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Home > Get Started at the Center > Becoming an RZC Friend or Member > Membership Application

Membership Application

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Name(Required)
If other than your first name
(E.g., she/her, he/him, they/them)
Date of Birth(Required)
Mailing Address(Required)
Permanent Address
(If different than mailing address)
(E.g., single, married, partnered, divorced, widowed)
Emergency Contact: Name(Required)
Please enter a phone number and whether to text or call. If using a phone isn't an option, please enter an email address.

Personal Information

(E.g., office, trade, tech, professional, artistic, etc.)
If you like, please list any present or past association with other religious or spiritual groups, including Buddhist groups
If you like, describe meditation retreats you have attended or private Zen instruction that you have received
If you have attended an Introductory Workshop or Introduction to Practice conducted by Roshi Bodhin Kjolhede, Sensei John Pulleyn, Sensei Donna Kowal, or one of their senior students, please give the date and location
If you have previously been a member of the Rochester Zen Center, please state when
Please tell us about any medical or psychological conditions or medications you'd like us to know about and any accommodations you may need (e.g., ASL, wheelchair access). This information will be kept confidential.
Note: If you have a food allergy and attend a RZC event where food is served, you should check directly with the Head Cook to confirm ingredients.
As a way to get to know you, it's helpful If you upload and share a digital photo of yourself.
Please note: the maximum size is 2 MB. Also, if you use "Save & Continue Later, uploaded files are not saved.
Accepted file types: jpg, jpeg, png, Max. file size: 2 MB.

PLEASE NOTE: this form may take SEVERAL SECONDS to submit.

  • About
    • Who We Are
    • Affiliate Groups
    • Our Retreat Center
  • Contact Us
  • Get Started
    • What is Zen Practice?
    • How to Sit
    • Intro to Zen: Meditation Workshop
    • Tuesday Beginners’ Night
  • Practice with us
    • Online Zazen
    • Weekly Schedule
    • Extended Sitting
    • Residential Zen Training
    • Live Streaming Audio
  • Community
    • Family Program
    • Uprooting Racism
    • Zen of Living and Dying
  • Calendar
  • Resources
    • RZC Podcast
    • Zen Bow
    • Zen Chants
    • Suggested Reading List
    • FAQ
  • Sesshin
    • In-person Sesshin
    • Online Sesshin
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7 Arnold Park, Rochester, NY 14607 (585) 473-9180

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