Please check one:
Men's Weekend
Women's Weekend

Full Name: (Last, First, Middle Initial)

Nickname: (if desired for name tag)

Mailing Address:

City: State: Zip:

E-mail Address:


Phone Numbers:
Home:
Cell:

Age:

Marital Status:

Spouse Name:

Children:(Ages and sex helpful)

Are you actively seeking a closer walk with the Lord?
Select One Yes No

Have you ever attended a Cursillo, Walk to Emmaus, Via De Christo, Koininia, Kairos or Pathways weekend?
Select One Yes No

If yes. When and where?:

If married, has your spouse attended a Tres Dias or equivalent weekend?
Select One Yes No

If spouse has not attended, has he/she submitted an application through a sponsor?
Select One Yes No

If spouse has attended, when was their weekend?

Church attending:

Occupation:

Hobbies/Interests:

Are you? (Check all appropriate)
OUTGOING     QUIET     LEADER      FOLLOWER

Do you have any physical disabilities or chronic illnesses that might limit your participation in three full days of Tres Dias (i.e. diabetes, cardiac conditions, depression, severe allergies, and vision problems) do you take any prescription medications? If so please describe:

Special diet - if so please describe:

Please describe why you want to attend Tres Dias and what you hope to gain:

Emergency Contact Information:

Sponsors name:

The cost of the weekend is $85.00 per candidate. Please make your payment option selection below. Fee paid by Sponsor, paypal, or mail check.
Select One Paypal Mail Check Paid by Sponsor

Electronic Signature:

Date: (MM/DD/YYYY)


Comments or Questions: