Southern Ohio Emmaus - Sponsorship Form

Southern Ohio Emmaus - Sponsorship Form
This application is to be filled out by the Sponsor. Please fill out all questions. The questions marked with a red asterick must be filled out to submit this form.
Your Pilgrim's Full Name:*
Women's Spring Walk #73 March 12-15, 2026Men's Spring Walk #73 April 16-19, 2026Women's Fall Walk #74 September 17-20, 2026Men's Fall Walk #74 October 15-18, 2026
Sponsor's name:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Cell phone:*
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Name of the Emmaus Community of the walk you attended:*
Your Walk number:*
Church you attend:*
Pastor's Name:*
YesNo
YesNo
If you have not attended a sponsorship class, you MUST have a co-sponsor who has attended a sponsorship class.
Co-sponsor name (if required):
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Cell phone:
Format: (000) 000-0000.
Work phone:
Format: (000) 000-0000.
PLEASE ANSWER THE FOLLOWING QUESTIONS
YesNo
YesNo
If so, please explain?
YesNo
PilgrimSponsorChurchScholarship needed
If a scholarship is needed to help cover pilgrim fees, how much is needed? Please list an amount up to $82.50.
Scholarships are limited to up to one-half of the fee and based upon approval of the Board of Directors.
YesNo
YesNo
If not, Name of person who will?
Their phone number:
Format: (000) 000-0000.
YesNo
YesNo
YesNo
YesNo
If not, Name of who will?
Their Phone number:
Format: (000) 000-0000.
If you have any questions, please get in touch with the Registrar, Suzette Wallace, 740-606-1191 or email: suznlfd@gmail.com.

Please make checks payable to: Southern Ohio Emmaus and mail to : 284 W Lake St, Roseville OH 43777.

If needed, you can also contact the Board Chairperson, Fonda Welker at (740) 603-1060
Today's date:*

MonthDayYear
Date
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Southern Ohio Emmaus - Sponsorship Form

PLEASE ANSWER THE FOLLOWING QUESTIONS