Saint Gemma’s
Catholic Pilgrimages
www.TakeaPilgrimage.com
Registration Form
Select one Pilgrimage in
2014:
___ February
15-23:
___ April 25 – May 2: Rome & Assisi – Canonization of John Paul II: $2995 double occupancy
___ April 25 – May
2:
___ September 22 -
October 3:
___ October 6-17:
___ October 18-26:
Name
First Last
Street Address
City State/Province
Postal/Zip Code Country
Email Phone
Payments:
How will you be paying?
___ I will send a check for my deposit and final payment.
___ I will send a check for my deposit and use paypal.com to make my final payment.
___ I will use paypal.com to make my deposit and send a check for my final payment
___ I will use paypal.com for my deposit and final payment.
Name as it appears on your
passport:
(Needed by
airlines to verify identity when you check in. You can send
this later if you don't have a passport yet)
Date of Birth:
(Needed by airlines to verify
identity when you check in)
How did you hear about us?
___ Online
search
___ Catholic radio
___ Link on Catholic website
___ Catholic periodical
___ Friend/family
___ Facebook
___ Catholic bookstore
___ Other
Additional information or
Promo Code:
· If part of a Pilgrimage Group (Catholic parish or other Catholic group going together) please include the name of your group here.
· Please include any additional information you wish us to know.