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 Fee Breakdown: $40 Deposit $100 Remaining $140 Total Please note that the $40 deposit is due for this Walk as soon as possible after both the Candidate and Mentor applications are sent (the remaining $100 can be paid at any point before or on the evening of the Walk). Checks/money orders should be made payable to SWVA Emmaus. In the event you must cancel, please notify the Registrar as soon as possible (using the contact info below) so that you may be rescheduled. In the event of cancellation, the deposit will be refunded and you will be notified by phone, mail, or email prior to the Walk date. The 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 Share this:Email
