Rosh Pina Membership Survey

Rosh Pina does not charge a formal membership rate, instead asking our members to donate an amount of their choice. We recommend that members donate $260 per adult for their membership, and $340 per adult if they are able. However, a donation of any amount is welcome and qualifies for membership. Membership includes a Yom Kippur ticket. You can also purchase a Yom Kippur ticket without membership for $80 by selecting the "Guest Yom Kippur ticket" option at the bottom of this form.

The Yom Kippur schedule for 5787 will be:

Kol Nidrei: 6:50pm
Shacharit: 9:00am
Yizkor: approx. 11:45am
Mincha: 5:20pm
Neilah: approx. 6:30pm
Fast Ends: 7:47pm

Household Information

First Name

Last Name

Email

Phone Number

Hebrew Name

Children aged 12 and up are counted as adults.

How many adults in your household are you responding for? (Total Including Yourself)

Name of Adult 2 in Household

Email Address of Adult 2

Hebrew Name of Adult 2

Name of Adult 3 in Household

Email Address of Adult 3

Hebrew Name of Adult 3

How many children in your household are you responding for?

Name of Child 1

Name of Child 2

Name of Child 3

Name of Child 4

Name of Child 5

Special Dates

Bar/Bat Mitzvah Parsha

Bar/Bat Mitzvah Parsha of Adult 2

Bar/Bat Mitzvah Parsha of Adult 3

When are the yahrzeits of any of your family members? For each, include your family member's name, relationship, and Hebrew yahrzeit.

Volunteer Opportunities

Rosh Pina is able to thrive due to our volunteer spirit. How will you be able to volunteer for us this year?

In what way would you like to be involved in services? Select all that apply. If you would like to learn how to do any of these things, please specify in Other.

Yom Kippur

Would you like to order tickets for Rosh Pina's Yom Kippur services?

Number of Yom Kippur tickets needed (ages 12 and up) -- women's side of the mechitza:

Number of Yom Kippur tickets needed (ages 12 and up) -- men's side of the mechitza:

My Products

Rosh Pina Membership Donation with Yom Kippur Ticket$260.00

Quantity

Rosh Pina Membership Donation without Yom Kippur Ticket $260.00

Quantity

Yom Kippur Guest Ticket$80.00

Quantity

I would like to donate an amount other than $260 for Rosh Pina membership (payment instructions will be given after you press submit)Free

Total $0.00