Team ApplicationFill out this form to participate on a conference room team Walk # * Which Walk? * Men's Women's Walk Dates * MM DD YYYY Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Name of church you Attend * Pastor's name * Special Dietary Needs? Are you on any medications? Medical or physical limitations Are there any medical or physical limitations that may affect your participation at the Emmaus weekend? Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### Team assignment for this Walk SD ASD LD ALD TL ATL Music Brd Rep Talk assigned for this walk Please list all previous talk titles you've given on previous walks List other ways you have worked for the Mid-Ohio Valley Emmaus community on previous walks (kitchen, logistics, agape, board member, etc?) Thank you!
