CHRYSALIS REQUEST
RESERVATION - 2003
All information MUST be filled
in, or application and fee will be returned.
PLEASE TYPE OR PRINT LEGIBLY
- ALL INFORMATION IS REQUIRED FOR PLACEMENT ON A
CHRYSALIS FLIGHT.
- WE MUST HAVE YOUR SIGNATURE, YOUR SPONSOR'S
INFORMATION AND YOUR PASTOR/YOUTH DIRECTOR SIGNATURE BEFORE YOUR APPLICATION CAN BE
PROCESSED.
- RETURN THE COMPLETED FORM WITH YOUR FEE TO YOUR
SPONSOR, OR MAIL WITH SPONSOR INFORMATION.
- IF YOU HAVE NOT RECEIVED ANYTHING REGARDING
CONFIRMATION OR WAIT STATUS WITHIN ONE MONTH, PLEASE CONTACT THE REGISTRARS OFFICE.
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Chrysalis requested 1st Choice #______ Date
______ 2nd Choice #______ Date ________
Last Name ____________________First Name _________________Name Tag___________
Male[ ] Female[ ]
DOB:____/____/____ Age as of 6/01/03______
Address _______________________City ___________ST___Zip_____________
Home Phone ( )____-______ Email Address:
____________________________
Church and the denomination presently attending:_____________________________
School Name: __________________________Grade Next Fall('02-'03)__________
Has Chrysalis Been Fully Explained To You? [ ]Yes [
]No Has post Chrysalis follow up been explained?
[ ]Yes [ ] No
********************************************************************************************************
***ALL PARTICIPANTS MUST BE 15-18 AS OF 6/1/2003 AND
HAVE COMPLETED 9-12 GRADES***
Please enclose a check for the cost of
the weekend with this application. Scholarships are available, but should be arranged through your sponsor.Your application cannot
be process-
ed before the full registration fee is received. Register ONLY if you intend to
be present for
the entire weekend. You must have your sponsor or youth director sign this form.
Each
person registered should be sponsored by someone who has already attended
Chrysalis,
Emmaus, Tres Dias or other similar 3 day experience. You will receive
confirmation by
mail as well as a list of necessary items to bring. THE MEDICAL RELEASE FORM
MUST
BE FILLED OUT FOR ALL AGES, SIGNED AND RETURNED WITH YOUR COMPLETED
APPLICATION. If you find that you are unable to attend a Chrysalis, on which
you are
either accepted or on the waiting list, please contact the Registrar
immediately. Refunds
are processed only for written requests.
REFUND POLICY: THE FULL FEE MINUS $25.00 WILL BE REFUNDED TO THE
PAYER
OF THE REGISTRATION FEE UP TO 7 DAYS PRIOR TO THE BEGINNING DATE OF THE
CHRYSALIS IF YOU CANCEL ANY TIME AFTER THE 7 DAYS, YOU WILL FORFEIT
100% OF THE
FEE UNLESS YOUR SPACE CAN BE FILLED. IF YOU NEED TO LEAVE
AT ANY TIME DURING THE WEEKEND, YOU WILL NEED TO RE-APPLY AND PAY THE
FEE AGAIN.
Your Signature
____________________________________________DATE:_________
SPONSORS INFORMATION:
Sponsorship is the most important job in
Chrysalis. The quality of sponsorship influences the pilgrim, the health of the
Chrysalis movement, and the Church being affected by Chrysalis. Thank you
for your dedication and effort to promote the Chrysalis vision of developing
Christian leaders who will strengthen the local church.
PLEASE PRINT [
](please check if this is a new address)
Sponsor's Last
Name:____________________ First Name______________________
Address:_________________________ City _________________ST ____Zip_________
Home Ph.( )____-_____ Work
Ph.( )____-______Email Address:_______________
Church and the denomination presently
attending:________________________________
Where did you attend your Flight/Emmaus Walk/Cursillo(or
other similar 3 day experience)?
___________________________________________________________________________
Flight/Walk#______ When? __________Where? ___________________Active in reunion/small
group?________ (If you are not active in a reunion or accountability
group,
Please make every effort to join one soon. This is an essential part of
the weekend experience.)
Check made payable in full to
"Treasurer, Southwest Texas Conference"
Mail this completed form and fee to:
Emmaus Registrar P. O. Box 781149, San Antonio, TX 78278