Membership application form
Please send the completed form to the address shown below.
Por favor, retornar este formulario a la siguiente dirección.
Membership Application Form. /Formulario para Nuevos Miembros.
(Please complete ALL SECTIONS in CAPITALS) (Por favor, usa MAYUSCULAS) Applications will not be considered unless ALL sections are completed.
| First Name(s) Nombre | |
| Surname Apellido | |
| Date(s) of Birth (Fecha de nacimiento) | |
| Hebrew Name (s) | Ben / Bat |
| Spanish Address, DireccionAddress 1 | |
| Address 2 | |
| Address 3 | |
| Town | |
| Post Code | |
| Country | |
| Phone Number (land)Telefono | |
| Phone Number (mob)Movil | |
| Email Address | |
| Alternative AddressAddress 1 | |
| Address 2 | |
| Town | |
| Post Code and Country | |
| Phone Number (land) |
Burial Requirements
| If this application is accepted, please reserve a designated double plot in the Benidorm Jewish Cemetery. We enclose a cheque for €200 as a donation made payable to Comunidad Israelita de Alicante. | Yes/No | |
| If this application is accepted, I/We wish to be buried in the Benidorm Jewish Cemetery. Please reserve me/us plot/s. I/We enclose a cheque for €25 as a donation per person made payable to Comunidad Israelita de Alicante | Yes/No please state number of plots | |
| Next of Kin with name and Phone number | ||
(Tick as appropriate)…(Marcar el apropiado:)
I wish to apply for membership of the Comunidad Israelita de Alicante and I enclose my Annual Subscription of: Family Membership: 250 euros. Individual Membership/Country membership if your main residence is not in Spain: 150 euros.
Solicito el ingreso como miembro en la Comunidad Israelita de Alicante, e incluyo mi suscripción de: Familiar: 250 euros. Individuales: 150 euros.
(Note: Annual subscriptions are renewable on the 1st January each year) (Nota: El abono esta renovable de 1 Enero cada ano)
Your application will depend upon production of certain documents and information to establish authentication of your Jewish background. Su aplicacion puede depender de la produccion de ciertos documentos e informacion.
Signature (Firma)___________________________ Date (Fecha)_________
Mr Rodney Shears, Hon. Treasurer, C/ Cagliari 1, Buzon 104,Urb. Java,03730 Javea
Alicante SPAIN
This information will NOT be disclosed to third parties, and will be used only by the Comunidad for administration purposes.
|
Click to download a printable version of the |