EmailMe Form - Directory Update

Name: *

First Last

Name on Emmaus event (if different from above):

First Last

Emmaus event (Community; & Walk, Flight, or Encounter #): *

Phone: *

### - ### - ####

Date of Birth:

MM / DD / YYYY

Please provide if you are comfortable doing so. This information is used only to determine eligibility for serving on a Face to Face Encounter team (team members are to be at least 55 years old).

Home Address:

Old Email Adress:

New Email Address:

Community emails you wish to receive:

ALL

Community Notices only

Prayer Requests only

Remove name from emailing list?

No

Yes

Comments: