Pilgrim Registration
I am applying for: Men's Walk
Women's Walk
First Name
Last Name
Birthdate (use xx/xx/xxxx format):
Age
Address
City
State
Zip Code
I currently am
Married
Single
Widowed
Divorced
Sex
Female
Male
Spouses Name
Name you wished to be called
Primary Phone Number
Secondary Phone Number
Email Address
Please give name and phone number of relative other than spouse to contact in case of emergency.
Name
Phone
Relationship
Are you on a special diet?
No
Yes
Please specify
Are you diabetic?
No
Yes
Are you a vegetarian?
No
Yes
Do you have any food, drug or environmental allergies?
No
Yes
Do you use a CPAP/BiPAP machine?
No
Yes
Do you smoke?
Unknown
No
Yes
Are you on medication?
No
Yes
Do you have any physical challenges?
No
Yes
Please specify
Sponsor name
Sponsor cell
Sponsor email
Are you clergy?
No
Yes
Has your sponsor talked with you concerning: (check all that apply)
Walk site
Transportation
Clothing
Bedding
Gatherings
Reunion Groups
Please explain briefly why you wish to attend:
In what religious and community organizations are you involved?
Your Church
Denomination
Pastor name
Pastor cell
Pastor Email
The above information is necessary for proper placement in a Walk to Emmaus. Submission does not guarantee attendance as we have limited spaces available. Early application will help your acceptance. The cost of the weekend is $200 which includes lodging, meals, and supplies. A preregistration, non-refundable deposit of $25 made payable to Three Rivers Walk to Emmaus can be mailed to:
Sharon Gallagher, Registrar 700 Greenleaf Drive, Monroeville, PA 15146 Or you can pay on line after submitting this form..
The balance due will be payable upon your arrival. Please do not let your inability to pay deter your attendance. Speak to your sponsor about financial aid which may be available. All information on this application will remain confidential.
Questions : Phone 412-372-4765 or e-mail registrar@TRWE.org
Please finish the registration process by clicking the Submit button below
To insure you are not a robot, answer what is 1+1+1= (number only, no text!)
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