Application

SWVA Emmaus Candidate Application CANDIDATE APPLICATION

EMMAUS WEEKEND REQUESTED

Tap below to choose your weekend*


APPLICANT INFORMATION




Marital Status (Tap one)


If Married, has spouse attended Emmaus?


Is spouse attending adjacent walk?


Do you smoke? (Needed for planning purposes)


MEDICAL/PHYSICAL INFORMATION

EMERGENCY CONTACT INFORMATION


A deposit of $40 is due with this application. Checks/money orders should be made payable to SWVA Emmaus. In the event you must cancel, please have your sponsor notify the community as soon as possible (using the contact info below) so that you may be rescheduled. In the event of cancellation, your deposit will be refunded and you will be notified by phone, mail, or email prior to the Walk date. Your payment should be sent to:

SWVA Emmaus Registrar
Robin Claris
112 Country Lane
Thaxton, VA 24174
Contact the SWVA Emmaus Registrar Registrar Contact (opens new tab)

Please review and tap Confirmed before sending.