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New Mispalel
New Mispalel
New Mispalel Form
Dear
New Mispalel,
Welcome to
the Mercaz Torah & Tefillah community.
Please complete this form:
*
Family Name
Spouse Last Name (if different)
*
Home Phone
*
Address 1
Address 2
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
*
Family tribe
Please Select One
Kohen
Levi
Yisrael
*
Title
Please Select One
Mr
Mrs
Ms
Rabbi
Dr
*
Spouse Title
Please Select One
Mr
Mrs
Ms
Rabbi
Dr
*
First name
*
Spouse first name
*
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
Spouse Cell
Birth date
Children?
Yes
No
Children (English and Hebrew names; English date of birth). Start each on a blank line.
Observe Yahrzeit(s)?
No
Yes
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.
Abilities, Volunteer, and Other information (Enter any special abilities or tasks you would like to volunteer for)
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NShei
Wed, March 22 2023 29 Adar 5783
