Membership Form – Holland Park Synagogue

APPLICATION FOR MEMBERSHIP

PRIVATE & CONFIDENTIAL

I hereby apply for election as a Member of the Spanish & Portuguese Synagogue, address above, in accordance with the rules of the Congregation of the Synagogue now in force, and I undertake to abide by the rules and any other rules that may hereafter be enacted. I also undertake to pay to the Synagogue an Annual Finta (Membership Contribution) in the sum fixed by the Executive Committee from time to time.

Title

In case of a lady applicant, please give status

Hebrew Name

Cohen Levy Israel

Father's Hebrew Name

Widowed lady to give Hebrew name of late Husband

Full Address

Post Code

Home Telephone Number

Office Telephone Number

Email Address

Occupation

Date of Birth

Place & Country of Birth

Please attach a current photo of the applicant and their partner if married.

If hitherto a member of another Synagogue, please state full name & address:

By whom introduced or name of nearest relative who is a member of the Congregation

In the case of a married applicant, please give name & address of Synagogue where married, date on which marriage took place

Enclose a copy of your Ketubah

Wife's Name

Wife's Hebrew Name

Wife's Maiden Name

Wife’s Date of Birth

Wife's Home Telephone Number

Wife's Office Telephone Number

Wife's Email Address

Wife's Occupation

If either the applicant or his wife is a convert to Judaism, please give name & address of authorising Beth Din and date of conversion

In the case of single applicant, state name & address of Synagogue where parents were married and date of marriage

Name(s) of children (if any)

Hebrew Name(s) of Children

Date(s) of Birth of Children

Details of Nahalot (if any)

I am willing/not willing to sign a Gift Aid Form (please delete as appropriate)

Willing Not Willing

All members shall pay Finta Beth Haim (Ascama12). The Executive Committee Reserves the rights to forego this payment if the following declaration is signed. If this is not signed, you will be invoiced as per attached schedule.

I Agree

I do not desire now to acquire the right to be buried in the Burial Grounds of the Congregation and request the Executive Committee to forego my contribution of Finta Beth Haim.

Signature of Applicant

Date Signed

APPLICATION FOR MEMBERSHIP

PRIVATE & CONFIDENTIAL

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