Illinois Prairieland Walk to Emmaus

Illinois Prairieland Walk to Emmaus

Spring Walk #26

Men’s Weekend: April 19-22, 2012 Women’s Weekend: April 26-29, 2012

This section to be completed by the APPLICANT. Please print the answer to all questions so that your needs can be best met during your Walk to Emmaus.

Male / Female (Circle One)

Name:____________________________________________________________

Address: ______________________________________

______________________________________

Primary Telephone : (____)_____-_______ Cell Phone: (____)_____-_______

E-Mail: ______________________________ Age: ________

Circle Marital Status: S M D W Spouse’s Name _______________________

Name you wish to have on your name badge: ____________________________

Sponsor’s Name: ____________________________

Name and denomination of church where you are an active member:

_____________________________________________________________

Pastor’s Name: ____________________________

What ministries are you active in at your church?

What community organizations are you active in?

____________________________________________________________________________________________________________________________________________________________

Has the Walk to Emmaus been explained to your satisfaction? YES / NO

Have Grouping and Post-Emmaus been explained to you? YES / NO

Are you on a special diet? NO Renal Cardiac Diabetic Other

Please explain: ______________________________________________________

Are you allergic to any foods? NO Dairy Wheat Peanuts Nuts Eggs Soy Seafood Other

Please explain: ________________________________________________________________

Please list any special medications that you are currently taken and the times they must be taken:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you have any physical or mental challenges? NO / YES, please explain:

Would you be able to sleep on a top bunk? YES / NO / YES, BUT PREFER NOT

Sign: ____________________________________ Date: ______________

Please enclose a pre-registration deposit of $20 with this application. This will be applied to your total registration of $95. This deposit is non-refundable. The remaining balance of $75 is due at your weekend registration. Please make checks payable to ILLINOIS PRAIRIELAND WALK TO EMMAUS or IPWE. After completing this application, give it to your sponsor ASAP, who will fill out the remaining portions and send it in. Thank you.

**Applications received by 9/9/2010, with $20 deposit, will receive an additional $20 credited to their balance.

If you feel that you are unable to meet the financial demands of attending a Walk to Emmaus Weekend, there are some scholarships available. Please indicate with an x in the space below if you need to request scholarship assistance.

______ I am in need of a full scholarship of $95

______ I am in need of a half scholarship of $48

SUBMITTING APPLICATION DOES NOT GUARANTEE ACCEPTANCE

PRE-REGISTRATION DEPOSIT - $20 received _______/_______/_______ check #________

REGISTRATION BALANCE - $75 received _______/_______/_______ check #___________

PAID IN FULL _____/_____/_____ check#_____________

This section should be filled out by the Candidate’s SPONSOR who has already attended an Emmaus, Cursillo, Tres Dias, Journey, or Chrysalis weekend.

Candidate’s Name: _______________________________________________

Sponsor’s Name: _________________________________________________

Sponsor’s Address: ______________________________________

______________________________________

Primary Telephone : (____)_____-_______

Cell Phone: (____)_____-_______

E-Mail: ______________________________

Church you are regularly attending: _______________________________

Name of Walk You Attended (Community/Walk #/ Year, if known):

______________________________________________________

Are you now in a reunion group? Yes / No

Are you praying and sacrificing for your candidate? Yes / No

Is the candidate's pastor aware that he/she is making a walk? Yes / No

Are you able to assist the candidate to get into weekly grouping? Yes / No

If the candidate is married, have you explained Emmaus to the spouse? Yes / No

Will you care for the spouse over the weekend? Yes / No

Will you bring the candidate to the weekend site? Yes / No

Will you participate in the weekend? Yes / No

Have you read the Sponsorship Tips document available online? Yes / No

How long have you known this candidate? _____ years.

Briefly explain why you think this person would make a good candidate:

Please tell us more about your candidate. Circle the most appropriate response and provide an explanation as necessary.

Is your candidate more...?

Extroverted / Introverted

Sensing / Intuitive

Thinking (Analytical) / Feeling (Emotional)

Sequential / Global

Leader / Follower

Impressionable / Decisive

Joiner / Observer

Please share any concerns or anything else that you feel would be helpful to the team:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE RETURN THIS APPLICATION AS SOON AS POSSIBLE TO:

Sharon Coyne

699 Boulevard de Cannes

Edwardsville, IL 62025

Or e-mail to registration@ipwe.org