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Enter your information - spouse information will be entered below (if applicable)
Name
Prefix First Last
Date of Birth
Month
Day
Year
Hebrew Birth Month
Hebrew Birth Day
Cell Phone Number
Home phone
Email
(Hebrew Name) BEN/BAT (Father's Hebrew Name)
Tribe (males only)
- Kohen
- Levi
- Yisrael
Bar Mitzvah Parsha (males only)
Spouse Information:
- Not Applicable
Hidden
Section Break
Wedding Anniversary
Month
Day
Year
Hebrew Wedding Anniversary Month
Hebrew Wedding Anniversary Day
Spouse Name
Prefix First Last
Spouse Date of Birth
Month
Day
Year
Spouse Hebrew Birth Month
Spouse Hebrew Birth Day
Spouse Cell Phone Number
Spouse Home Phone (if different)
Spouse Email
Spouse (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Spouse Tribe (males only)
- Kohen
- Levi
- Yisrael
Spouse Bar Mitzva Parsha (males only)
Children Living In Your Home
- Not Applicable
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
Child 1
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Hebrew Birth Month
Child's Hebrew Birth Day
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Child 2
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Child's Hebrew Birth Month
Child's Hebrew Birth Day
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Child 3
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Child's Hebrew Birth Month
Child's Hebrew Birth Day
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Child 4
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Child's Hebrew Birth Month
Child's Hebrew Birth Day
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Child 5
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Child's Hebrew Birth Month
Child's Hebrew Birth Day
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Child 6
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Child's Hebrew Birth Day
Child's Hebrew Birth Month
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Child 7
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Child's Hebrew Birth Day
Child's Hebrew Birth Month
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Child 8
Child's Name
First Last (if different)
Child's Gender
- Male
- Female
Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)
Child's Bar Mitzva Parsha (males only)
Child's Date of Birth
Month
Day
Year
Child's Hebrew Birth Day
Child's Hebrew Birth Month
Child's Email (if over 13)
Child's Cell Phone Number (if over 13)
Child's School
Other School
Child's Current Grade
Please share any of your child's hobbies, strengths, and interests.
Yahrtzeit List
You can add additional entries by clicking the plus sign to the right.
Departed's English Name Departed's (Hebrew Name) BEN/BAT (Father's Hebrew Name) Yahrtzeit Observed By: Departed's Relation to Observer English Date of Death Hebrew Date of Death
Hidden
Section Break
Mi Shebairach List (if applicable)
Please enter the names of individuals you wish to make a mi shebairach for when you get an aliyah. Add additional entries by clicking the plus sign to the right. If you entered Hebrew names for immediate family members above, they will automatically be included. This field is for anyone you did not include above.
(Hebrew Name) BEN/BAT (Father's Hebrew Name) English Name (First and Last) Relation
I moved recently, or my address in the directory is incorrect.
Clicking "yes" will open a space to enter your current address.
- Yes
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Any other information we should know about?

Departed's English Name	Departed's (Hebrew Name) BEN/BAT (Father's Hebrew Name)	Yahrtzeit Observed By:	Departed's Relation to Observer	English Date of Death	Hebrew Date of Death

(Hebrew Name) BEN/BAT (Father's Hebrew Name)	English Name (First and Last)	Relation

Enter your information - spouse information will be entered below (if applicable)

Section Break

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Child 7

Child 8

Section Break