To enable the Community to have a correct & updated record of your service please complete this sheet.  Also, if you have already completed this sheet, please do so again to ensure that the Team Selection Committee has your information and is aware of your desire to serve.

 

GREAT PLAINS EMMAUS

COMMUNITY MEMBER INFORMATION FORM

 

Information provided on this sheet will be used only for non-commercial purposes by the Great Plains Community, Newsletter Editor, Team Selection committee, etc. Please complete this form and return to the address listed below. Thank You!

 

PLEASE PRINT CLEARLY AND LEGIBLY

 

Name:   _________________________________________________________________

Mailing Address:    _________________________________________________________

Home Phone:   ___________________  email address:    __________________________

Walk Number Attended and Date:   ____________________________________________

Would you like to receive Community information via your email? ____________________

Reunion Group Participation/Name:    __________________________________________

Church Name:   ___________________________________________________________

Specialty Areas:           

            Able to serve on Music Team?   ________________   Vocal?   _________________

            Instrument(s)   _______________________________________________________

            Clergy?  Name of Denomination   ________________________________________

                            Ordained?  ____________________

Interested in serving on:  Kairos _________________       Emmaus  __________________

                                    Torch  ______________________     Chrysalis __________________

Team Experience:

List the Walk served on, position, and talk(s) given. Please list each team separately. Also include community if other than Great Plains. Use back of paper if necessary.

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Return completed form to:

Tracy Stewart

4409 Hidden Hill Road

Norman, OK 73072

Form: GPEDATA.DOC                      Revision Date: 6/18/2004