DRAFT

In order to help us identify you, please also submit a recent photograph as well as your initial membership contribution.

Membership Application

Name(Required)
Date of birth(Required)
Mailing address(Required)
Permanent address (if different)
Emergency Contact: Name(Required)

Personal Information

Medical Information

Please answer the following medical questions to help us understand any difficulties that may arise in your meditation practice. This information will be kept confidential. Please notify the Head of Zendo if any of your answers change after you submit this application.
Are you in psychotherapy at this time?(Required)

Mailing Preferences

The Center's quarterly mailings and other announcements are sent via email. Do you wish to opt out of receiving this information?(Required)
By default the Center's quarterly periodical, Zen Bow, is sent to members as a physical magazine. Would you rather receive Zen Bow via email only?(Required)
The Center's Board of Trustees occasionally allows an organization such as the Buddhist Peace Fellowship to use the Center's mailing list. Would you like to be excluded from such mailings?(Required)

Membership Pledge

The suggested annual pledge is $500 for Contributing Members and $1,000 for Sustaining Members, but members are free to contribute more or less. We only ask that members give what their financial circumstances realistically permit, even if that is substantially less than the suggested amounts. If you join part way through the year, you may pro-rate your contribution based on the number of months remaining in the year.
Please enter a number greater than or equal to 0.
Please state your intentions by checking one of the boxes below.(Required)
I will pay my initial membership contribution by:(Required)

Payment Information

  • Please make your initial membership contribution upon submitting this application.
  • You may pay future contributions by writing a check, having your bank set up recurring payments to the Zen Center from your account, or by donating online.
  • If you wish to donate online, you may do so after submitting this application by clicking on any of the "Donate Online" buttons on the Center's website.
  • Membership and other donations to the Rochester Zen Center, a New York not-for-profit religious corporation, are tax-deductible as provided by law.

I agree to comply with the membership policy of the Rochester Zen Center. I also agree to follow the Center's practice forms, customs, and etiquette, and abide by the ethical guidelines, code of conduct, and sexual harassment policies.(Required)