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Information about you
Start the survey by creating an account. This way you'll be able to save the survey as you go along.
Username
*
Please choose a username for YOUR EcoSynagogue account using your synagogue or community name.
Password
*
Please choose a password to access your EcoSynagogue account
Enter Password
Confirm Password
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Rabbi
Prefix
First
Last
Email
*
Phone Number
*
Additional Name
*
This should be the name and contact details of a member of your community’s professional team, office manager or similar.
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Rabbi
Prefix
First
Last
Email
*
Phone Number
*
Information about your Synagogue
Name of Synagogue
*
Synagogue denomination
*
Synagogue address
*
Synagogue phone number
*
Approx number of members
*
Do you have a Synagogue building
*
Yes
No
Do you have land attached to your Synagogue building?
*
Yes
No
Approx age of main synagogue building
*
The details you supply will be stored and will be used to send you information about EcoSynagogue and affiliated projects. The details will be stored in compliance with the Data Protection Act and will not be supplied to others without your permission.
*
Please check this box to proceed.
Phone
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