Dakotas Walk to Emmaus - Request for Participation
Dates: Men's - October 3 - 6, 2019
Women's - October 10 - 13, 2019

Location: Storm Mountain, Rapid City, SD

Cost: $150 per person

Online Payment: https://dakotaswalk2019.eventbrite.com

Mailing Payment:
Please mail a $50.00 non-refundable deposit to (Susie Ryks, 47837 249th Street, Garretson, SD 57030).
Make check payable to: DAKOTAS WALK TO EMMAUS. The balance ($100) can be paid upon arrival.

Registrations need to be accepted two weeks prior to the walk in order to plan for accommodations and meals.

Name *
Your answer
Address: (Street, City, State, Zip) *
Your answer
Email *
Your answer
Phone Number *
Your answer
Date of Birth *
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DD
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YYYY
Gender *
Marital Status *
If Married, Spouse's Name and Phone Number
Your answer
Occupation *
Your answer
Name of Church you attend *
Your answer
Pastor's Name *
Your answer
Has the WALK TO EMMAUS been explained to you, including reunion groups *
Please explain any health problems or physical limitations that may affect your participation at the WALK TO EMMAUS:
Your answer
Please list medications that we should know about:
Your answer
List any medically required dietary needs:
Your answer
What do you expect to gain from the WALK TO EMMAUS? *
Your answer
Sponsor’s Name: *
Your answer
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