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           Sex

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?      Please specify    

Are you diabetic?      Are you a vegetarian?      Do you have any food, drug or environmental allergies?

Do you use a CPAP/BiPAP machine?      Do you smoke?      Are you on medication?

Do you have any physical challenges?      Please specify    

Sponsor name      Sponsor cell    

Sponsor email      Are you clergy?    

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:

Colleen Clark, Registrar 8831 Breezewood Dr., Pittsburgh, PA 15237 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 412-298-6920

or e-mail registrar@TRWE.org

Please finish the registration process by clicking the Submit button below

 

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