Interfaith Marian Pilgrimages
Registration Form:


Name: (As it is in your passport)……………………………………………………………………

Passport number:……………………………………………………………………

Expiration date: (Must be valid 3 months after your return.)…………………………………

Nationality:……………………………………………………………………

Address:…………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Telephone:………………………………………………

Fax:…………………………………………………………

e-mail:……………………………………………………

I prefer: single room, double room, triple room

I’ll come alone, but would like to share a room with someone of my gender.

Departure city:…………………………………………………………

Gender: female, male

Age:………

Religion/spiritual affinity:………………………………………………………………………………………………………………

My spiritual practice consists of:…………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………

I don’t yet have a regular practice.

How did you hear about us?:………………………………………………………………………………………………

I have read and agree with your Terms and Conditions:

Signature………………………………… Date…………………………


Send your registration form along with a $ 500.- deposit per person, payable to Ellen Rozett.

Mail your check to:

Interfaith Marian Pilgrimages
c/o Ella Rozett
P.O. Box 646
Graton, CA. 95444,
USA

If you don’t get a confirmation of your reservation within 10 days, contact Ella Rozett.