Emmaus Walk Application Northern Lights Community Walk to Emmaus Application Northern Lights Community Walk to Emmaus Application The Walk to Emmaus is a three day experience of renewal, learning and sharing in the atmosphere of a Christian community. It is a different experience for each individual. It is designed to help mature people work toward a Christian way of life with community support. Husbands and wives may wish to make a joint commitment to attend a Walk. Each person must submit a separate application, and married couples are requested to turn in their applications at the same time if possible. First Name Last Name Preferred Nickname (for nametag) Address Address 2 City State Zip Code Email Cell Phone Gender Male Female Birth Date Are you Clergy? Yes No Occupation Marital Status Single Married Separated Divorced Widowed Spouse Name (if applicable) Spouse Cell Phone (if applicable) Do you require any physical assistance/medical equipment? If so, please explain: Do you require medications at certain times? (other then waking or before sleep) If so, please detail the times required: Do you require a special diet or do we need to be aware of any allergies? If so, please list below. Please list an Emergency Contact Name (other than the sponsor) Emergency Contact Cell Phone Church & Denomination Currently Attending Your Church Pastor Name Sponsor First Name Sponsor Last Name Sponsor Email Sponsor Cell Phone Please mail a non-refundable deposit of $35 to be applied to the total fee of $150. Make checks payable to Northern Lights Emmaus Community. The balance of the fee will be collected at the Registrar’s table upon arrival. After clicking the SUBMIT button, you will receive an email with the completed information. Please forward the email to your sponsor. Please send your check to the Emmaus Registrar. Registrar: David Martin, 1904 Court Donegal, Middletown, Ohio 45042 or Email to: registrar@nlemmaus.org Applicant's Electronic Signature is clicking Yes - We need your ACTUAL signature when you arrive at the event. Yes No When you click the SUBMIT button, you will receive an email of this completed form. reCAPTCHA Submit If you are human, leave this field blank.
