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Cum Christo Application
First Name
Name on Name Tag
Email
Address
City
Occupation
Marrital Status
Yes
No
Age
Clergy Name
Do you require physical assistance?
Yes
No
Do you use CPAP?
Yes
No
Primary Care Provider
I know in order to attend a Cum Christo Weekend, I must have a sponsor who has previously attended a Cum Christo, Cursillo or Walk. I have a sponsor?
Yes
No
Last Name
Phone Number
State
Zip Code
Birthdate
Gender
Woman
Man
Name of Church Attending
Do you have food allergies or intolerance, if so please list:
Do you take medications that are tme sensitive?
Yes
No
Emergency Contact Name
Emergency Contact Phone Number
Preferred Hospital
St. Vincent Healthcare
Billings Clinic
Spnsors Name
Sponsor Phone Number
Has your sponsor explained the Cum Christo Weekend to you?
Yes
No
May we print your name as a participant?
Yes
No
Message
Submit
Thanks for submitting!
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