Fields marked with an asterisk (*) must be filled in!
* Email address:
* First Name:
* Last Name:
* Gender:
* Mailing Address:
* City:
* State:
* Zip Code:
* Fourth Day Group:
* Primary Phone:
Other Phones:
 
I went on my weekend in: (year attended, For example, 2001)
I am in a reunion/accountability group that meets regularly.
I attend my church regularly, and I'm active in the congregation
I am an ordained clergy member.
I have worked on: (don't include support team participation in this count)
 

I have worked in the
following team positions:
(check all that apply)
Lay Director Asst Lay Director Table Leader
Asst Table Leader Musician Asst Musician
Spiritual Director Asst Spiritual Dir Support Team Mbr
 

I have given the
following Emmaus talks:
(check all that apply)
Priority Growth Through Study Changing Our World
Prevenient Grace Means of Grace Sanctifying Grace
Priesthood of all Believers Christian Action Body of Christ
Justifying Grace Obstacles to Grace Perseverance
Life in Piety Discipleship Fourth Day
 

I have given the
following Chrysalis talks:
(check all that apply)
Ideals Communication Through Prayer Christian Action
God Designed You Christian Growth Through Study Single Life
Faith God's Gift to You God Empowers You
God Loves You Marriage Priesthood of All Believers
Prodigal God Sustains You Next Steps
 
I would like to ---- Receive the Community Newsletter
Find a Reunion Group
Serve on an Emmaus Team
Serve on an Emmaus Support Team
Serve on a Chrysalis (youth/young adult ministry) Team
Serve on a Kairos (prison ministry) Team
Serve on a Kairos Outside (ministry to spouses of prisoners) Team
Help with music. I play