Shenandoah Valley Emmaus Pilgrim Application
To be completed by the Applicant. A $40 Application Fee is required and is payable with this form submission. Each pilgrim is sponsored by an individual(s) who have experienced Emmaus or similar 3 day weekends. Your sponsor will help prepare you for your Emmaus Walk and support you in various ways. They will complete their own form to partner with yours for a complete application.
First Name *
Last Name *
Name as your would like it on a name badge *
Street Address *
Town *
State, 2 letter abbreviation *
5 digit Zip Code *
Preferred Phone with Area Code *
Is this a mobile phone
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Email address for confirmation *
Age
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Occupation *
Marital status *
Spouse's Name
Has your spouse attended Emmaus?
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Has your spouse submitted an application to attend a Walk?
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Do you require any physical assistance to attend? If so, please describe... *
List any important food allergies/restrictions that may require special attention by Food Service.
List any other health problems that may affect your attendance.
List any medications and times to be taken other than at meal time, bedtime, or awakening.
What faith community are you active in? Church Name *
Denomination
Town church is located in
Your pastor's name *
Your pastor's email address *
Your sponsor's name *
Your sponsor's email or phone *
Briefly share why you wish to attend an Emmaus Weekend, what you hope from it, or anything else you would like to share.
The application fee is $40.
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