PLEASE PRINT

TO BE FILLED OUT BY APPLICANT

Today's Date ___________________

Name _________________________________________ Nickname ___________ Sex________ Ag e ________ Birthday ______________

Current Mailing Address ____________________________________ City _____________________ State ________ Zip ______________

Home Phone (_______) _______________________ Work/School Phone (______ ) __________________ Work Place (City) __________

Occupation ________________________________________

Name/Denomination of Church You Attend ____________________________________________ City____________________ State _____

Are You Ordained or Licensed Member of Clergy? _____________________________ Name of your Pastor __________________________

Marital Status ___________________ Spouses's Name __________________________________________

Other Family Members at Home _____________________________________________________________________________________

Spouse attended Emmaus/Cursillo? ________ Submitted an Application? __________ Where? ___________________________________

In what religious community or organization are you active? _______________________________________________________________

From whom did you learn about this program? __________________________________________________________________________

Do you have health problems that may affect your attendance? _________ If yes, specify _________________________________________

____________________________________________________________________________________________ Do you smoke? ________

Are you on a special diet? ________ Please specify ________________________________________________________________________

State why you wish to attend an Emmaus weekend, what you expect from it, and anything else about yourself you wish to share:

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Name of Sponsor ___________________________________ Applicant Signature ______________________________________________

The above information is necessary for your proper placement on an Emmaus weekend. Please fill in all applicable blanks. Please enclose a registration fee of $20.00 (checks payable to SHENANDOAH VALLEY EMMAUS). There will be no additional cost to you.

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SPONSORSHIP

SPONSORS ARE ASKED TO READ THE FOLLOWING STATEMENT CAREFULLY, AND TO GIVE IT THEIR PRAYERFUL CONSIDERATION:

The Emmaus Walk is a method of Christian renewal in the church. Individuals recommended for Emmaus should be those with an active desire to deepen their faith and understanding of God's love and to become closer to Christ in their daily lives and their discipleship. A sponsor is requested to provide information to the applicant and to the applicant's family, to assist him/her in the Emmaus fellwoship, and to provide transportation to and from the Emmaus weekend.

TO BE COMPLETED BY SPONSOR:

Sponsor's Name __________________________________ Home Phone (_______) __________________ Work/School (______)_______

Address ____________________________________________ City _____________________________ State _______ Zip ____________

Name/Denomination of Church You Attend _______________________________________ City __________________ State __________

Where and when did you talke your Walk? _____________________________________________________________________________

Was it Emmaus. Cursillo, Chrysalis, or other? ___________________________________________________________________________

Why do you want to sponsor this person? _______________________________________________________________________________

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Sponsor's Signature _____________________________________________ Date _______________________

Date application received ___________________ Date Accepted _____________ Spouse application received _________________

Fees received: Registration _____________- Sponsor ________________ Scholarship ___________________