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Shaarey Tphiloh Member Update
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* Indicates required question
Email
*
Your email
Name of Member 1 (First and Last)
*
Your answer
Hebrew Name of Member 1 ( ___ ben/bat ___, for example: "Yitzchak ben Avraham and Sarah")
Your answer
Member 1 Birthdate
*
MM
/
DD
/
YYYY
Name of Member 2 (First and Last)
Your answer
Hebrew Name of Member 2 ( ___ ben/bat ___, for example: "Yitzchak ben Avraham and Sarah")
Your answer
Member 2 Birthdate
MM
/
DD
/
YYYY
Home Address (include house or apt #, City, State and Zip Code)
*
Your answer
Home Phone # (please include area code)
Your answer
Member 1 Cell Phone # (please include area code)
Your answer
Member 2 Cell Phone # (please include area code)
Your answer
Member 1 Email address
*
Your answer
Member 2 Email address
Your answer
Marital Status
Single
Married
Divorced
Widowed
Children [name(s), Hebrew name(s), birthdate(s)]
Your answer
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