Middah a Month Registration Form

* = required fields

SECTION 1 – Personal Data

First Name

Last Name

Address

City

State/Province

Zip/Postal Code

Country

E-mail

Phone Number

If registering as a family, please list the family members:

* Middah a Month is only available to people who have completed a course offered by The Mussar Institute or who have a strong background in Mussar studies. Please list here the last Mussar course you completed, or key details of your history of Mussar studies.

SECTION 2 – Payment

Please select one of the following four payment plans:

* You may pay by

	Credit card via PayPal.

	TO PAY BY CHECK/CHEQUE - YEARLY PLAN ONLY: To pay by check/cheque, please make payable to “The Mussar Institute”. For payment in other currencies, please send a money order or bank draft for the equivalent amount. Mail to: The Mussar Institute Suite 357 5525 West Boulevard Vancouver, BC V6M 3W6 Canada

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