Day Four Restore! Registration Form

Day Four Restore! Registration Form

Last Registration Day - August 22, 2022
Event Information: Day Four Restore is a new, one-day retreat designed to refresh the spirit and renew the commitment of those who have attended an Emmaus Ministries event or another Fourth Day ministry.

Hosted by the Louisville Area Emmaus Community

Event Date: August 27, 2022

Event Time: 09:00am - 4:00pm

Event Location: Crestwood United Methodist Church

Event Address: 7214 Kavanaugh Rd, Crestwood, KY 40014 (Gymnasium)
Attendee Information

Please fill name and contact information of attendees.
Your Name

Prefix First Name Last Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Original Walk/Flight number:
Church
Please describe any special dietary or mobility needs:
Would you be interested in being a table leader?
The table leader will assist the table discussion time by asking open-ended questions to encourage dialogue and direct the conversation toward the topics in the presentation. The table leader may also be asked to facilitate prayer times with the members of his/her table.
Are you registering another attendee?

No Yes
Guest Name

Prefix First Name Last Name
Email Address
example@example.com
Contact Number *
Please enter a valid phone number.
What was your original Walk/Flight? *
Church
Would you be interested in being a table leader?
The table leader will assist the table discussion time by asking open-ended questions to encourage dialogue and direct the conversation toward the topics in the presentation. The table leader may also be asked to facilitate prayer times with the members of his/her table.
Please describe any special dietary or mobility needs:
Registration with a minimal fee to cover our location rental and lunch is $40.00 per person. This form is due by August 19, 2022. Payment due no later than day of event.

Fees may be paid by ONE of the following methods:
- by check mailed to P. O. Box 71, Crestwood, KY, 40014 (by Aug 19, 2022)
- at the door with cash, check, credit card or PayPal transfer, OR
- online through our PayPal DONATION button. (Select Other, enter amount, follow online instructions.)
Please verify that you are human. *
Should be Empty:

Day Four Restore! Registration Form

Attendee Information