Candidate Application Women's Walk #90- October 9th-12th 2025
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Email *
Select the WOMEN'S walk you plan to attend
Date of Birth  *
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Candidate's First & Last Name (Include name you prefer to go by if different)  *
Age
Gender 
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 Candidate's Email *
Mailing Address
Cell Phone Number *
Occupation  *
Company Name *
Church Affiliation OR Church Name *
Spouse' Name *
Has their spouse attended a Walk to Emmaus?
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If YES, what walk number or date did they attend? *
Special Diet or Dietary needs *
Special Medications or Medical Instructions  *
Do you have any health problems or physical challenges that could affect your participation on a Walk to Emmaus?  
 *
Do you Snore? *
Do you Smoke? *
Do you have trouble hearing? *
Has the Walk to Emmaus been explained to you including the Post-Walk to Emmaus activities?   
 *
Emergency Contact #1 
(aside from Sponsor)
 *
Name:
Phone Number:
Emergency Contact #2  
(aside from Sponsor)
 *
Name:
Phone Number:
Sponsor's Name: *
Sponsor's Phone Number  *
Sponsor's Email *
Sponsor's Address 

Do you give New Horizons Emmaus Community permission to publish your name on their website and/or social media pages? 

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I verify this information to be true and completed to the best of my knowledge. *
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A copy of your responses will be emailed to the address you provided.
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