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Name: Title Rev. Mr. Mrs. Miss <\SELECT>        Name Called:

Address:    City:   State:   Zip:

Home Phone:    Work Phone:    Cell Phone:

Email:    Occupation:

Home Church:    Denomination:

Have you attended a Kairos type weekend: Yes/No No Yes <\SELECT> 

        If Yes weekend attended   Weekend Kairos Kairos Outside Cursillo Emmaus Via de Cristo Tres Dias Other <\SELECT>  Location:    Date:

Previous Kairos Experinece:         

Previous Cursillo etc Experience:  

Would you be willing to give a talk:  Yes/No Yes No <\SELECT>

Talents you will share (music, sign, etc.):

It is expected that you are active in your Reunion Group and your local church.  It is understood that attendance at Team Meetings is required.