Register for a Central Mississippi Emmaus Walk |

To register for a Central Mississippi Emmaus Walk online, you must complete the following steps:

Complete Registration Form
Payment of a $25.00 non-refundable Deposit or the $225.00 Full Registration Fee. Once a completed application, along with a payment, are received, the application will be processed.

Both steps must be completed for you to be registered. When the form has been entered correctly and submitted, you will be redirected to the payment page.

Note: Effective January 1, 2025, the registration fee has increased to $225.00.

Step 1: Complete Registration Form

Fill out all required fields below and click the button to continue to the payment step. If you are not directed to the payment step, scroll up through your form entry and check for errors.

Register for an Emmaus Walk

"*" indicates required fields

1Pilgrim

2Sponsor

* Required Fields

Pilgrim Last Name:*

Pilgrim First Name:*

Pilgrim Address:*

Street Address City State Zip Code

Pilgrim Phone*

Pilgrim Email (Sponsor's email if Pilgrim has no email):*

Which Walk?*

Name Wished on Name Tag:*

Date of Birth:*

Number of Children:*

Please enter a number less than or equal to 12.

Church Now Attending:*

Pastor's Name:*

Marital Status:*

Gender:*

If Married, has spouse been on Walk to Emmaus?*

If Married, has spouse applied for a Walk?*

Has the Walk to Emmaus, the follow-up program of Emmaus groups, and post Emmaus meetings been explained to you?*

In what religious or community organizations are you active?*

Are you on a special diet?*

If so, what sort of diet?

Do you have a health problem or physical handicap that may affect your attendance at a Walk to Emmaus?*

If yes, please specify:

State briefly why you wish to be involved in the Emmaus Community and what you expect from it:*

Emergency Conctact Name:*

First Last

Emergency Contact Phone:*

Register for a Central Mississippi Emmaus Walk

Step 1: Complete Registration Form

Register for an Emmaus Walk

* Required Fields

SPONSOR INFORMATION

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