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Membership Type
Basic Membership
Co-Membership
First Name
Last Name
DOB
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Father's Hebrew Name
Mother's Hebrew Name
Address
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Marital Status
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Is Applicant a Convert?
Yes
No
If yes, please answer the following
Place of Conversion
Date of Conversion
Beth Din
Co-Applicant Information
First Name
Last Name
DOB
Hebrew Name
Tribe
Cohen
Levi
Yisrael
None Set
Father's Hebrew Name
Mother's Hebrew Name
Cell Phone
Email
Is Co-Applicant a Convert?
Yes
No
If yes, please answer the following
Place of Conversion
Date of Conversion
Beth Din
Wed, April 24 2024
16 Nisan 5784
Social Media
Wed, April 24 2024 16 Nisan 5784
