NAME:  ___________________________________________________________________

ADDRESS: _________________________________________________________________

HOME PHONE:  (        )  _______________________  WORK: (        ) __________________

Emmaus Community and Walk Number: ____________________________________________

I have attended at least one of the annual training day workshops:    ________ YES  _______ NO

I have worked behind the scenes on a walk ________ as _______________________________

I have been on a Conference Room Team _______ as _________________________________

My special interests-hobbies-talents ______________________________________________

I attend _______________________________ church, in ____________________________
                                                                                                            (town)
Age ________ 20 to 40        _______ 40-60        _______ 60 to Heaven

I want to work behind the scenes on (Men's)(Women's) Walk # ________________________

Behind the scenes I can help with: (Please list top 3 preferences 1st, 2nd, 3rd)

_______ Soliciting food and monetary donations for break tables
_______ Send Off Refreshments
_______ Set Up and Take Down
_______ Luggage
_______ Dinning Room (Behind the Scenes Support Staff)
_______ Break Tables (Behind the Scenes Support Staff)
_______ Prayer Chapel  (Behind the Scenes Support Staff)
_______ Agape  (Behind the Scenes Support Staff)
_______ Worship/Setting Up Altars  (Behind the Scenes Support Staff)

During the Walk weekend, Behind the Scenes Support Staff Only will be allowed to stay
at the camp.  Their cost for the weekend is $150.00 for room and board.

Mail to:    Andy Anderson, 713 Lake Road, Newport, NC 28570
Phone:     (252) 223-3350 (H)
Email:      aanderson@havelocknc.net