Long Island Tres Dias   Application to Serve on Team

PERSONAL INFORMATION   Print out this page and complete form                                                                                     Name___________________________________   Male   Female          Date of Birth_____/_____/_____                              Street ___________________      City   _______________________  State_____  Zip  ___________                                   Home phone# (      )_________   Work # (      )___________  Fax: (      )   ___________   Email: _____________                 Marital Status (circle one)  Single /  Widow /  Div.  / Married - Has your spouse made a Weekend?     Yes      No

CHURCH & COMMUNITY INFORMATION                                                                                                                                       Original Weekend #  ______    Where?__________________________When?__________________________              Please indicate if other than Long Island Tres Dias   ____________________

HOME CHURCH                                                                                                                                                                                            Name of Church     ________________________________  Denomination   ________________________                                Address    ___________________________________________________________________________

TRES DIAS EXPERIENCE                                                                                                                                                                                   # of Long Island Tres Dias Weekends you have worked (check one)   ______0-1 ______2-4 ______5 or more

Team Experience (check team assignments you have served in)                                                                                                                ______Rector         _____Asst. Rector        _____Spiritual Advisor       _____Chief Auxiliary      ______Chief Kitchen        _____Chief Musician     _____Auxiliary    _____ Kitchen Aux     ______Table Leader

ROLLO EXPERIENCE                                                                                                                       ______Ideals______Church______Piety  ______Study______Action______Leaders ______Environments______CCIA______Reunion Groups ______Fourth Day

Community Experience                                                                                                                                                                                      Do you participate in:   (Place one of these  Often   "O" ,     Sometimes   "S" ,     Rarely   "R" ,      Never  "N")                    Palanca  _____        Secuelas  _____        Agape Cleanup   _______       Candle Chapel  ______     Mananita   _____            Agape Set-up   _____      Closing  _______     Tres Dias School       YES______ No______

If accepted to serve on a team, do you:  

Have any physical restrictions that may prevent you from doing a certain task                                                                       No____    Yes   (explain)_________________________________________________________________

Have any special medical, physical, or dietary needs?                                                                                                                    No____   Yes   (explain)________________________________________________________________

Fully understand the commitment of time, prayer and talents it will involve?                                                                                      No  ____   Yes  (explain)  _______________________________________________________________

Total cost of the Weekend to the Community is $225.  Any donations are greatly appreciated.

 Signature__________________________________________________      Date__________________

WHETHER YOU HAVE WORKED A WEEKEND OR NOT -_PLEASE FILL OUT APPLICATION AND RETURN TO: Paul Pugliese, 311 Uniondale Ave, Uniondale, NY11533

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