New Card Activation

For a new card, fill out the form below to request activation. All fields are required.

Full Name:

Email Address:

Phone Number:

Home Address:

Card Number (4 digits):

Membership Type:--Select Type--Shul Member #1 (If you are a member of the Shul and not the Mikvah)Guest #2 (If you are not a member of either the Shul or the Mikvah)Mikvah Member #4 (If you are a Member of the Mikvah)

Optional Notes:

Submit Activation Request

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Reactivation Request

If your card access has expired or your membership status has changed, please submit a reactivation request below.

Card Number (4 digits):

New/Current Membership Type:--Select Type--Shul Member #1Guest #2Mikvah Member #4

Reason for Reactivation / Notes:

Submit Reactivation Request

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Admin Login

Admins can log in here to view recent card activation and reactivation requests.

Admin Email

Admin Password

Log In & View Requests