Pathway East Georgia Walk to Emmaus Servant Volunteer Form

 
Please enter as much information as possible. Name, Phone Number and e-mail are required.
 
 
Name
 
Phone
 
Email
 
Address
 
City
 
State
 
Zip
 
Church
 
Age
 
Male or Female?
 
Home Phone
 
Work Phone
 
Mobile Phone
 
 
 
Emergency Contact Information
 
How would you like to serve?
 
Other Comments?
 
Are you willing to give a talk?
 
Any Special Talents?
 
Limitations?
 
Special Diet?
 
Medications?
 
Are you currently certified to administer CPR, a registered nurse, a physician, or other health care professional?
 
Please describe
 
Have you served on a previous Walk to Emmaus/Chrysalis/etc. weekend? How many? In what capacity? If you have given a talk, which one(s)?
 
EXPERIENCE
 
Name, date and location of your original Walk or Flight
 
Do you participate regularly in a reunion group?
 
Do you regularly attend Gatherings?
 
I understand that the Team Formation Committee and the Support Team Committee will select the team in accordance with the guidelines established by the PEGWTE Board of Directors. I understand that I will be expected to pay a team fee. I also understand that I may or may not be chosen to work this weekend.
 
Re-enter your name here as a signature
 
Date