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

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 2022 Annual General Meeting. I authorize the Temple Shalom President and/or the following member to vote as my proxy at the 2022 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 2022 Annual General Meeting. I authorize the Temple Shalom President and/or the following member to vote as my proxy at the 2022 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)

City

Province ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonUSAOther

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 Children

English name for Child 1

Hebrew 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)

Parsha Read for Child 2 (Past / Future)

English name for Child 3

Hebrew name for Child 3

Date of Birth for Child 3

Religious School Start Date for Child 3

B'nei Mitzvah date (Completed / Expected)

Parsha Read for Child 3 (Past / Future)

English name for Child 4

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)

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 you wish to provide, please do so here.

Would you like us to register you, or another adult member of your household, as a Temple Shalom member of ARZA? 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/what-is-arza/ Would you like us to register you, or another adult member of your household, as a Temple Shalom member of ARZA? 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/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: $

Click if you are paying by E-transfer. See https://templeshalom.ca/join-us/donate/ for more payment options. Click if you are paying by E-transfer. See https://templeshalom.ca/join-us/donate/ for more payment options.

E-transfer Password/ Security Question Answer:

Click to confirm that you have reviewed the membership criteria and are eligible for membership: Click to confirm that you have reviewed the membership criteria and are eligible for membership: