Print and complete this form and mail to:

NAME _________________________PHONE (____)_______________

ADDRESS ________________________________________________

CITY, STATE, ZIP________________________________________

YEAR OF MY PILGRIM WALK OR FLIGHT _________ WALK/FLIGHT NO. ________ EMMAUS COMMUNITY _________________

(Please precede Walk No. with W, and Chrysalis Flight No. with C)

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

ARE YOU WILLING TO SERVE IN ANY CAPACITY, (INCLUDING AGAPE TEAM)? PLEASE ANSWER YES/NO __________

I AM ACTIVE IN THIS CHURCH OR GROUP: __________________

I AM ACTIVE IN THIS REUNION GROUP: ____________________

I AM ACTIVE IN THIS EMMAUS COMMUNITY:__________________