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Greater Columbus Walk to Emmaus Pilgrim Registration Form
Registrar : Dannelle Harenberg
Phone: 614-432-2081
Email: dbride0503@gmail.com
Pilgrim registration fee: $90, including a $15 deposit upon registration acceptance.
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Email
*
Your email
Gender
*
Male
Female
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
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DD
/
YYYY
Age
Your answer
Nickname/Name Tag Preference
Your answer
Address
*
Your answer
Phone Number (Home/Cell)
*
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Email address
*
Your answer
Occupation
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Church Name
Your answer
Pastor's Name
Your answer
Do you regularly attend church services?
Yes
No
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Spouse's Name
Your answer
Spouse's Walk Number (if applicable)
Your answer
Emergency Contact Name
*
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Emergency Contact Phone Number
*
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Your relationship to Emergency Contact
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Please list any medications that need to be taken at a specific time of day.
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Do you have any medical conditions that would limit your participation in weekend activities? Please describe so we can anticipate what you might need.
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Is there anything else you would like to share with your walk team? Please do so below.
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You will receive a written invitation for the next Walk with available space. As space is limited, please respond as promptly as you are able. We would appreciate a yes or a no. The invitation will most likely come through email.
I understand
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Can you attend on short notice?
Yes
No
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Please call me ASAP - I have questions!
Yes!
No, I don't have any questions.
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Greater Columbus Emmaus Community does not exclude or otherwise discriminate against any person on the ground of race, color, national origin, disability, age, sexual orientation, gender identity, religion, or creed.
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Call me, I have questions
I would like to pay for my registration fees by
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Check (Dannelle will give you the address via email, phone, or text)
Electronically (e.g., Venmo, Zelle, PayPal)
A copy of your responses will be emailed to the address you provided.
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