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Virtual Access Form 2022-23
Please verify reCaptcha before submitting the form.
Available to any non-resident of Miami-Dade County who is interested in participating via virtual access in the religious programming offered during the 2022- 2023 fiscal year. The cost is $360.
Virtual Access includes e-mail blasts, access to weekly worship services, High Holy Day services, participation in our festive supplemental holiday celebrations, as well as an electronic copy of the bi-monthly newsletter, Chai Lites.
It does not include voting rights, access to educational programs, access to clergy for life cycle events, or counseling assistance which are benefits of membership.
Adult 1 - Title
Adult 1 - First Name
Adult 1 - Last Name
Adult 1 - Nickname
Adult 1 - Birth date
Adult 1 - Email
Adult 1 - Mobile Phone
Adult 1 - Can we use your cell phone for texting services?
Please Select One
Yes
No
Adult 1 - Hebrew Name (if applicable)
Please use English letters
Adult 1 - Religious Background
Please Select One
Reform
Conservative
Orthodox
Other
Non-Jewish Denomination
Adult 1 - If you a member of a Synagogue, please list Synagogue name and location.
Adult 1 - Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Adult 1 - Wedding Date
Adult 1 - Photo
You can upload a maximum of 1 files.
Adult 1 - Employer
Adult 1 - Job Title/Occupation
Retired?
Yes
No
Adult 1 - Address and Unit #
Adult 1 - City
Adult 1 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Adult 1 - Zip
Adult 1 - Home Phone
Is this also the Billing Address?
Please Select One
Yes
No
Billing Street Address and Unit #
Billing City
Billing State
Billing Zip
Adult 2 - Is there a second adult on this Virtual Access?
Please Select One
Yes
No
Adult 2 - Title
Adult 2 - First Name
Adult 2 - Last Name
Adult 2 -Nickname
Adult 2 - Birth date
Adult 2 - Email
Adult 2 - Mobile Phone
Adult 2 - Can we use your cell phone for texting services?
Please Select One
Yes
No
Adult 2 - Hebrew Name (if applicable)
Please use English letters
Adult 2 - Religious Background
Please Select One
Reform
Conservative
Orthodox
Other
Non-Jewish Denomination
Adult 2 - Photo
You can upload a maximum of 1 files.
Adult 2 - Employer
Adult 2 - Job Title/Occupation
Adult 2 - Retired?
Yes
No
Is home address for Adult 2 same as for Adult 1?
Please Select One
Yes
No
Adult 2 - Address and Unit #
Adult 2 - City
Adult 2 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Adult 2 - Zip Code
How did you find us?
Attended Services/Event
Clergy
Family/Friend
Newspaper / magazine
Social media
Website / internet
Word of mouth
2022-2023 Virtual Access - $360
Mon, January 30 2023 8 Sh'vat 5783