Application PRV A Closer Walk Application Step 1 of 7 14% Registration Total Select your Walk Weekend(Required) Women’s Walk #19 September 17 – 20 Men’s Walk #20 October 15 – 18 This field is hidden when viewing the formWomen's Weekend DatesThis field is hidden when viewing the formWomen's Start DateThis field is hidden when viewing the formWomen's Candlelight DateThis field is hidden when viewing the formWomen's End DateThis field is hidden when viewing the formMen's Weekend DatesThis field is hidden when viewing the formMen's Start DateThis field is hidden when viewing the formMen's Candlelight DateThis field is hidden when viewing the formMen's End Date Pilgrim Name(Required) First Last What name does the pilgrim want on their name tag?Leave blank to use provided first and last namePilgrim's Date of Birth(Required) MM slash DD slash YYYY Pilgrim's Phone(Required)Pilgrim's Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pilgrim's Email(Required) Enter Email Confirm Email Church where pilgrim attends worship regularly(Required)Enter “None” if the pilgrim does not regularly attend a church.Has the purpose of the Walk been explained to the pilgrim?(Required) Yes No Have the follow-up activities been explained to the pilgrim?(Required) Yes No Briefly describe any physical limitations that may affect the pilgrim's participationBriefly describe any special physical assistance or diet the pilgrim requiresEmergency Contact (other than Sponsor)Emergency Contact Name(Required) First Last Emergency Contact's Relationship to Pilgrim(Required)Emergency Contact's Phone Number(s)(Required) APPLICANT’S PASTOR’S ENDORSEMENT IS STRONGLY ENCOURAGED A Closer Walk is a spiritual renewal program intended to strengthen the local church through the development of Christian disciples and leaders. The program’s approach seriously considers the model of Christ’s servanthood and encourages Christ’s disciples to act in ways appropriate to being “a servant of all.” Church NameChurch NamePastor's Name First Last Pastor's Title Sponsor's Name(Required) First Last Sponsor's Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Sponsor's Phone(Required)Sponsor's Email(Required) Enter Email Confirm Email Is the sponsor currently in a reunion group?(Required) Yes No Is the sponsor active in community activities?(Required) Yes No Is the sponsor familiar with the sponsor expectations?(Required) Yes No Has the sponsor explained the A Closer Walk weekend and Fourth Day activities?(Required) Yes No Payment(Required)I will be paying today electronicallyI need to make alternate payment arrangementsAlternate Payment Explanation(Required) Walk Pilgrim Fee(Required) Price: Payment(Required) If you have any problems with the application, please contact [email protected] for assistance.