Congregation Am Chai
Member Update Form

Items with an asterisk (*) are required               
Please complete this form in either paper form or online (link is at www.amchai.org/Newsinfo.html).  If in paper form, send it to the Membership Chairman.

NOTE: Please enter all dates as month/day/year (mm/dd/yyyy)

First Name of Member:*  Last Name of Member:*     Member Birthday   

Name of Additional Member (if needed, such as spouse with different surname)

First      Last      Birthdate   

Address (Street):*   City:*    State:*   Zip Code:*  

Home Phone:* (with area code) (###-###-####)   Work Phone: (with area code) (###-###-####)  

Email address:*       Anniversary Date (if married):   

Tribe:          


Please list the names and birthdates of your household members below

Name                                                       Relationship        Birthdate

(Include last name if different                (wife,husband,

than Member's)                                          son, etc.)

1                

2                

3                

4                

5                

Please list Yahrzeit below
Name                                                                    Relationship        Date

               

               

               

               

               

               

               

               

               

10               


revised 05/19/2008