Tidewater Chrysalis Teaming Application

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Greetings! We are excited to welcome you on the weekend experience. Tidewater Chrysalis will be held at Triple R Ranch from January 13th 8am - January 15th (MLK Holiday) 5pm. If you have any issues accessing or submitting this form please contact (Call or Text) the Chrysalis Registrar at 757-572-3787 or email to tidewaterchrysalisregistrar@gmail.com

Email *

Full Name *

Name for your Nametag (If you go by something different than your first name)

Date of Birth *

YYYY

Gender *

Female

Male

Street Address: *

City *

State *

Zip Code *

Cell Phone Number *

Church you attend

Have you teamed Chrysalis before? *

Yes

Please list any chrysalis or emmaus weekends on which you have served as well as your assigned role on these weekends

Do you play an instrument or sing

Yes

Clear selection

If instrument, which ones

Clear form

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