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	Walk	Where
Select	10/12/2023	Emmaus Womens Walk # 112	Camp Bethany
Select	2/8/2024	Emmaus Mens Walk # 113	Camp Bethany
Select	3/7/2024	Emmaus Womens Walk # 114	Camp Bethany


	First*	Last* + Jr, etc.	Name Tag
Name
Address*
City/State/Zip*
Phones	Home*	Work	Cell
Email		Birthday
Occupation		Employer
	Name	City	Denomination
Church
I am a SingleDivorcedWidowedMarried ManWoman
Who can help us contact you prior to the walk, or in case of emergency?
	First*	Last*	Email
Contact
Address*
City/State/Zip
Phones	Home*	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.
Explain:

My shirt size is S M L XLXXL XXXL

I CanCannot attend on short notice.
The Walk to Emmaus HasHas Not 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: Women's Registrar: Montie’ Dobbins 5111 Tensas Dr, Bossier City, LA 71111 C(318) 655-5976