Riverdale Temple Membership Application

Welcome to Riverdale Temple! We are delighted you have chosen to become part of our community. We hope that you will find membership an enriching experience, and encourage you to explore the diverse opportunities for Jewish expression that Riverdale Temple offers. Feel free to speak with our administrator with any further questions at 718-548-3800.

Information for Adult #1

* First Name

Middle Name

* Last Name

Mailings Should Be Addressed As? (i.e, Mr. Mrs. different last names)

Hebrew Name (if known)

* Home Address

* City

* State

* Zip Code

* Mobile Phone

Work Phone

* Preferred Email Address

Alternate Email Address

Birthdate

Marital Status

If Married, Date of Marriage

Other Religious Affiliation (if applicable)

Did your Jewish Education include (check all that apply)

Bar/Bat MitzvahConfirmationPost-Confirmation Religious School

Previous Synagogue Affiliation (if applicable)

Previous Synagogue Address

City

State

Zip Code

Occupation

Title

Employer

Work Adress

City

State

Zip Code

Specialization/Area of Expertise

Languages Spoken

Parents’ Information

Father’s Name

Mother’s Name

Yahrzeits Observed

First Name

Last Name

Date of Death

Relationship

Observed

EnglishHebrew

First Name

Last Name

Date of Death

Relationship

Observed

EnglishHebrew

First Name

Last Name

Date of Death

Relationship

Observed

EnglishHebrew

Information for Adult #2

First Name

Middle Name

Last Name

Mailings Should Be Addressed As? (i.e, Mr. Mrs. different last names)

Hebrew Name (if known)

Home Address

City

State

Zip Code

Mobile Phone

Work Phone

Preferred Email

Alternative Email

Birthdate

Marital Status

If Married, Date of Marriage

Other Religious Affiliation (if applicable)

Did your Jewish Education include (check all that apply)

Bar/Bat MitzvahConfirmationPost-Confirmation Religious School

Previous Synagogue Affiliation (if applicable)

Previous Synagogue Address

City

Zip Code

Occupation

Title

Employer

Work Adress

City

State

Zip Code

Specialization/Area of Expertise

Languages Spoken

Parent’s Information

Father’s Name

Mother’s Name

Yahrzeits Observed

First Name

Last Name

Date of Death

Relationship

Observed

EnglishHebrew

First Name

Last Name

Date of Death

Relationship

Observed

EnglishHebrew

First Name

Last Name

Date of Death

Relationship

Observed

EnglishHebrew

Children’s Information

First Name

Middle Name

Last Name

Birthdate

Sex

Current Grade

Bar/Bat Mitzvah Date

Name of School

First Name

Middle Name

Last Name

Birthdate

Sex

Current Grade

Bar/Bat Mitzvah Date

Name of School

First Name

Middle Name

Last Name

Birthdate

Sex

Current Grade

Bar/Bat Mitzvah Date

Name of School

Please DO NOT include our family in the Member Only Directory.

Membership Categories and Rates

Individual Annual Membership: $1,711

Family Annual Membership: $3,111

Financial Information

Indicate which membership category is applicable to you:

Total Membership Commitment

It is Riverdale Temple policy that nobody be turned away who wishes to affiliate with the congregation, but does not have the financial means to do so. If you are experiencing a challenging financial situation, our clergy and administrators are available to discuss your concerns confidentially.

Please click here to make your payment

* Adult #1 – Please sign your application electronically (Full Name) here:

Adult #2 – Please sign your application electronically (Full Name) here:

I/We understand that all resignations from Riverdale Temple MUST be received in writing by the temple office no later than 30 days prior to the effective resignation date.

Please sign electronically below:

* Adult #1 – Please sign electronically (Full Name) here:

Adult #2 – Please sign electronically (Full Name) here: