/ PECOS RIVER VALLEY EMMAUS
Southeast New Mexico and West Texas

APPLICATION TO ATTEND A WALK

/ Date Rec’d.______
Amt. Rec’d.______
APPLICANT INFORMATION – Please Print Clearly. You must be sponsored on your Walk by someone who has completed a Walk to Emmaus, Tres Dias, Cursillo, Chrysalis or similar weekend. Your sponsor must complete and sign the sponsor’s section of the form. Your pastor’s endorsement is strongly encouraged.
 Male
 Female / First Name / Last Name / What name do you want on your nametag?
Mailing Address / City /
State
/ Zip
Home Phone
( ) / E-Mail address / Has the purpose of the Walkto Emmaus been explained to you? /  Yes  No
Birth Date / Church where you attend worship regularly / Have the follow-up activities been explained to you? /  Yes  No

SCHEDULING PREFERENCES (see website for schedule:

1st Choice Date and Location / 2nd Choice Date and Location / Applicant’s Signature

MEDICAL INFORMATION

Briefly describe any physical limitations that may affect your participation?
Briefly describe any special physical assistance or diet you require?

EMERGENCY CONTACT (Other than Sponsor)

Name / Relationship
Phone Numbers
APPLICANT’S PASTOR’S ENDORSEMENT IS STRONGLY ENCOURAGED – (Please Print Clearly)
The Walk to Emmaus is a spiritual renewal program intended to strengthen the local church through the development of Christian disciples and leaders. The program's approach seriously considers the model of Christ's servanthood and encourages Christ's disciples to act in ways appropriate to being "a servant of all." You may find more information at
Church Name / Pastor’s Title and Name / Pastor’s Signature
THIS SECTION MUST BE COMPLETED BY THE SPONSOR – (Please Print Clearly)
Your role as the sponsor is probably the MOST IMPORTANT aspect of your applicant’s Walk to Emmaus Weekend. If you are not able to provide the support required by your applicant, you should FIND ANOTHER SPONSOR for this applicant. In addition, you should be clear about the purpose and intent of the Walk to Emmaus, and believe that this applicant meets the guidelines (See chapters 7 and 8 of the Day Four Booklet for details).
Please do not allow a physically-limited applicant to attend a Walk to Emmaus in a rugged setting unless specific arrangements for assistance have been made with the Lay Director of the weekend. A note on the application is NOT SUFFICIENT!
First Name / Last Name
Mailing Address / City /
State
/ Zip
Home Phone
( ) / E-Mail address / Sponsor’s Signature
Are you now in a group reunion? /  Yes  No / Are you active in community activities? /  Yes  No / Are you familiar with the actions expected of you as the sponsor? /  Yes  No / Have you explained the Walk to Emmaus weekend and Fourth Day activities? /  Yes  No

Mail completed applications with fullpayment (Checks should be made out to Pecos River ValleyEmmaus) to

Terry Maupin 1211 W. Main ArtesiaNM88210 e-mail:

Phone: 575.748.1301 w 575.365.8801 c 575.746.6888 h