BETHLEHEM WALK TO EMMAUS
Pilgrim Application
Please complete and return to your sponsor. A nonrefundable registration deposit of $35.00 is required. The deposit will be applied toward the $125.00 registration fee for the weekend. This fee offsets some of the expenses of your Emmaus weekend. Make checks payable to Bethlehem Walk to Emmaus. Send application and fee to:
Bonnie Hicks /Registrar
454 Co. Rd. 19, Headland, Al. 36345
Phone: 334 693-2457 email : jahicks@centurytel.net
Name___________________________________________
Age_______DOB__________Sex_________________
Address_________________________________________City________________________State____Zip___________
Home Phone (____)___________________________Email_________________________________________________
Occupation__________________________________Work Phone (_____)_____________________________________
Name preferred on Name Tag_________________________________________________________________________
Marital Status:____S____M____D____W____Spouse’s Name_______________________________________________
Has spouse attended a Walk to Emmaus / Cursillo / Tres Dias / Via de Cristo / Chrysalis_______When________________
Name of Church you regularly attend_____________________________City____________________________________
Your Sponsor’s Name_______________________________________________________________________________
Has your sponsor explained the Emmaus Weekend?________________Reunion Groups?__________________________
Describe any special diet you are on_____________________________________________________________________
__________________________________________________________________________________________________
Describe any special medication you are on________________________________________________________________
__________________________________________________________________________________________________
Describe any physical condition that would require special attention during your Walk________________________________
__________________________________________________________________________________________________
Briefly state why you wish to attend the Walk to Emmaus_____________________________________________________
__________________________________________________________________________________________________
Please sign_________________________________________________________________________________________
For use by Registrar Only
Date Received: Deposit Received: $
Date Invitation Sent:: Response:
Revised: April 2009