, Pilgrim Application
MEMPHIS WALK TO EMMAUS
APPLICATION

APPLICANT INFORMATION

The Memphis Emmaus Community is delighted you are seeking to participate in the Walk to Emmaus. Emmaus is for active Christians who are members of churches whose own renewal will mean new energy, commitment and vision in the church and everyday interactions, for Christ's sake. This is only an application. Notification of your assigned weekend will be made by mail or email. Please note, your sponsor will need to complete the Sponsor Application portion before your application will be considered complete. All information is confidential.
---------- Incomplete applications cannot be processed  Fields with * are required -----------

*First Name *Last Name    Name Tag     
*Address  *City *State *Zip
*Primary Phone # (enter only numbers) Secondary Phone # (enter only numbers)
Sex Age *Birthdate  (mm/dd/yy) Email
Your Church   Pastor  Member Visiting
Marital Status
Spouse First Spouse Last
Spouse applying to adjacent walk?  Spouse attended previous walk 
Occupation Clergy 
Emgerency Contact Information
List family members or friends, other than your spouse, who may be contacted in case of a medical emergency.
First Name Last Name Relationship Phone Number(enter only numbers)
Address City State 
Has your sponsor explained what will happen over the weekend and answered any questions you have
Typing your complete name below you are using this as your signature.  Check this box for confirmation

RELEASE AND INDEMNIFICATION:
In consideration of my being allowed to participate in the Walk to Emmaus, Kairos, or Chrysalis (collectively the “Activity”), I hereby agree to release Memphis Emmaus, Inc., and any and all affiliated organizations, their employees, agents, and representatives, volunteers, including volunteer drivers, (collectively “Releases”), from any and all claims, including negligence, which may be asserted by me, or on my behalf, arising from or relating to my participation in the Activity. In the event this release is held to be invalid or unenforceable, I hereby agree to indemnify, defend, and hold harmless Releases from any and all claims, including negligence, and including attorneys’ fees and expenses, which may be asserted by me or on my behalf arising from or relating to my participation in the Activity. I also give permission for photos from the Activity to be used for promotional purposes by Memphis Emmaus, Inc.

Applicant Signature    Date
MEMPHIS WALK TO EMMAUS WEEKEND DATES
Men's Walk#177 2/8/2018
Women's Walk#176 10/26/2017 Women's Walk#178 2/22/2018
Check these dates carefully, mark the weekends of your choice for your first, check the red box, and second choices check the green box. Married couples should attend consecutive ( "adjacent" ) weekends. If you cancel fewer than 10 days prior to your assigned walk, it may be necessary to re-apply.
MEDICAL INFORMATION / SPECIAL NEEDS
Disclaimer: Every effort will be made to accommodate special needs of the pilgrims, provided we are aware prior to the walk. Otherwise, we cannot guarantee they will be met once at Country Place. Also, be aware that communion will be served during the walk. Pilgrims who have special needs - for communion (e.g. gluten-free bread ) please NOTE on this application in the appropriate box.  Please list any special needs or concerns, such as: medical, allergies, medications taken, medical problems, dietary needs.
Medical Needs Dietary Needs
 
Specify:   



Specify:

Spedify:

Specify:

Specify:
Specify ANY OTHER NEEDS:
SPONSOR INFORMATION

*Primary Sponsor's First Name   *Last Name  Signature
*Primary Sponsor Best Phone (enter only numbers) *Primary Sponsor Current Email

COMPLETED APPLICATION ON
Registration Fee $150.00   Mail Deposit or complete registration fee by check to:
Please indicate deposit for Walk # on your check
Initial Deposit 50.00   Memphis Emmaus Registration
Balance Due at SendOff
Please pay balance before walk date.
100.00   P.O. Box 240414  
Memphis, TN 38124            or pay with 
SPONSOR INFORMATION MAY BE ENTERED LATER BY CLICKING 'SAVE FOR SPONSOR' BUTTON