Linitzer Benefit Society
Membership Application
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Minutes
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AM/PM Option
Personal Information
Name of Applicant
*
Mr.
Mrs.
Ms.
Dr.
Prefix
First Name
Middle Name
Last Name
Date of Birth
*
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Month
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Day
Year
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Were you (and your spouse/partner if applicable) born of the Jewish faith?
*
Yes
No
If not, please give details about your conversion (when, where, and by whom):
Martial Status
*
Single
Married
Common Law
Separated
Divorced
Date of Marriage
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Month
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Day
Year
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Name of Second Applicant (First Applicant's Spouse or Partner)
Mr.
Mrs.
Ms.
Dr.
Prefix
First Name
Middle Name
Last Name
Date of Birth
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Month
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Day
Year
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Contact Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal Code
Home Phone Number
*
Applicant One Cell Number
Applicant Two Cell Number
Applicant One Work Number
Applicant Two Work Number
Applicant One Email
*
example@example.com
Applicant Two Email
*
example@example.com
Alternate Contact (Not Spouse)
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Family Information
Children's Name (if applicable)
First Name
Last Name
Date of Birth
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Month
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Day
Year
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Children's Name (if applicable)
First Name
Last Name
Date of Birth
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Month
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Day
Year
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Children's Name (if applicable)
First Name
Last Name
Date of Birth
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Month
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Day
Year
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Children's Name (if applicable)
First Name
Last Name
Date of Birth
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Month
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Day
Year
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Background Information
Other Memberships and/or Affiliations and length of time
Why do you wish to join our organization and are you willing to get involved in any activities?
Which of the following committees would you like to volunteer for?
*
Breakfast Committee
Charity Bingo Committee
Summer BBQ Committee
Hanukkah Party Committee
Do you have a Linitzer sponsor?
Yes
No
Sponsor's Name
First Name
Last Name
Relationship
Applicant's Statement
By selecting "I agree" below, I am agreeing to the following
I hereby certify that the information contained in this application is true and I agree to abide by the rules of the Society. I understand and agree that if any statement is found to be untrue, I may forfeit all benefits of the Society and may be expelled from membership, and that no refunds shall be due for amounts previously paid by me to the Society. I understand that admission to the Society is contingent on attending three general meetings and an Executive meeting. I further understand that to maintain my membership in the Society I am expected to attend no fewer than three (3) events per 12 month period (commencing on the day of my induction to the Society) and should I fail to do so I may be called before the Executive who have the power and authority to terminate my membership without refund.
Applicant One
*
I agree
I do not agree
Applicant Two
I agree
I do not agree
Submit
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