Print and complete this form and mail to:

NAME _________________________PHONE (____)_______________

ADDRESS ________________________________________________

CITY, STATE, ZIP________________________________________

YEAR OF MY PILGRIM WALK_________ WALK NO. ________

I'VE WORKED ______ WALKS AND ______ CHRYSALIS WEEKENDS SINCE THEN.

POSITIONS I HAVE WORKED: (circle all that apply)

Agape Team / Agape Chairman / ALD / Lay Director / Bellringer/

Table Leader / Assistant Table Leader / Music Team

Spiritual Director / Clergy Team

I PLAY THESE MUSICAL INSTRUMENTS_______________________

I SING AND/OR LEAD WORSHIP: Yes No

I AM ACTIVE IN THIS CHURCH OR GROUP: __________________

I AM ACTIVE IN THIS REUNION GROUP: ____________________

I AM ACTIVE IN THIS EMMAUS COMMUNITY:__________________