Birmingham Emmaus Community: Pilgrim Application

Pilgrim Application

To be completed by Pilgrim

Name
FirstLast
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Home Phone
Work Phone
Cell Phone
Email
Who is your Sponsor?
Church
Pastor
Age
Occupation
Spouse Name
FirstLast
Has your Spouse attended a Walk?
Emergency Contact
FirstLast
Please check all that apply
- Special Dietary Needs
- Medical Needs
- Health or physical needs which might affect your Walk?
If you checked any of these areas please provide any information that will help us meet your needs during the weekend.
Have you had any traumatic events within the last year? (Such as death of a loved one, divorce or job loss)
Briefly state why you have decided to participate in the Walk to Emmaus
Signature

The total cost of the weekend is $125.00. Please make check out to Birmingham Emmaus Community and mail your check to the address below or Pay via the Payment Center on the sidebar. Please submit this application online.
(Checks will not be deposited until the Monday after the Walk) If you do not have a sponsor, mail the registration fee to:

Birmingham Emmaus Community c/o Karen Trippe
857 Ramsey Road
Rainbow City, Al 35906

I hereby authorize representatives of the Birmingham Emmaus Community to act on my behalf according to their best judgment in any emergency. In consideration for the acceptance of this Pilgrim’s application, I hereby waive and release the Birmingham Emmaus Community from any and all liabilities which may arise during my participation in a Walk to Emmaus.