Application CANDIDATE APPLICATION EMMAUS WEEKEND REQUESTED Tap below to choose your weekend* ▼ Women's Walk #187 (April 25—28, 2019) Men's Walk #188 (May 2—5, 2019) APPLICANT INFORMATION VAAKALAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTWAWVWIWYDC-- Marital Status (Tap one) ▼ Married Single Separated Divorced Widowed If Married, has spouse attended Emmaus? ▼ No Yes N/A Is spouse attending adjacent walk? ▼ No Yes N/A Do you smoke? (Needed for planning purposes) ▼ No Yes 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 Registrar Contact (opens new tab) Please review and tap Confirmed before sending. Confirmed
