Pilgrim Registration Form - OUR LADY of LOURDES in NEW MILTON

Pilgrimage 15th May 2017 – 22nd May 2017: 100TH ANNIVERSARY OF THE APPARITIONS OF OUR LADY IN FATIMA

Pilgrim Registration Form - OUR LADY OF LOURDES IN NEW MILTON

Pilgrimage 15th May 2017 – 22ndMay 2016:

Lisbon – Santarem – Tomar – FATIMA –
Coimbra–Alcobaca – Batalha - Obidos

Please read the following information before filling in the registration form:

Deadline:The deadline for completing the registration form is 29 OCTOBER 2016.

On completion of the registration form:

A deposit of £250 is required with the registration form – note that a non-refundable deposit of £250shouldbereturnedwiththisregistration form (preferable in cash, if it must be cheque, please address it for Fr Marcin Drabik)

The registration form can be sent to:Fr. Marcin Drabik, Our Lady of Lourdes, 15 Mount Avenue, New Milton BH25 6NT; Alternatively, it can be sent to:

Required forms:

After completing this registration form, the following additional form(s) will be sent to you for your completion:

• Medical form
• Parental consent form (for those under the age of 18)

1. Personal detailsPlease fill in all the boxes in this section.

Title / Mr / Mrs / Ms / Dr / Revd / Fr / Sr / Other
Name
Address
Postcode
Email
Parish
Town
Home number
Mobile number
Date of birth / DAY / MONTH / YEAR
Passport number
Nationality
Country of issue
Date of issue / DAY / MONTH / YEAR
Date of expiry* / DAY / MONTH / YEAR

* Pleasenote:your passportmust bevalidforthe entireperiodofthepilgrimage and must have at least six months remaining upon arriving back in England.

2. Emergency contact

Please fill in all the boxes in this section.

Title / Mr / Mrs / Ms / Dr / Revd / Fr / Sr / Other
Name
Address
Postcode
Email
Home number
Mobile number
How is this person related to you?

Payments

Payment 1: £250 deposit (submitted with this form)

Payment 2: £475 by 31 December 2016

Payment 3: £75 extra payment for a single room together with the 1st payment.

3.Insurance

Grouptravelandmedicalinsuranceis notincludedin theoverallcost.You will need toarrangeyourown insurance,but pleasesupplytheinformationto us by filling in all the boxes below.

Company or Companies you are insured with
Policy number(s)

People living within the European Union should bring their European Health Insurance Card (EHIC). More information can be found at:

4. Visas

This section applies only to those who may have to apply for a Visa. If you are holding a British passport, you do not require a Visa and can skip this section.

If you require a Visa for the pilgrimage, please complete the necessary steps.

Information about Visas can be found at:

5. Special requirements

This section applies only to those with special requirements. If you do not have any, skip this section.

Please specify below any information or special requirements you may have in order for us to best assist in providing you with your pilgrimage.

10Signature and date

Please sign and date your registration form in the space provided below.

SignatureDate

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