The Upper Room
GRACE Emmaus COMMUNITY
of the CAROLINAS, Inc.
(To be referred to hereafter as GEC)
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Postmark __________ |
RETURN TO SPONSOR |
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Check # __________ |
SPONSOR'S NAME____________________________________ |
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Deposit __________ |
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TO BE FILLED IN BY CANDIDATE
1. NAME______________________________________________
PHONE ( )
___________________________________
2. ADDRESS
________________________________CITY __________________________STATE_______
ZIP_______________
E-MAIL
ADDRESS _______________________________________________________________________________________
3. NAME DESIRED ON NAME TAG
_________________________________________ AGE_____ MALE____ FEMALE ____
4. PASTOR'S NAME
___________________________________CHURCH_____________________________________________
5. WHAT ACTIVITIES WITHIN YOUR
CHURCH DO YOU PARTICIPATE IN OR HAVE YOU PARTICIPATED IN? ______________________________________________________________________________________________________
6. MARRIED ________ SINGLE ________ WIDOWED ________ DIVORCED _______ SEPARATED _______
7. PRESENT OCCUPATION
_________________________________________
COMPANY______________________________
8. IN WHAT COMMUNITY ORGANIZATIONS
ARE YOU ACTIVE? ___________________________________________________
_______________________________________________________________________________________________________
9. HAS THE WALK TO EMMAUS BEEN
EXPLAINED TO YOU? Yes ______ No
______
10. HAS THE FOLLOW-UP MEETING BEEN
EXPLAINED TO YOU? Yes _____ No
______
11. HAS THE MONTHLY GATHERING OF THE
EMMAUS COMMUNITY BEEN EXPLAINED TO YOU?
Yes ______ No ______
12. HAS THE GROUP
13. STATE BRIEFLY WHY YOU WISH TO
ATTEND THE WALK TO EMMAUS AND WHAT YOU EXPECT FROM IT:
_______________________________________________________________________________________________________
________________________________________________________________________________________________________
14. ARE YOU ON A DOCTOR PRESCRIBED
DIET? Yes _____ No_____ IF YES,
TELL US HOW WE CAN BEST SERVE YOU. (NOTE: PLEASE INFORM YOUR SPONSOR OF ANY OTHER
DIETARY NEEDS SO THAT HE/SHE CAN PROVIDE IT FOR YOU )
________________________________________________________________________________________________________
15. DO YOU HAVE ANY ALLERGIES, FOOD
OR OTHER, THAT WE NEED TO BE AWARE OF? Yes _____ No______ IF YES, LIST:___________________________________________________________________________________________________
16. DO YOU HAVE A HEALTH PROBLEM OR A
HANDICAP THAT MAY AFFECT YOUR ATTENDANCE ON THE EMMAUS WALK? Yes ______ No ______ IF YES, TELL US HOW
TO MAKE YOUR WEEKEND EASIER. ________________________________
_______________________________________________________________________________________________________
17. ANY DIFFICULITIES WALKING SHORT
DISTANCES? Yes ___ No___ UPHILL? Yes ___ No___ DOWNHILL? Yes ___ No___
18. WOULD YOU BE WILLING TO SLEEP ON
A TOP BUNK? Yes _____ No______
19. GIVE NAME, ADDRESS, PHONE NUMBER
OF NEAREST RELATIVE NOT LIVING WITH YOU:
NAME________________________________________________________ PHONE ( )__________________________ ADDRESS
________________________________CITY __________________________STATE_______
ZIP_______________
20. UPON COMPLETION OF THE WALK WEEKEND, I WISH TO BE A MEMBER
OF GEC. YES______
NO _______
21.
SIGNATURE________________________________________
DATE: _____________________
22.
IMPORTANT: ALL OF THE ABOVE INFORMATION IS NECESSARY FOR YOUR PROPER
PLACEMENT ON A WALK TO EMMAUS. PLEASE FILL IN ALL BLANKS. PLEASE ENCLOSE A NON-REFUNDABLE PRE-REGISTRATION DEPOSIT 0F $25.00. THIS WILL BE
APPLIED TOWARD YOUR CONTRIBUTION OF $90.00, WHICH PARTIALLY OFFSETS THE EXPENSES OF YOUR WEEKEND. MAKE CHECK PAYABLE TO GRACE EMMAUS COMMUNITY OR GEC. THE REMAINING BALANCE WILL BE DUE PRIOR TO
SEND-OFF FOR THE WEEKEND.
GRACE Emmaus COMMUNITY
of the CAROLINAS, Inc.
CANDIDATE’S NAME _______________________________________
1.
NAME
(S)___________________________________________
ADDRESS_______________________________________
2.
CITY_________________________________ STATE________________ ZIP ____________
3.
TELEPHONE: HOME ( ____ ) ________________
WORK ( ____ ) ________________ CELL (____) ________________
E-MAIL
ADDRESS
____________________________________________________________________________________
4.
NAME
& DENOMINATION OF CHURCH NOW ATTENDING
_______________________________________________________________________________________
5.
DO
YOU ATTEND REGULARLY? __________ WHAT CHURCH ACTIVITIES DO YOU (HAVE YOU)
PARTICIPATED IN?
________________________________________________________________________________________________________________________________________________________________________________________________________
6.
WAS
YOUR WALK EMMAUS _____ CURSILLO _____
CHRYSALIS _____ OTHER __________________________
7.
WHERE
_____________________________
WHEN___________________________
WALK #_____________
8.
NAME
OF YOUR REUNION GROUP ______________________________ MEETS
________________________________
9.
DO
YOU PARTICIPATE IN MONTHLY COMMUNITY GATHERINGS? YES_____ NO _____
10.
NUMBER
OF CANDIDATES YOU ARE SPONSORING ON THIS WALK _________
11.
HOW
LONG HAVE YOU KNOWN YOUR CANDIDATE?
________________________________
HAVE YOU ATTENDED A SPONSORSHIP TRAINING CLASS? YES_____ NO_____
12.
IS
CANDIDATE ACTIVELY PARTICIPATING IN A LOCAL CONGREGATION? YES_____ NO _____
IN
WHAT WAYS DO THEY SERVE?
_____________________________________________________________________
____________________________________________________________________________________________________
13.
IF MARRIED,
BOTH SPOUSES ARE EXPECTED TO ATTEND THE WALK TO EMMAUS. IN THE EVENT THAT ONE
SPOUSE DOES NOT WISH TO ATTEND, HAVE YOU APPROACHED THE COUPLE AGAIN AFTER A
MINIMUM SIX-MONTH PERIOD FROM FIRST CONTACT TO ASCERTAIN IF THAT SPOUSE HAS
CHANGED DECISION?
YES_____ NO _____ N/A _____
14.
AFTER
PRAYERFUL CONSIDERATION, DO YOU RECOMMEND THAT THE MARRIED SPOUSE ATTEND AS A
"SINGLE" (SUBJECT TO # 13 ABOVE?) YES_____ NO _____ N/A _____
15.
DOES
YOUR CANDIDATE HAVE THE PHYSICAL HEALTH TO PARTICIPATE IN THE 72-HR WEEKEND
WALK?
YES____
NO____ IF NO,
EXPLAIN WHAT WE NEED TO DO TO MAKE PARTICIPATING POSSIBLE.
____________________________________________________________________________________________________
16.
HAVE
YOU DISCUSSED YOUR CANDIDATE’S DIETARY NEEDS, AND ARE YOU PREPARED TO PROVIDE
SPECIAL FOODS NEEDED IF NOT DOCTOR PRESCRIBED?
YES____ NO ____
17.
IS
YOUR CANDIDATE UNDER ANY EMOTIONAL STRAIN?
YES____ NO ____ IF YES, PLEASE EXPLAIN:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
18.
I UNDERSTAND THE SPONSOR'S RESPONSIBILITIES AND
OBLIGATIONS AND PLEDGE TO SUPPORT MY CANDIDATE BEFORE, DURING, AND FOLLOWING
THE WALK.
SPONSOR'S SIGNATURE:
__________________________________________________ DATE: _________________________
ALL BLANKS MUST BE FILLED IN ON BOTH SIDES AND DEPOSIT OF
$25.00 INCLUDED OR APPLICATION WILL BE RETURNED TO THE SPONSOR FOR COMPLETION.
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RETURN TO: |
GEC Registrar |
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