Member Last Name:

Member First Name:

M. Initial:

Yes (Thanks so much!)
Undecided
No

If your answer was No, please indicate the reason:

Moving out of area
Cost of membership
Becoming less observant
Becoming more observant

If Undecided, may we call you?

Sure No

2. If you have children under 13 yrs. of age, will they be enrolled in Religious School this coming year?

Yes No

Yes No
4. Do you have any friends or family members who might be interested in becoming Ohr HaTorah members?

(If yes, please complete 4a)

Yes No

Yes No

Never
Seldom
Once a month
Twice a month
Weekly