Nashville Emmaus Community Team Member Registration

Nashville Emmaus Community Team Member Registration Form

Visit us at www.NashvilleEmmaus.org
Walk Type

Men's WeekendWomen's WeekendFace to Face Encounter
Ministerial Status

ClergyLaity
Request for

SpringFall
Year of the Walk
Name (as it appears on the Team Member's name badge)

First NameLast Name
Please check boxes below if you are in need of a Nashville Emmaus Community name badge or lanyard with Emmaus cross.

Name Badge ($5 for replacement badges, N/C if new to the community)Cross on lanyard ($5 for replacement cross, N/C if new to the community)
Email Address
Please use best contact email. Print legibly.
Phone Number
Please share best contact phone number.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Church you attend
Your Denomination
City of your church
What year did you take their Walk (and Walk# if known)?
Is this your first Weekend to serve?

YesNo
What role are you filling on this Weekend?

Weekend Lay DirectorAssistant Lay DirectorTechnical DirectorFacilities CoordinatorCoachWeekend Spiritual DirectorAssistant Spiritual Director, SpeakerTable Leader, SpeakerAssistant Table LeaderMusicianAssistant MusicianBoard RepresentativePrayer Chapel CoordinatorAssistant Prayer Chapel CoordinatorKitchen CoordinatorAssistant Kitchen CoordinatorAssistant Agape Servant
Are you giving a Talk? If yes, please enter the name of Talk Title below.
Do you have any allergies? If yes, please list all below.
Do you have any dietary restrictions? If yes, please explain below.
Do you have any medical conditions? If yes, please list all below.
Do you have any special needs? (For example, electrical outlet in sleeping room for CPAP, fan, other appliances.) If yes, please list below.
Are you currently in a Reunion Group or similar covenant group?

YesNo
Team Member's Signature

Clear
Today's Date

MonthDayYear
Team member's cost for the Emmaus Weekend is $100.00.

Team member's cost for the Face to Face Encounter is $50.00

To pay by CC, use the button below.

To pay by PayPal, use this link, not the PayPal button: https://nashvilleemmaus.org/donations

Select payment type and process payment. Please include a note about who the payment is from to ensure the treasurer gives credit for payment.

If you are new to the community or had a name change, the name badge and/or cross and lanyard are Free of Charge. If you desire a replacement name badge and/or cross and lanyard the cost is $5.00 each. You may pay online (below) or pay by check. If the latter, please make check payable to Nashville Upper Room Emmaus Community and mail the check with a copy of the Team Member Registration form to: Bruce Myers, 1777 Old Russellville Pike, Clarksville, TN 37043-1787.
My Products
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Emmaus Team Member Registration
$100.00



Face to Face Team Member Registration
$50.00



Replacement Name badge
$5.00



Replacement Cross and lanyard
$5.00



New Name badge
$ Free



New Cross and lanyard
$ Free



Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

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Nashville Emmaus Community Team Member Registration Form