & Grounds,

___ Social & Cultural,___ Chorus___Monthly Newsletter,___ Membership , ___ Cemetery,

___ Gift Shop, ___ Library, ___ Family Learning Center

Do you have a Cemetery Plot? _____________

If no, would you like more information to reserve one with CBZ?_____________________________

Emergency Contact1_________________________Tel______________Relationship______________

Emergency Contact2_________________________Tel______________Relationship______________

Children(s) Name-1 ________________Hebrew Name ______________________Birthday__________

Children(s) Name-2 ________________Hebrew Name______________________Birthday__________

Children(s) Name-3 _______________ Hebrew Name_______________________Birthday__________

Please include additional Yahrzeit information on the back of this application.

Name of Deceased ____________________________________ Relationship ____________________

Date of Death_____________________________________________________________________

Name of Deceased ____________________________________ Relationship ____________________

Date of Death_____________________________________________________________________

For information regarding the CBZ Family Learning Center, Please contact: Rabbi Shimon Dudai at 305-294-3414 or Liz Young 294-4463.

For questions and more information regarding membership, please call either Alan Solomon, the membership committee chairman 305-849-9001 or Rabbi Shimon Dudai at 305-294-3414.

The Board of Directors for CBZ is elected by the members in good standing at the Annual Meeting.
Anyone who has been a member in good standing for four or more years may be elected to the Board.

Please return this form and your check payable to Congregation B’nai Zion to the attention of the
Board’s President, Dr. Fred Covan at 750 United Street, Key West, Florida 33040.

Revised: NOV 2009