Hosted by: ST MARK'S UNITED METHODIST CHURCH

REGISTRATION Encounter #10

July 19, 21, 26 & 28, 2022 ~ 9:00 am-3:00 pm
St. Mark's UMC is located at 1267 N. Rutherford Blvd, Murfreesboro, TN 37130
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Mailing Address

City, State & Zip
Church Affiliation
Year of Retirement
Explain any Mobility, Dietary, Visual or Hearing Impairment issues:

Please share the additional information to make your Face to Face Encounter complete:
Pastor's Name

First Name Last Name
Pastor's Phone Number
Please enter a valid phone number.
Pastor's Email
example@example.com
Pastor's Address

Mailing Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please share the additional information to make your Face to Face Encounter complete:
Friend's Name

First Name Last Name
Friend's Phone Number
Please enter a valid phone number.
Friend's Email
example@example.com
Friend's Address

Mailing Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please share the additional information to make your Face to Face Encounter complete:
Family Member's Name

First Name Last Name
Family Member's Phone Number
Please enter a valid phone number.
Family Member's Email
example@example.com
Family Member's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Payment
The total cost* for the four day participation of Face to Face Encounter #10 at St. Mark's UMC is $65. You may pay online (below) or send a check payable to "Nashville Walk to Emmaus" to:

Nashville Emmaus Community Registrar

PO Box 292643

Nashville, TN 37229-2643

*Total cost covers materials, beverages, snacks, & lunch for all four days.

For further information, please visit our website: www.NashvilleEmmaus.org or contact Nita Wright at nita_wright@bellsouth.net
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Face To Face Encounter Fee
$ 65.00

Total

$ 0.00

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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