EmailMeForm
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: