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SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Address(Required) Primary Phone(Required)Select:Cell phoneHome phoneWork phonePrimary Phone Number(Required)Second PhoneSelect:Cell phoneHome phoneWork phoneSecond Phone NumberThird PhoneSelect:Cell phoneHome phoneWork phoneThird Phone NumberRelationship Status (E.g., single, married, partnered, divorced, widowed)Children and Their Ages Employer or School Occupation Emergency 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Personal InformationSkills and Avocations (E.g., office, trade, tech, professional, artistic, etc.)Association with Other Religious or Spiritual GroupsIf you like, please list any present or past association with other religious or spiritual groups, including Buddhist groupsMeditation Retreats and Private Zen InstructionIf you like, describe meditation retreats you have attended or private Zen instruction that you have receivedIntroductions to the Rochester Zen Center 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 locationPrevious Membership If you have previously been a member of the Rochester Zen Center, please state whenTell us why you'd like to become a member of the Rochester Zen Center(Required)Medical Information and AccommodationsPlease 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.A Recent PhotoAccepted file types: jpg, jpeg, png, Max. file size: 20 MB.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.PLEASE NOTE: this form may take SEVERAL SECONDS to submit. Δ
