Beach
Hebrew
Institute

 

Membership
Registration
Form

deadline: August 24, 2011

2011-2012 Fees

Family (couple or single adult with dependant children): $550.00
Single Adult: $325.00
Tickets for High Holy Days are included in membership

Welcome to our on-line payment process. There are two steps in this process: registration & payment. First, please complete the registration form below. When you have completed this form, an email will be sent to you and to the shul with your information.
No other recored will be kept.

Second, when you have completed the form, you will be taken to a new page that gives you the address to which you need to mail your cheque before your registration will become final. Thank you for completing both steps of the process.

Membership Fees are tax deductible.

* Required

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First Adult Member
Check one:	Cohen	Levi	Yisrael
*Given Name:			Hebrew Name
*Family Name:
*E-mail:
*Street:
*Apt.:
*City:		*Province:	--Select-- ON AB BC MB NB NF NS NT NU PEI QC SK YT
*Postal Code.:
Telephone:
	*home	work	cell

Second Adult Member
Given Name:			Hebrew Name
Family Name:
E-mail:
Telephone:
	home	work	cell

Children in Household (dependant and under age 24)
yyyy-mm-dd
Name		Date of Birth		Gender:	F M
Name		Date of Birth		Gender:	F M
Name		Date of Birth		Gender:	F M
Name		Date of Birth		Gender:	F M
Name		Date of Birth		Gender:	F M

Additional High Holy Day Tickets for extended family members

Additional tickets may be purchased for $100.00

Number of tickets required:

Names for each ticket:	1:
	2:
	3:
	4:

Reminder for Yahrzeit   No Change.

			month & day
Name:		YahrZeit Date:
Name:		YahrZeit Date:
Name:		YahrZeit Date:
Name:		YahrZeit Date:

*

<==Type the correct answer

You will receive an acknowledgement in your email presently.