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IPBS Application For Membership
To apply for an individual membership in the Irish Protestant Benevolent Society of Montreal, please complete this application in it's entirety and submit. Thank you!
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* Indicates required question
Email
*
Your email
Salutation
*
Choose
Mr.
Ms.
Mrs.
Dr.
First Name
*
Your answer
Last Name
*
Your answer
Street
*
Your answer
City
*
Your answer
Province/State
*
Your answer
Postal Code
*
Your answer
Mobile Phone
*
Your answer
Home Phone
*
Your answer
Business Name
Your answer
Business Phone
Your answer
Spouse (if applicable)
Your answer
What is your Irish heritage?
Your answer
Other connection(s) to the IPBS?
Your answer
Thank you for interest to become a member of the Irish Protestant Benevolent Society of Montreal. The annual dues are $25.00, payment of which must be made at the time your application is conditionally approved and annually thereafter.
By checking this box I authorize this request for membership to the IPBS for the named individual on this form.
*
Yes, Authorized
Required
---------------------- FOR IPBS INTERNAL USE -------------------------
Applicants, please do not enter anything in this section.
Proposer Name
Your answer
Seconder Name
Your answer
Date Conditionally Accepted
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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