July 14, 2025 -

  • 419.517.8400

CBI Membership Form

Thank You for Your Interest in
Congregation B'nai Israel

Please fill out the the form below and click on the “Submit” button when you are finished. If you have questions, please contact our Membership and Community Outreach Coordinator, Rhoda Miller at

rmiller@cbitoledo.org

CBI Membership Form

Application for membership at Congregation B'nai Israel, Sylvania, Ohio.

"*" indicates required fields

Member "A" Information

Member "A" must be Jewish
Member Name*
Title

Primary Address*
Date of Birth
Marital Status
Wedding Anniversary
Sex

Bar/Bat Mitzvah Date
Tribal Affiliation
All Jews identify as being a Kohen (a descendant of Aaron), or Levite (from the tribe of Levi), or simply an Israelite, a Jew with no particular tribal affiliation.
Use English letters, include "ben" or "bat"
Jewish By...
Would You Be Interested in Any of the Following?

Member "B" Information

Member "B" is spouse/partner of Member "A"
Member Name
Title

Primary Address
Only fill out if address is different from Member "A" Primary Address.
Sex

Date of Birth
Bar/Bat Mitzvah Date
Tribal Affiliation
All Jews identify as being a Kohen (a descendant of Aaron), or Levite (from the tribe of Levi), or simply an Israelite, a Jew with no particular tribal affiliation.
Use English letters, include "ben" or "bat"
Jewish By...
Would You Be Interested in Any of the Following?

Second Home Information

If you have a second home, please complete this information.
Date leaving Primary Address
Date returning to Primary Address
Address - Second Home

Children's Information

Child 1: English Name
Use English letters, include "ben" or "bat"
Child 1: Date of Birth

Child 2: English Name
Use English letters, include "ben" or "bat"
Child 2: Date of Birth

Child 3: English Name
Use English letters, include "ben" or "bat"
Child 3: Date of Birth

Child 4: English Name
Use English letters, include "ben" or "bat"
Child 4: Date of Birth

Child 5: English Name
Use English letters, include "ben" or "bat"
Child 5: Date of Birth

Yahrzeit Information

If you wish to be notified for a yahrzeit, please fill out the following information.
Yahrzeit 1: Name of Deceased
Yahrzeit 1: English Date of Death
Yahrzeit 1: Before or After Sundown
The Hebrew calendar date changes after sundown each day. In order to calculate the correct Hebrew date of death, please indicated whether the deceased passed before or after sundown.

Yahrzeit 2: Name of Deceased
Yahrzeit 2: English Date of Death
Yahrzeit 2: Before or After Sundown
The Hebrew calendar date changes after sundown each day. In order to calculate the correct Hebrew date of death, please indicated whether the deceased passed before or after sundown.

Yahrzeit 3: Name of Deceased
Yahrzeit 3: English Date of Death
Yahrzeit 3: Before or After Sundown
The Hebrew calendar date changes after sundown each day. In order to calculate the correct Hebrew date of death, please indicated whether the deceased passed before or after sundown.

Yahrzeit 4: Name of Deceased
Yahrzeit 4: English Date of Death
Yahrzeit 4: Before or After Sundown
The Hebrew calendar date changes after sundown each day. In order to calculate the correct Hebrew date of death, please indicated whether the deceased passed before or after sundown.

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Congregation B'nai Israel
6525 Sylvania Avenue, Sylvania, Ohio 43560
419.517.8400|Email Us

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