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Personal Information:
This is a new request or renewal or update of my information already on file.
Email Address:
Full Name:
Gender: Female Male
Address:
City/State/Zip:
Home phone:
Work phone:
Cell phone:
I was a pilgrim/butterfly on: Emmaus Walk # Chrysalis Flight/Journey #
Birth Date (optional, but required for Chrysalis):
Smoker: Yes No
Bilingual: YesNoLanguage:     


Church/Forth Day Group Information:
Emmaus and Chrysalis is for the development of Christian leaders. A current and active member in Christian congregations is necessary to the fulfillment of this purpose. The Fourth Day Groups (FDG) and Next Step Groups (NSG) exists to provide leadership opportunities through the hosting and support of Emmaus and Chrysalis events.
Church Home:
Church Denomination:
Are you active in your Local FDG Emmaus Gatherings? Yes No
Fourth Day or Next Step Group:
Are you active in a weekly Reunion Group? Yes No
Reunion Group Name:


Application Information:
I would like to server on Emmaus Walk Chrysalis Flight
Walk/Flight Number:
Please leave me on file to serve as needed: Yes No
Team Position: Outside Team Music Conference Room
I am willing to travel more than 100 miles for team meetings Yes No
Please place me on track to eventually serve as a Walk/Flight/Journey Lay Director. Yes No
Music Team Applicants: Singer Instrument:     
*Medical Professional only: Occupation and Title


Prior Walk Information:
The Team Selection Committee is charged with maintaining a balance of experience on each Emmaus/Chrysalis Team. Please fill out as completely as possible.
N/A Emmaus Chrysalis Kairos         #
Date Lay Director
Talk Given
Asst TL Table Leader Asst. Lay Director Lay Director Music Outside Team N/A
N/A Emmaus Chrysalis Kairos         #
Date Lay Director
Talk Given
Asst TL Table Leader Asst. Lay Director Lay Director Music Outside Team N/A
N/A Emmaus Chrysalis Kairos         #
Date Lay Director
Talk Given
Asst TL Table Leader Asst. Lay Director Lay Director Music Outside Team N/A
N/A Emmaus Chrysalis Kairos         #
Date Lay Director
Talk Given
Asst TL Table Leader Asst. Lay Director Lay Director Music Outside Team N/A
N/A Emmaus Chrysalis Kairos         #
Date Lay Director
Talk Given
Asst TL Table Leader Asst. Lay Director Lay Director Music Outside Team N/A
N/A Emmaus Chrysalis Kairos         #
Date Lay Director
Talk Given
Asst TL Table Leader Asst. Lay Director Lay Director Music Outside Team N/A


Recommendations:
Lay Director of applicant's FDG/NSG:
Pastor or FDG/NSG Spiritual Director of this applicant:

If accepted to serve as a TEAM MEMBER, I commit to attending all Team Meetings and to be present for the entire weekend, including closing. I also agree, in a spirit of love and obedience, to follow the guidelines for Team Service as outlined in the Team manual and as directed by the Southwest Texas Emmaus/Chrysalis Community Board through its representative, the Lay Director of the weekend.

Signed:     Date:

NOTE: Applications are kept for three years. Please submit a new form after that date if you wish to remain listed on the Team Selection Database. Please update your information after serving on a team.