APPLICATION FOR MESSIANIC JEWISH CONVERSION (GERUT)

CONTACT INFO  
First Name

Middle Name

Last Name
Suffix
Address
City
Province/State
Postal Code
Country
Phone
E-mail
PERSONAL INFO  
Birthdate (Must be 18 or over)
Occupation
Your Jewish heritage is Ambiguous Unknown
Mother's Maiden Name
(This is for security purposes)
Gender Male Female
If male, are you circumcised? Yes (required) No
Marital Status
If married,
spouse's name is
Is your spouse Jewish? Yes No Ambiguous No Spouse
Does your spouse agree
with your conversion?		 Yes No No Spouse
Do you follow
Messiah Yeshua?		 Yes (required) No
Years you have believed in Him:
SYNAGOGUE INFO  
Name
Full Address
Affiliation (CTOMC, UMJC, MBI, IAMCS, IFMJ, AMC, etc.)
Leader
Is your leader Jewish? Yes No
Phone
E-mail
Years attending
Ministry positions, if any
Does your synagogue
approve of your conversion?		 Yes No Do not Know
JEWISH LIFESTYLE  
Your chosen Hebrew name? (required)
Has Jewish mikveh performed?
(If yes, attach certification)		 Yes (required) No
Do you observe the Shabbat? Yes (required) No
Do you keep Biblical Kosher?
(Rabbinic Kosher not required)		 Yes (required) No
Do you try to follow Biblical Torah?
(Orthodox observance not required)		 Yes (required) No
Have you learned necessary
Hebrew blessings?
(V'shamru, Kiddush, etc.)		 Yes (required) No
Written account of your
Jewish lifestyle:
weekly routines,
observances,
confession of faith, etc.
FEES  
I want a Jewish conversion
certificate from CTOMC ($50.00)		 Yes (Required) 
Check or money order to CTOMC, Box 20064, Halifax, NS B3P 1L1
Certificate wording: "Meshiki Beit Din Yisrael  certifies that Real Name, having the Hebrew name of Hebrew Name has satisfactorily evidenced before this court to live in accordance with Hebrew Law and to joyfully acknowledge Jewish heritage and religion, and to be the offspring of Abraham, and thus is forever a Yehudit Ben Yisrael."
I want CTOMC to maintain a file
of authorization for me
($35.00 each year)		 Yes
Check or money order to CTOMC, Box 20064, Halifax, NS B3P 1L1

Signature

"I hereby affirm that the above statements are true and accurate to the fullest extent of my ability and knowledge."

__________________________________________

NOTE: If the "Submit this Application" button is not functioning, just copy and paste the filled out application into an email addressed to ctomc@eastlink.ca and we will review your application and reply.

Thank you for your application and participation in the Israel of G-d. If possible send or bring a signed recommendation from your rabbi to: CTOMC Box 20064 Halifax, NS B3P 1L1.