*First Name:
*Last Name:
*Address:
*City:
*State:
*Postal Code:
Phone: (optional)
*Email:

* required

How did you hear about Congregation Etz Chaim?    

How would you like us to follow up with you?
 Please call the phone number listed above.
 Please mail me your brochures and information.
 Please mail me a sample copy of the monthly newsletters L'Chaim.
 Please add me to your email list for regular updates and announcements.


Please tell us a little more about yourself. These items are optional but will help us get to know you. Do you live in South Florida?
I'm a full time resident
I/we live here during winter season only. Are you currently a member of any synagogue?  
I/we belong to another synagogue.  
I/we do not belong to a synagogue at this time. Are you currently a member of any synagogue?  
I/we belong to another synagogue.  
I/we do not belong to a synagogue at this time. Have you been a Bar/Bat Mitzvah?  
Yes.  
No.
What age group do you fall into?    

Do you have children?
No.
Yes, adult children.
Yes, young children.
There is a lot going on at our synagogue.

Which activites would interest you?
 Attending Shabbat services.
 Social activities
 Educational programs
 Etz Chaim Sisterhood
 Tzedakah & Tikkun Olam Committee
 Ritual Committee Please use this space to direct questions or comments to Congregation Etz Chaim: 
 

PRIVACY POLICY:
We understand and appreciate the importance of privacy regarding the personal information you provide to us.
We use the data gathered only to provide you with more information about our synagogue.
The information you give will NOT be sold or distributed at any time to any unaffiliated third parties.
 

 
 
 
   
 

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