Please Select a Form: Please Select a Form:Renewal Form for Returning MembersForm for New Members

Adult 1 Title Adult 1 TitleMs.Mrs.Mr.Dr.Mx.RabbiOtherDecline to provide

Adult 2 Title Adult 2 TitleMs.Mrs.Mr.Dr.Mx.OtherRabbiDecline to provide

Legal Name (for tax receipts) - Adult 1 / Returning Family Name

Legal Name (for tax receipts) - Adult 2

Preferred Name / Pronouns (optional)

Preferred Name / Pronouns (optional)

Hebrew name for Adult 1

Hebrew name for Adult 2

Date of Birth for Adult 1

Date of Birth for Adult 2

I authorize the Temple Shalom President and/or the following member to vote as my proxy at the 2024/2025 Annual General Meeting. I authorize the Temple Shalom President and/or the following member to vote as my proxy at the 2024/2025 Annual General Meeting. President The following person

I authorize the Temple Shalom President and/or the following member to vote as my proxy at the 2024/2025 Annual General Meeting. I authorize the Temple Shalom President and/or the following member to vote as my proxy at the 2024/2025 Annual General Meeting. President The following person

Authorized Proxy for Adult 1

Authorized Proxy for Adult 2

Click to add a second adult member: Click to add a second adult member:

Home Address (to appear on tax receipt)

Province ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonUSAOther

City

Postal Code

Home Phone

Adult 1 Cell / Work Phone

Adult 2 Cell / Work Phone

Adult 1 Email

Adult 2 Email

Number of Children Number of ChildrenNo Children1 Child2 Children3 Children4 Children5 Children

Hebrew name for Child 1

English name for Child 1

Date of Birth for Child 1

Religious School Start Date for Child 1

B'nei Mitzvah date (Completed / Expected)

Parsha Read for Child 1 (Past / Future)

English name for Child 2

Hebrew name for Child 2

Date of Birth for Child 2

Religious School Start Date for Child 2

B'nei Mitzvah date (Completed / Expected)

English name for Child 3

Hebrew name for Child 3

Parsha Read for Child 2 (Past / Future)

Date of Birth for Child 3

Religious School Start Date for Child 3

B'nei Mitzvah date (Completed / Expected)

English name for Child 4

Parsha Read for Child 3 (Past / Future)

Hebrew name for Child 4

Date of Birth for Child 4

Religious School Start Date for Child 4

B'nei Mitzvah date (Completed / Expected)

Parsha Read for Child 4 (Past / Future)

English name for Child 5

Hebrew name for Child 5

Date of Birth for Child 5

Religious School Start Date for Child 5

B'nei Mitzvah date (Completed / Expected)

Parsha Read for Child 5 (Past / Future)

The Temple board has decided to annually re-build the Yizkor list. We invite all members to name friends, family and any other loved ones whose names they would like to have read from the bimah as a part of the Yizkor service, on Yom Kippur. Click to add names. The Temple board has decided to annually re-build the Yizkor list. We invite all members to name friends, family and any other loved ones whose names they would like to have read from the bimah as a part of the Yizkor service, on Yom Kippur. Click to add names.

English Names for the Yizkor list

Hebrew Names for the Yizkor list

(Optional) If there is any additional information or changes from last year you wish to provide, please do so here.

Would you like us to donate $18 of your membership contribution so that you, or another adult member of your household, can be registered as supporters of ARZA through Temple Shalom? ARZA Canada is the Reform Zionist voice in Canada and Israel. They emphasize equality, justice, and democracy in Israel. Learn more here: https://templeshalom.ca/jewish-life/jewish-resources/national-international-resources/what-is-arza/ Would you like us to donate $18 of your membership contribution so that you, or another adult member of your household, can be registered as supporters of ARZA through Temple Shalom? ARZA Canada is the Reform Zionist voice in Canada and Israel. They emphasize equality, justice, and democracy in Israel. Learn more here: https://templeshalom.ca/jewish-life/jewish-resources/national-international-resources/what-is-arza/

(Optional) Please indicate the names of the adults in your household who wish to be Temple Shalom members of ARZA:

Membership Type Membership TypeReturning Member / Family – 1.8% of Gross Family IncomeFirst-time Member Family – $450First-time Member – $270Student – $108Affiliate - $75

Total Contribution: $

Please indicate how you will be paying Please indicate how you will be payingE-Transfer (please include password below)Cheque (make out cheques to Temple Shalom)CanadaHelps (please see description at the top of the page for more information)Cash (please contact Patrick at treasurer@templeshalom.ca to arrange for cash to be delivered safely)

Please indicate below if you will be paying in multiple installments Please indicate below if you will be paying in multiple installmentsSingle paymentTwice-yearly paymentsQuarterly paymentsMonthly paymentsOther (please contact Patrick at treasurer@templeshalom.ca to make other arrangements)

Click if you are paying by E-transfer. Click if you are paying by E-transfer.

Click to confirm that you have reviewed the membership criteria and are eligible for membership (https://templeshalom.ca/about/by-laws/): Click to confirm that you have reviewed the membership criteria and are eligible for membership (https://templeshalom.ca/about/by-laws/):

E-transfer Password/ Security Question Answer: