|First Name: *
||Last Name: *
|Two digit STATE + ZIP (or Province + Code)
PLEASE don't skip the state *
|Country: (Change if not USA)
||Home Phone: (Leave blank if you only have a cellphone)|
Cell Phone: *
Email Address: *
Alternate Email (Only if you have an additional address)
Please enter only personal email address, such as gmail, hotmail, msn, yahoo. Not corporate, government, or LDS/BYU.
|Interest (Control-click ANY that apply)
ANY Optional Comment, etc.
1) This Organization has no affiliation with the Church, does not represent the Church, receives no support from the Church, is not sanctioned by the Church in any way; therefore, its actions cannot be attributed to the Church.
2) No Officer, Director, or member shall proselytize or act in any way that may be construed as having the purpose of proselytizing of descendants of Abraham in the State of Israel.
Your applying implies that you agree to support the B'nai Shalom Mission Statement.