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 Cross Bayou - Walk to Emmaus

Request for Reservation

For Walk

Register ONLY IF YOU INTEND TO BE PRESENT FOR THE ENTIRE WEEKEND.
Return this signed form, to your sponsor along with payment of $180
                                   Make checks payable to Cross Bayou Emmaus Community

You must print this form to complete the process.

Tell us about yourself. When you finish, this form will print on your local printer. Please sign it and mail it according to the directions on the bottom. Fields with a red asterisk * are required.

Please Tell us which Walk you are registering for. (They are gender specific.)

Which Walk?*

 Starts WalkWhere
Select3/8/2018 Emmaus Mens Walk # 97Camp Bethany
Select4/12/2018 Emmaus Womens Walk # 98Camp Bethany

 First*Last* + Jr, etc.Name Tag
Name  
Address* 
City/State/Zip*    
PhonesHome*  Work Cell
Email Birthday 
OccupationEmployer
NameCityDenomination
Church
I am a   
Who can help us contact you prior to the walk, or in case of emergency?
First*Last*Email
Contact  
Address* 
City/State/Zip    
PhonesHome*  Work Cell

List all allergies, special diets, physical handicaps, or other pertinent information that may affect your attendance or well being at your Walk to Emmaus weekend.

My shirt size is

I  attend on short notice.
The Walk to Emmaus  been explained to me including post-walk follow up.

Your signature Date

Sponsor's signature Sponsor name* (print or type)

Sponsor must have been on a Walk to Emmaus, Cursillo, Tres Dias, or similar event.

Mail To: Men's Registrar: Montie’ Dobbins 5111 Tensas Dr, Bossier City, LA 71111 C(318) 655-5976