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* Family Name

Spouse Last Name (if different)

* Home Phone

* Address 1

Address 2

* City

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* Member type

* Family tribe

* Title

* Spouse Title

* Bar Mitzvah Parasha

Bar Miztvah Parasha

* First name

* Spouse first name

* Convert

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Did you convert to Judaism?

In case you selected Please Contact Rabbi Yeshurun

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* Gender

* Spouse gender

* Hebrew name (no parent name)

* Spouse Hebrew name (no parent name)

* Father's Hebrew name

* Spouse father's Hebrew name

* Mother's Hebrew name

* Spouse mother's Hebrew name

* Email

Spouse email

Cell phone

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Birth date

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Wedding anniversary

Children?

Children (English and Hebrew names; English date of birth). Start each on a blank line.

Observe Yahrzeit(s)?

Yahrzeits [Full English name of deceased; full Hebrew name of deceased; English date of passing; Hebrew date of passing; Name of person observing; Relationship to observer]. Start each on a blank line.

Other information (if needed)

Fri, October 20 2017 30 Tishrei 5778

Fri, October 20 2017
30 Tishrei 5778

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Rosh Chodesh Cheshvan

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Candle Lighting: 6:31p

Parshat Noach

Shabbat, Oct 21

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Friday, Oct 20

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