The Northern Virginia
Reconstructionist Community

Is this the first time you have submitted a survey to NVRC? Yes No

Your first and last names:
First and last names of second adult in household:

Street Address:
City:	State: Zip Code:

Home Phone (with area code):
Work Phone (with area code):
Cell Phone (with area code):

Preferred E-mail Address:
Secondary E-mail Address:

What is the best way to contact you? Phone E-mail Snail Mail

Do you have children? Yes No

If yes, what are their ages?

How did you hear about NVRC? Please check all that apply.
The Washington Post
The JCCNV Program Guide
The Washington Jewish Week Ad
The Washington Jewish Week Calendar
A friend
The Jewish Reconstructionist Federation
NVRC Website
The Connection Newspapers
Other (Please specify: )

What is (are) your main reason(s) for learning more about NVRC? Check all that apply.
Want to attend regular services
Want to be part of a Jewish community and be with people who share similar values
Want to have a place/group to celebrate religious holidays
Want to have religious education for my children
Want to attend discussion groups about Reconstructionism, Judaism, religion, Torah
Want to have access to a rabbi for lifecycle events, counsel, etc.
Want to seek group or individual opportunities to perform community service
Other(Please specify: )

What are the best days and times for you to attend services and events? Please check all that apply.
Friday evening
Saturday morning
Saturday evening
Sunday morning
Sunday evening
Weeknights

If you indicated weeknights, what is the best night for you?
Monday
Tuesday
Wednesday
Thursday
What is the best time span for you on weeknights?

What is the most convenient location in Northern Virginia for you?
Arlington Annandale Burke Springfield Fairfax Alexandria Other
If you selected Other, please specify:

If you have children, would it be beneficial if we were able to arrange a child care provider during services and events? Yes No

Would you be willing to pay a small fee for child care during services and events? Yes No

Are you interested in helping NVRC grow by taking an active role in the community? Yes No

If so, which of the following activities are of interest to you? Please check all that apply.
Lead a Friday night service
Lead a Saturday morning service
Help set up an Oneg or Kiddush
Sponsor an Oneg or Kiddush
Plan or lead an adult education program
Help in the Hebrew School
Help out during the High Holy Days
Help with publicity
Help plan a special event for adults (theater outing, museum trip, speaker, etc.)
Lead a Saturday morning youth service
Plan a Tikkun Olam (community service) initiative

If there are other ways you would like to help NVRC grow, please tell us about them below:

Do you subscribe to NVRC_News, our announcement-only Yahoo! Group? Yes No

If no, would you like us to add you to the NVRC_News Yahoo! Group? Yes No

If there is anything else you'd like to tell us, please do so in the box below:

Thank you for completing our Contact Information & Survey form. To submit the form, please click on the Submit button below.