Pilgrim Application

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Pilgrim Application

Pilgrim Information

Email *

First Name *

Middle Name (not middle initial)
*

Last Name *

Birthday
*

YYYY

Name Preference for Nametag

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Church you attend
*

Church city
*

Gender *

Male

Female

Required

Are you married? *

Yes

Required

Name of Spouse

Are you a full-time vocational minister? *

Yes

Required

Are you ordained? *

Yes

Maybe

Have you ever attended another three-day movement as an adult? (Walk to Emmaus, Cursillo, etc) *

Yes

Special Requests:

Food Allergies

Mobility Assistance (can you walk up and down a sloped hill & climb a flight of stairs with minimal assistance?)

Medication

Sleeping Arrangments (breathing machine)

None

Other:

Required

If you marked any special requests above, please provide the details here:

Emergency Contact: In case of illness or emergency, who should be contacted?

Name of Emergency Contact *

Phone Number for Emergency Contact *

Relationship to Pilgrim *

Agreement *

*I have accepted Jesus Christ as my Lord and Savior.

*I understand that the purpose of the Tres Dias Weekend is to strengthen and deepen my relationship with Him.

*I understand that I will be exposed to the essential truths of the Gospel in Scripture, and I am willing to having it transform my life.

*In order to provide a more conducive and less distracting environment for all of this to occur, I understand that it is part of the Tres Dias experience that watches, cell phones, laptops and other electronic devices not be used by pilgrims on the weekend, and that an emergency number will be provided to my family and friends should they need to contact me.

Required

Signature *

Date *

YYYY

Name of Sponsor (first&last)
*

If you have any questions, please contact Mark Meintel or Diane Meintel.

tdcaz.preweekend@gmail.com
602-622-8199 (Mark Meintel)
602-622-0233 (Diane Meintel)

Send me a copy of my responses.

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