Last Name N-Z Team Application Renewal

Last Name N-Z Team Application Renewal
Date of Application*

MonthDayYear
Date
Is this your first application to serve on a North Mississippi Emmaus Team?*
Name*

First NameLast Name
Date of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Gender*
Marital Status*
Original Walk Number*
Place*
Spouse's Name (if applicable)

First NameLast Name
Has your spouse attended an Emmaus Walk?
If spouse attended, what was their walk #?
If spouse attended, where did they attend?
I am a *
Church Denomination*
Are you physically limited in any way that would need to be considered on team assignments?*
If so, please explain
If there is a physical reason you need a bottom bunk, please explain below:*
Check any special interests or skills below:*

Can Type/Use ComputerCan Work on Short NoticeSong LeaderPlay PianoPlay Guitar
Everyone who wishes to serve must have a current application on file, and you can serve on only one walk each year. The names of the applicants are furnished to the Lay Director (four to sixteen months prior to the weekend of the walk). If you are asked to serve as a team member, you will be asked to contribute a $40.00 fee to cover the costs of the overnight team meeting, and a fee of $155.00 at the beginning of the walk to help defray the expenses of food and lodging. DO NOT send money with this application.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: