Personal Information

• First Name:
  
• Last Name:
  
• Address - Line 1:
  
• Address - Line 2:
  
• City:
  
• Zip:
  
• Email:
  
• Home Phone:
  
• Mobile Phone:
  

• Status in Israel: Citizen Volunteer Tourist Other
• Primary Language: Hebrew Arabic Russian English Other
• Other languages spoken:
  

• 0 1 2 3 4 5 6 7 8 9 10 How many children do you have?
• Boy Girl Age: First Child:
• Boy Girl Age: Second Child:
• Boy Girl Age: Third Child:
• Boy Girl Age: Fourth Child:
• Boy Girl Age: Fifth Child:
• Boy Girl Age: Sixth Child:
• Boy Girl Age: Seventh Child:
• Boy Girl Age: Eighth Child:
• Boy Girl Age: Ninth Child:
• Boy Girl Age: Tenth Child:
• How long are you planning to stay in Israel?

Congregation Information

• YesNoDo you consider Shemen Sasson to be your home congregation?
• How long have you been attending Shemen Sasson?
• YesNoDo you currently attend a Shemen Sasson Life Group?
• YesNoWould you like to join a Shemen Sasson Life Group?

• How can Shemen Sasson better serve your needs?
  
• In what way would you like to serve within the Shemen Sasson community?
  
• Other comments?
  

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• Enter Code: