Cursillo Movement:

Diocese of Allentown, PA

to Christ

Make a Friend, Be a Friend,
Bring Your Friend to Christ!

Pre-Cursillo Application Form

- What is Cursillo?

Cursillo Applicants

Cursillo Applicants should fill out the following form and submit it.
Please read information at bottom of the form after your electronic signature.

De Colores!!!
Form to be Filled Out by Cursillo Applicant
CURSILLO APPLICATION
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Parish Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Marital Status Single Engaged Married Divorced Separated Widow(er)
- Occupation (If Retired...type "Retired" Please enter valid data.
- Employer Please enter valid data.
- Involved in Parish Activities? Often Sometimes
- Describe Activites
- Involved in any religious movement(s) such as Marriage Encounter, Charismatic Renewal, etc? Please specify.
- Food Allergies or Special Diet Requests Please enter valid data.
- Other Special Needs on Weekend Please enter valid data.
- I agree to and understand that this is only an application for attending a Cursillo weekend, and if accepted I will be notified by letter with the date, place, and other relevant information.
  I Agree Please select this field.
- Electronic Signature REQUIRED Please fill out this field. Please enter valid data.
- Sponsor's Name Please enter valid data.
- A registration fee of $75.00 is requested with this application. $25.00 of this
  deposit is non-refundable. The deposit will be applied to the donation requested on the Cursillo Weekend.
  
  Please make checks payable to:
  ALLENTOWN CURSILLO MOVEMENT
  Cost should not be a factor in making a Cursillo weekend.
  
  Mail check to:
  John & Lisa Siciliaino
  3410 Woodland Ave
  reading, PA 19606
Submit

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