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Membership

Join Our Community

* Membership type

Please Select OneMembership - Family ($200) *includes children living at home under 25Membership - Individual ($100)

Primary contact

* Title

* First Name

* Last Name

* Gender

* Date of Birth

* Marital Status

If married, please complete the spouse section below before submitting application.

Date of Marriage

* Preferred Email

* Home Phone

* Mobile Phone

Mailing Address

* Mailing Address

Apt #

* City

* Province / State

* Postal Code / Zip

Cottage Address

Address

Apt #

City

Province

Postal Code

Work

Occupation

Your Title

Business Phone

Business Name

Business Address

City

Province / State

Postal Code / Zip

Spouse

Title

First Name

Last Name (if different)

Gender

Birthday

Spouse Email

Spouse Mobile Phone

Occupation

Title

Business Phone

Business Name

Business Address

City

Province / State

Postal Code / Zip

Gabbai

* Tribe

* Your Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Spouse Hebrew Name

* Spouse Father's Hebrew Name

Spouse Mother's Hebrew Name

Children

Please Select OneYesNo

Child 1.

English Name

Hebrew Name

Date of Birth

Child 2.

English Name

Hebrew Name

Date of Birth

Child 3.

English Name

Hebrew Name

Date of Birth

Child 4.

English Name

Hebrew Name

Date of Birth

Please list any other children in the "other information" box below - include their English and Hebrew names and their Date of birth.

Yahrzeit(s)

* Track Observances

Please Select OneYesNo

Yahrzeits [Full English name of deceased; full Hebrew name of deceased; English date of passing; Hebrew date of passing; Name of person observing; Relationship to observer]. Start each on a blank line.

Other

Please provide us with any other information that you feel may be helpful

* I/we are the party applying for membership with Congregation House of Israel and understand that I/we are responsible for this membership account

I/we are the party applying for membership with Congregation House of Israel and understand that I/we are responsible for this membership account

Wed, March 22 2023 29 Adar 5783

Telephone: 819.326.4320

E- mail: info@houseofisrael.org

MAIL ADDRESS:

P.O. Box 293
Ste-Agathe-des-Monts, Québec
J8C 3A3

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