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


    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
    Gerri Richards
    3026 Hollowell Av SW
    Roanoke, VA 24015
    Contact the SWVA Emmaus Registrar Registrar Contact (opens new tab)

    Please review and tap Confirmed before sending. ▼