Pilgrim Application
Pilgrim Information
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Email *
First Name *
Middle Name *
Last Name *
Birthday
*
MM
/
DD
/
YYYY
Name Preference for Nametag
Street Address *
City *
State *
Zip Code *
Phone Number *
Email Address *
Church you attend
*
Church city
*
Gender *
Required
Are you married? *
Required
Name of Spouse
Are you a full-time vocational minister? *
Required
Are you ordained? *
Have you ever attended another three-day movement as an adult? (Walk to Emmaus, Cursillo, etc) *
Emergency Contact: In case of illness or emergency, who should be contacted?
Name of Emergency Contact *
Phone Number for Emergency Contact *
Relationship to Pilgrim *
Agreement
*I have accepted Jesus Christ as my Lord and Savior.
*I understand that the purpose of the Tres Dias Weekend is to strengthen and deepen my relationship with Him.
*I understand that I will be exposed to the essential truths of the Gospel in Scripture, and I am willing to having it transform my life.  
*In order to provide a more conducive and less distracting environment for all of this to occur, I understand that it is part of the Tres Dias experience that watches, cell phones, laptops and other electronic devices not be used by pilgrims on the weekend, and that an emergency number will be provided to my family and friends should they need to contact me.

Signature *
Date *
MM
/
DD
/
YYYY
Name of Sponsor (first&last)
*
If you have any questions, please contact Paul, Barbara and Kelly Rogers
tdcaz.preweekend@gmail.com
(480) 5774719 (Paul)
(480) 577-4758 (Barbara)
(480) 215-0607 (Kelly)
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