Pilgrim Application

If you'd rather print out the Application and mail it in,  CLICK > GRACE Application

*Denotes required field.

To Be Completed by Pilgrim/Applicant:

Please ensure that a $50.00 non-refundable deposit toward the $165.00 fee, payable to G.R.A.C.E. Community will be sent to Grace Registrar

*Full Name: *Name for Name Tag:
Are You Clergy?:


Home Phone: Cell Phone:
Street Address: City:
State: Zip Code:
Date of Birth: Marital Status?:
Are you on a special diet or medication:

If so, please specify diet needs/list medications:
Do you have a health or physical limitation that may affect your attendance:

If so, please specify:

  Completion of the Church and Pastor information below confirms that the Pastor supports the Pilgrim's participation in this walk.

Church Name: City:
Denomination: Pastor's Name:

Emergency Contact #1: Phone:
Emergency Contact #2: Phone:
Has the Walk been explained to you?:

If married, was it explained to your spouse:

To Be Completed by Sponsor:

*Full Name: Email:
*Home Phone: Cell Phone:
Street Address: City:
State: Zip Code:
Community/Date of your Walk: Walk Number:
Security Question:

Show me another question.
GroupM7 Design™ © Grace Emmaus Pilgrim Application