Servant Application – Cincinnati Emmaus Community

Servant Registration

Name

First Last

Gender

Address

Street Address City State / Province / Region ZIP / Postal Code

Home Phone Number

Cell Phone Number

Other Phone Number

Email

Original Walk Date*

Walk #

Place

Church Name and Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pastor of Church

Have you served on an Emmaus team before?

If so, where?*

Date of last team on which you have served?

How many teams have you served on?

I have previously served as (check all that apply):

I have given the following talks (check all that apply):

List special talents (music, computer, etc.):

Are you in a reunion/share/accountability group?

(If yes to above) Where/When?

Which Teams Are Of Interest? (Check All That Apply)

What Time of Year Are You Available? (check all that apply) (Note: prep begins 8-10 weeks in advance of an event)

Please include any special dietary, medical, or mobility needs:

Digital Signature (please type)

First Last

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