Leo Baeck 2


AJR Enrolment Form

Fields marked with * must be completed.
* surname:
* forename(s):
  daytime telephone number:
  evening telephone number:
* address:
  e-mail address:
  date of birth:
  refugee, second or
third generation?:
 second generation
 third generation
  town and country
or origin:
  former surname (if any):
  former forename(s) (if any):
  are you a synagogue user?
if so, please enter the name:
 what is your religion?:
 what is your occupation?:
 name of partner / spouse /
next of kin:
  address of next of kin:
  date of arrival in the UK:
  any other places of residence before
coming to the UK:
 how did you arrive?
 With Family
 As a Refugee 
 Camp Survivor
 In a Kindertransport
  would you be available to offer your services as a volunteer?
  please provide us with any other information
that would enable us to be of service to you: