Application Form

We hereby apply for membership at Congregation Beth Tikvah Ahavat Shalom Nusach Hoari (CBTASNH), Dollard-des-Ormeaux, Quebec. If accepted, we agree to abide by and conform to its Constitution and by-laws now existing or which may be ratified from time to time. We undertake to make payment in accordance with the present regulations or those which may be adjusted in the future.

Adult 1 - Title

Adult 1 - First Name

Adult 1 - Middle Name

Adult 1 - Last Name

Adult 1 - Date of Birth

Adult 1 - Hebrew Name

Adult 1 - Fathers Hebrew Name

Adult 1 - Mothers Hebrew Name

Adult 1 - Tribe

Adult 1 - Jewish By:

Adult 1 - Please attach your conversion certificate

Adult 1 - Marital Status

Adult 1 - Gender

Adult 1 - Home Mailing Address

Adult 1 - City

Adult 1 - State

Adult 1 - Zip Code

Adult 1 - Home Phone

Adult 1 - Cell Phone

Adult 1 - Email Address

Adult 1 - Employer

Adult 1 - Occupation

Adult 1 - Business Address

Adult 1 - Business Phone

Adult 1 - Would you be interested in serving on the Board of CBTASNH?

Adult 1 - Would you be interested in serving on a committee of CBTASNH?

Adult 1 - If interested, please indicate which committees:

Adult 1 - Please tell us about your previous community involvement:

Adult 1 - Services and/or activities you would like CBTASNH to provide:

Adult 1 - Additional comments:

Is there a second adult applying for membership?

Wedding Anniversary Date

if applicable

Name of Rabbi who performed marriage ceremony:

if applicable

Of Congregation:

if applicable

City:

if applicable

Adult 2 - Title

Adult 2 - First Name

Adult 2 - Middle Name

Adult 2 - Last Name

Adult 2 - Date of Birth

Adult 2 - Hebrew Name

Adult 2 - Fathers Hebrew Name

Adult 2 - Mothers Hebrew Name

Adult 2 - Tribe

Adult 2 - Jewish By:

Please attach your conversion certificate

Adult 2 - Gender

Adult 2 - Mobile Phone

Adult 2 - Email

Does Adult 2 live at the same address?

Adult 2 - Home Mailing Address

Adult 2 - City

Adult 2 - State

Adult 2 - Zip Code

Adult 2 - Home Phone

Adult 2 - Employer

Adult 2 - Occupation

Adult 2 - Business Address

Adult 2 - Business Phone

Adult 2 - Would you be interested in serving on the Board of CBTASNH?

Adult 2 - Would you be interested in serving on a committee of CBTASNH?

Adult 2 - If interested, please indicate which committees:

Adult 2 - Please tell us about your previous community involvement:

Adult 2 - Services and/or activities you would like CBTASNH to provide:

Adult 2 - Additional comments

How many children live in the family home?

Child 1 - Gender

Child 1 - First Name

Child 1 - Middle Name

Child 1 - Last Name

Child 1 - Hebrew Name

Child 1 - Telephone if different from yours

Child 1 - Date of Birth

Has Child 1 had a bar/bat mitzvah?

Child 1 - Bar/Bat Mitzvah Date

Child 1 - Currently Attending

Child 1 - Secular School Name

Child 1 - Grade/Year Graduated

Child 2 - Gender

Child 2 - First Name

Child 2 - Middle Name

Child 2 - Last Name

Child 2 - Hebrew Name

Child 2 - Telephone if different from yours

Child 2 - Date of Birth

Has Child 2 had a bar/bat mitzvah?

Child 2 - Bar/Bat Mitzvah Date

Child 2 - Currently Attending

Child 2 - Secular School Name

Child 2 - Grade/Year Graduated

Child 3 - Gender

Child 3 - First Name

Child 3 -Middle Name

Child 3 - Last Name

Child 3 - Hebrew Name

Child 3 - Telephone if different from yours

Child 3 - Date of Birth

Has Child 3 had a bar/bat mitzvah?

Child 3 - Bar/Bat Mitzvah Date

Child 3 - Currently Attending

Child 3 - Secular School Name

Child 3 - Grade/Year Graduating

Child 4 - Gender

Child 4 - First Name

Child 4 - Middle Name

Child 4 - Last Name

Child 4 - Hebrew Name

Child 4 - Telephone if different from yours

Child 4 - Date of Birth

Has Child 4 had a bar/bat mitzvah?

Child 4 - Bar/Bat Mitzvah Date

Child 4- Currently Attending

Child 4 - Secular School Name

Child 4 - Grade/Year Graduating

The names of your deceased loved ones will be read in synagogue the Friday evening before the Yhartzeit Date (anniversary of death). Unsure of the date? Choose a date on which to remember your loved one.

How many loved ones would you like to be remembered by Yahrzeit?

Full Name of Departed

Hebrew name and father’s Hebrew name

Relationship

To whom?

English Date of Death

AM/PM ?

Hebrew Date of Death

Full Name of Departed

Hebrew name and father’s Hebrew name

Relationship

To whom?

English Date of Death

AM/PM ?

Hebrew Date of Death

Full Name of Departed

Hebrew name and father’s Hebrew name

Relationship

To whom?

English Date of Death

AM/PM ?

Hebrew Date of Death

Full Name of Departed

Hebrew name and father’s Hebrew name

Relationship

To whom?

English Date of Death

AM/PM ?

Hebrew Date of Death

Full Name of Departed

Hebrew name and father’s Hebrew name

Relationship

To whom?

English Date of Death

AM/PM ?

Hebrew Date of Death

Full Name of Departed

Hebrew name and father’s Hebrew name

Relationship

To whom?

English Date of Death

AM/PM ?

Hebrew Date of Death

* Je consents que cette application soit rédiger en anglais. I agree to this application being in English. I agree that all correspondence from CBTASNH be in English.

Je consents que cette application soit rédiger en anglais. I agree to this application being in English. I agree that all correspondence from CBTASNH be in English.

Adult 1 - Name

Adult 1 - Date of Application

Adult 2 - Name

Adult 2 - Date of Application

Sat, 20 April 2024 12 Nisan 5784