Women's JTD #231 Pilgrim Application: April 3-6, 2025

Pilgrim Information

Pilgrim Name

Nickname/Preferred Name

Address

Pilgrim Phone

Pilgrim Email

This address will receive a confirmation email

Birth Date

Sponsor Information

Pilgrim Sponsor

Sponsor Phone

Sponsor Email

This address will receive a confirmation email

Faith Walk

Home Church

Denomination/Afiliation

Have you been on any of these similar weekend retreats? Journey to Damascus Walk to Emmaus Cursillo Tres Dias ACTS Other Similar (Please Explain) None

Retreat not listed above

Family/Work

Occupation

Marital Status

Single Married Divorced

In Case of Emergency

Emergency Contact Name:

Emergency Contact Relationship:

Emergency Contact Phone 1

Emergency Contact Phone 2

Are you medical emergency trained?

Nurse Med Dr. EMT None

Special Needs?

Special Dietary Needs? (Please list/explain)

Please list/explain any health issues or disabilities/Medication that may require specific accomodations

Registration Policy

All of the information within this application form is necessary for placement on the Houston Journey to Damascus weekend roster. Applications will be accepted in the order received complete with payment. Upon submittal, you will receive a confirmation. Pilgrims must be present at the retreat facility for the entire weekend, from Thursday evening to Sunday afternoon.

I agree

Refund Policy

To be eligible for a refund, applicants must send a notice of cancellation to the Lay Director or Board Representative via email by Sunday 5PM CT preceding the confirmed JTD weekend. The refund would be in the amount of the registration fee and will be issued in the form of a check by mail within 14 days following the JTD weekend. Refunds cannot be automatically applied to future journeys. An exception to this policy would be a death or medical emergency in the immediate family of the applicant that causes him/her to not be able to attend the JTD weekend. Any other exception to this policy requires the explicit approval of the JTD Board President.

I acknowledge that I've read and agree to the above refund policy

Payment & Fees

Payment

Add 3% to cover credit card fee for JTD (optional)

If applicable, short description of reason for requesting scholarship

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Women's JTD #231 Pilgrim Application: April 3-6, 2025

Description

Please Fix the Following