Oregon Trails Walk to Emmaus

Rooster Booster Registration / Update Form

Please complete the form below

Check ALL that apply

	Please leave me in the Emmaus Community Database
	Please remove me from the Emmaus Community Database (Include information below to be sure we remove the correct Community Member)
	I am receiving the Rooster Booster via email, but would prefer a copy mailed to me
	Please, do not use my email address for Emmaus communications, including the Rooster Booster Newsletter.
	I am currently not receiving the Rooster Booster. I would like the newsletter sent: Email Regular Mail

First Name:

required

Last Name:

required

Spouse:

Phone:

Include Area Code

Your E-mail:

required

Spouse E-mail:

Street Address 1 :

Street Address 2 :

City:

State:

Zip:

Church I (we) attend :

Walk Number :

or enter the Walk Location & Year,
or Lay Director in the Comments box below

Your comments:

Oregon Trails Walk to Emmaus respects the privacy of the individual. No information will be given out or sold to any other entity. This information is used solely for the purpose of communication within the Oregon Trails Walk to Emmaus Community.

Oregon Trails Walk to Emmaus

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