Membership Application - Congregation Beth Tikvah Ahavat Shalom Nusach Hoari

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MEMBERSHIP 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 - First Name

Adult 1 - Middle Name

Adult 1 - Last Name

Adult 1 - Date of Birth

Adult 1 - Hebrew Name

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

Adult 1 - Father's Hebrew Name

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

Adult 1 - Mother's Hebrew Name

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

Adult 1 - Tribe

Adult 1 - Jewish By:

Adult 1 - Marital Status

Adult 1 - Home Mailing Address

Adult 1 - City

Adult 1 - Province

Adult 1 - Postal 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:

ADULT 1 - CEMETERY

Members in good standing are entitled to cemetery rights.
New members 45 years and older are required to pay a surcharge.
Please call our office for additional information.

I hereby waive my cemetery rights at Kehal Israel, Congregation Beth Tikvah section.

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 - First Name

Adult 2 - Middle Name

Adult 2 - Last Name

Adult 2 - Date of Birth

Adult 2 - Hebrew Name

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

Adult 2 - Fathers Hebrew Name

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

Adult 2 - Mothers Hebrew Name

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

Adult 2 - Tribe

Adult 2 - Jewish By:

Adult 2 - Gender

Adult 2 - Mobile Phone

Adult 2 - Email

Adult 2 - Business Phone

Adult 2 - Employer

Adult 2 - Occupation

Adult 2 - Business Address

Does Adult 2 live at the same address?

Adult 2 - Home Mailing Address

Adult 2 - City

Adult 2 - Province

Adult 2 - Postal Code

Adult 2 - Home 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

ADULT 2 - CEMETERY

Members in good standing are entitled to cemetery rights.
New members 45 years and older are required to pay a surcharge.
Please call our office for additional information.

I hereby waive my cemetery rights at Kehal Israel, Congregation Beth Tikvah section.

How many children do you have?

Child 1 - Gender

Child 1 - First Name

Child 1 - Middle Name

Child 1 - Last Name

Child 1 - Hebrew Name

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

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

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

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

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

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

*Click X on the Hebrew keyboard to enter your Hebrew name in English.

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

Please add the Yahrzeit names and dates below. A Yahrzeit notice will be sent to you.

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

Mon, 16 February 2026 29 Shevat 5786

Congregation Beth Tikvah
Ahavat Shalom Nusach Hoari

136 Westpark Blvd, DDO, QC, H9A 2K2
Tel: 514-683-5610 | Fax: 514-683-1867 | info@bethtikvah.ca

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