Candidate application

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Walk Type*

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Walk Number*

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First Name*

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Last Name*

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Application Number

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This number can be found in the email. Leave blank if not sure.

Candidate Statement

Has the Walk to Emmaus been explained to you?*

YesNo Invalid Input

If the Walk has not been explained to you, please click on this information link

Preferred Name for Nametag

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Age Bracket*

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Marital Status*

SingleMarriedWidowedDivorced Invalid Input

Address*

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Address 2

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City*

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State*

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Zip*

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Email*

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Primary Phone Number*

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* Format 661.123.1234

Alternate Phone Number

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* Format 661.123.1234

Personal Information

Environmental and Food Allergies*

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Please explain or type "none" if not applicable

Medications*

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Please type in "None" if it does not apply

Emergency contact

Name*

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Emergency Email

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Phone*

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* Format 661.123.1234

Relationship*

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Your Christian Walk

Your Home Church*

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Pastor's Name*

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Why would you like to attend Walk to Emmaus?*

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Please describe...

What ministries are you involved in at church or with your community *

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Please describe...

Application Status

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Date Paid

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Registrar Notes

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Treasurer Notes

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Candidate Application

Website login

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