Membership application - Elwood Shule.

How many seats are being purchased?
Men Women
Personal Information
Surname
Home Phone
Home Address
Street Address Address Line 2 Suburb State
Postal Address
Street Address Address Line 2 Suburb State

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Children
Children
Name Hebrew Name DOB School attending/attended Bar/Bat Mitzvah Date Parsha Married? When & Where Surname Spouse Name

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Yahrtzeits
Yahrtzeits
First Name Last Name Relationship to applicant Date of Death (Secular) Before or After Sunset

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Additional Information
Indicate by checking the correct box
- Re-joining
- New
We learned about ETTC from
Reason(s) for joining ETTC: (Indicate as many of the reasons below as may be applicable)
- Family is a member
- Friend is a member
- Services
- Adult Education
- Children Services
- Other
If Other
Consent
A cheque for $50.00 to be applied as partial payment towards membership dues. Returnable if application rejected.

After submitting this application form the Rabbi would like the opportunity of an informal discussion with you.
Please indicate if you would prefer to talk with him by
- Phone
- In Person
Please provide one name and contact number as a character reference
Character Reference Name Contact Number
ETTC may require the applicant to obtain a Police Clearance certificate.

Once the Rabbi approves the application, it will be presented to the Board for approval

For Re‐Joining or New Applicants: We hereby apply for Membership in Elwood Talmud Torah Congregation and if accepted, we agree to abide by its Rules and bylaws and declare that the information provided is true and accurate:
Signature of applicant
Your signature will be automatically date stamped
Signature of Co‐Applicant
Your signature will be automatically date stamped
ALL APPLICATIONS ARE SUBJECT TO BOARD APPROVAL
Requested from the Rabbi
The following information is respectfully requested exclusively for the Rabbi’s confidential examination and must be completed.
This page will be retained by the Rabbi. No one else in the Synagogue (except possibly the President or Secretary, in the course of conveying this application to the Rabbi) will see this information.
Is the Applicant Jewish by birth
Is the Co‐Applicant Jewish by birth
If the answer is no, please continue: Name(s):
Conversion
If the applicant and/or spouse are a convert, please provide the date of conversion and the name of the officiating Rabbi/ Beis Din, and attach any official documents (or copies) received in connection with the conversion.
Date of Conversion (D/M/Y) Beit Din Officiating Rabbi Name of Beis Din
Divorce
Has the Applicant been previously married
- Yes
- No
Has the Spouse been previously married
- Yes
- No
If answer is [x] yes please continue: Name(s):
Was the marriage terminated by
- Divorce
- Death
- Annulment
Has the ‘Get’ been issued?
Max. file size: 128 MB.
Please upload a copy of any letter or document issued in connection with a regular divorce or annulment.

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Name	Hebrew Name	DOB	School attending/attended	Bar/Bat Mitzvah Date	Parsha	Married? When & Where	Surname	Spouse Name

First Name	Last Name	Relationship to applicant	Date of Death (Secular)	Before or After Sunset

Date of Conversion (D/M/Y)	Beit Din Officiating Rabbi	Name of Beis Din

Personal Information

Applicant

Spouse

Marriage Details

Children

Yahrtzeits

Additional Information

Consent

Requested from the Rabbi

Conversion

Divorce

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