Application to serve on a team for the Southeastern Michigan Walk to Emmaus

Name:                                                                           Name for name tag:                                                                    _ 

Address:                                                                       Male:             Female:              Original Walk #                          

City:                                                                             St:                Zip:                     Original Location:                       

Home Phone:                                                                Cell Phone:                                                                              

E-Mail Address:                                                                                                                                                            

                                    (Please Print Clearly)

Home Church:                                                               Gathering:                                                                                

Have you attended 4^th Day Workshop?                             When?                                                                                     

What walk would you like to work on?                                                   Dates:                                                                 

                                                                        (Location: City, St)

 Why do you want to serve on a team?  Please use the back of this application to explain if more space is needed:

 Have you had previous team experience?    Yes           No             Include other Communities & Chrysalis – use the back of

this form if more space is required.                                                                                                                                 

Walk #:                          Position on team:                                                            Talk Given:                                           

 Walk #:                          Position on team:                                                            Talk Given:                                           

 Walk #:                          Position on team:                                                            Talk Given:                                           

 In what ways do you support the Emmaus community?        Gathering: __ Agape: __ Candlelight: __ Closing: __ Other: __

                                                                                                                                     (Check all that apply)

 Are you a member of a Christ-centered small group?            Yes                 No            

 Do you lead singing?                  Play musical instruments? Yes                No                   Please List                               

 Do you have any disabilities, mental or physical that would hinder your performance on the team?          Yes           No         

 If yes, please explain:                                                                                                                                                    

 Team member(s) are requested to attend 4 team meetings.  Are you willing and capable to do so?         Yes           No         

 In your role as a team member, will you act as a servant in all situations?                                             Yes           No         

 Signature:                                                                                                                      Date:                                       

Mail application to:    Ed Pokrzywinski                                     E-mail any questions or concerns to:

                                1000 Chippewa                                 

                                Mt. Clemens, MI  48043                              teamselection@emmaussem.org

                                (586) 468-3266