Rosh Pina Membership Survey
Household Information
First Name
*
Last Name
*
Email
*
I would like to sign up for the Rosh Pina announcement email
Phone Number
Hebrew Name
How many adults (including children above 12) in your household are you responding for? (Total Including Yourself)
*
Please Select
1
2
3
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?
Please Select
0
1
2
3
4
5
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 thrives on its volunteering spirit. How will you be able to help us succeed this year?
Kiddush (coordinate, purchase food, set up, clean up)
Shabbat clean up (return siddurim to the closet, return the Torah downstairs, help kiddush committee clean up)
Gabbai (coordinate and run Shabbat services)
Leining foordinator
Davening foordinator
Marketing (email announcements, help with the website, social media)
Community lunches (organize community lunches, purchase food, set up, clean up, arrange for additional volunteers)
Social/Special events (help plan social events, happy hours, seudah shlishit, joint-minyan events)
Children's programming
Hospitality (host visitors and guests who are in need of shabbat meals)
Hospitality (coordinate meals for visitors and guests)
Educational programs (recruit scholars-in-residence, coordinate divrei torah)
In what way would you like to be involved in services? Select all that apply
Leading Kabbalat Shabbat
Leading Shabbat Ma'ariv
Leading Pesukei D'Zimra
Leading Shabbat Shacharit
Leading Torah Service
Leyning - on Shabbat or holidays
Giving a Dvar Torah
Leading Shabbat Musaf
Receiving Alliyot/other honors
My Products
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I would like to donate the standard Membership Fee
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
I would like to donate an amount different than the standard fee for Rosh Pina Membership (instructions on how to pay will be given after you press submit)
$
Free
Total
$
0.00
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