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      PilgrimRenewal
    Your Name (required)
    Address (required)
    City (required)
    State (required)
    Zip (required)
    email (required)
    phone (required)
    Marital Status (required) MarriedDivorcedSingleWidowed
    Spouse Name
    Spouse Phone
    Number of Children


    Family Member other than Spouse to contact in case of Emergency:

    Name (required)
    Phone (required)
    Relationship


    Your Background

    Occupation
    Education
    Date of Birth
    Church Name
    Pastor/Priest/Minister's Name
    Denomination
    Church Address
    Church City
    Church State
    Church Zip


    Weekend You Wish To Attend?

    Date
    Location
      MenWomenCoed
    Sponsor's Name (required)
    If you don't have a sponsor, enter 'I Need One'.
    Sponsor's Phone
    Sponsor's email
    Name to be used on name tag


    Medical Questions

    Do you have any special dietary requirements? YESNO
    What kind of dietary requirements?

    DiabeticVegetarianLow SaltGluten FreeOther:

    Do you require medications at specific times each day? YESNO
    Do you have any health or physical restrictions that require special equipment or facilities? YESNO

    If you answered "YES" to the above medical questions, Please give us some details so that we may assist you on YOUR weekend. If you want someone to call you regarding special needs, please let us know.

     

    Please talk to your sponsor regarding the cost of the week-end. If you are paying for the weekend, the cost is $120 (This includes the $20 application fee). You can conveniently use the PayPal 'Donate' on the right edge of this page towards to top to pay. If you can not pay for the week-end please talk it over with your sponsor. Additionally, there are scholarships available, contact the Pre-Weekend Chair for more information.



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