Yavneh Minyan of Flatbush Membership Information Update
RequiredRequired Question(s)
Please help us to update our records and serve you better.

We ask that you take a moment to complete this form, even if you have recently sent in a paper membership form.

If you receive this at multiple email addresses, it's only necessary to submit one survey per membership.

Thank you for your cooperation, and for being a member of the Yavneh Minyan of Flatbush!
 
Part 1. Member Information
 
Required
First and last name:
 

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Hebrew name (please use English transliteration): 

 

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Father's Hebrew name (please use English transliteration): 


 

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Mother's Hebrew name (please use English transliteration): 

 

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Occupation:

 

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Birthdate:

 

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If you have a family membership, first and last name of spouse: 

 

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Spouse's Hebrew name (please use English transliteration): 

 

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Spouse's Father's Hebrew name (please use English transliteration)

 

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Spouse's Mother's Hebrew name (please use English transliteration)

 

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Spouse's Occupation: 

 

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Spouse's Birthdate: 

 

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What is your Wedding Anniversary? 

 

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May we publish birthday and anniversary wishes to you and/or your spouse in the shul newsletter? 

Yes
No
Other  

Are you a 

Cohen
Levi
Yisrael
What is your Bar Mitzvah Anniversary/Parsha?
 

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Please list your children's names and birthdates (including Hebrew names [in English transliteration]), one per line: 

 

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May we publish birthday wishes to your children in the shul newsletter? 

Yes
No
Other  

Please list any yahrzeits you observe, including the date, name, and relationship. (Please use English transliteration for Hebrew names)

 

1000 characters left.
Please let us know what accommodations would improve or facilitate your experience at Yavneh?
Wheelchair accessibility
Large print books and handouts
Additional language books (please note language in comments)
Assisted listening devices
Health-related dietary restrictions
Other -- please specify in comments
  • Comment:

  • 500 characters left.
Part 2: Contact info. Please provide your contact information so we can update and/or verify our records.
 

Home Address: 

 

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Phone Number(s): 

 

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Email addresses that you would like us to send email to (including the newsletter): 

 

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Required

May we publish your address, phone, and email address in a directory available to Yavneh Members?

Yes
No
  • Comment:

  • 500 characters left.
Part 3: We would like your input on Minyan davening and activities. Please let us know your interests and concerns.
 

What would you like to see more of at the Yavneh Minyan? 

 

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Would you be interested in serving on any of the following committees? 

Hospitality/Greeting
Chessed
Fundraising
Building Search
Education
Singles
Membership Recruitment and Outreach
Other  
  • Comment:

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How would you like to contribute more to the Minyan? Please let us know if you can volunteer to help with events or activities, or if you have special skills that you can contribute. 

 

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Would you be willing to help with any of the following activities: 

Making phone calls about Minyan events
Delivering or providing food for shiva homes
Hosting people for Shabbat or Yom Tov meals
Helping to set up the shul before Shabbat
Other  

Any other comments or suggestions? 

 

350 characters left.