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YIKGH Membership Application
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* Indicates required question
Name
*
Your answer
Hebrew Name
Your answer
Spouse
Your answer
Hebrew Name
Your answer
Address
*
Your answer
Home Phone
Your answer
Cell
Your answer
E-mail Address
*
Your answer
Spouse E-mail Address
Your answer
Type of Membership
*
Single Member ($325 + $50 Security)
Family ($650 + $100 Security)
Name Child #1
Your answer
Age Child #1
Your answer
Name Child #2
Your answer
Age Child #2
Your answer
Name Child #3
Your answer
Age Child #3
Your answer
Name Child #4
Your answer
Age Child #4
Your answer
Father's Yahrtzeit
Your answer
Hebrew Date
Your answer
Mother's Yahrtzeit
Your answer
Hebrew Date
Your answer
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