1. Each of the three distinct forms on this webpage can only be submitted and transmitted separately.
2. You must click the "Submit" button directly below each form to submit the respective form, one after the other.
3. Transmitting any of the three forms on this webpage typically requires that your e-mail program reside on your computer.
4. If your e-mail program is "web-based" and an e-mail from you does not automatically open after clicking the "Submit" button, you cannot submit and have not transmitted the webform. In that case, copy the text of each form, and paste that text (only) into an e-mail. Then, fill in the "blanks" with your personal info, and e-mail it to coalition(at)fast(dot)net.

Registration
For FAMILIES participating more than one day
PLEASE  WAIT  WHILE  FORM  REDIRECTS  TO REGISTRATION -  2013

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Important Notes:
1.
If arriving after 9:00 p.m. on Thursday, Sept. 22 please contact Bob Whealan (in charge of shuttling pilgrims) prior to finalizing your flight/train/bus reservations to the Albany metro-region. Bob Whealan windedbuffalo@yahoo.com or 973/239-3632.
2. EACH and every adult pilgrim must e-sign and submit the "Release of Liability" form at the bottom of this webpage.
3.
Parent or guardian MUST e-sign and submit the "Parental Authorization of Minor Children" form at the bottom of this webpage.
More than 1 day, walking or 'Modified Pilgrimage'
My Name
Age
Cost
 $75*
Address
 City
ST / PROV
Zip / Postal Code
 Phone
Country
E -Mail
 
Family joining me more than one day are the following family members:
 
 
Name
Age
Postal Address & e-mail [e-address is CRITICAL]
  
2
$75*
3
+
4
+
5
+
6
+
7
+
+
See Family Rates Schedule for exact discount amounts. The first two family members, whether adult or/and minor, pay $75 each.
*
Family registrations postmarked after August 15 are not eligible for the family discount.
Family registrations postmarked August 16-31 cost $75 per adult and/or each child.
Family registrations postmarked September 1-14 cost $95 per adult or/and each child.
Family registrations postmarked after September 14 or 'walk-ons' cost $115 per adult and/or each child.

A volunteer may register on the same form with his/her family, but may not be included to calculate the discounted fee for family. See this page for more info.

My family & I are registering by August 15, please send us GRATIS the Pilgrimage Documentary on DVD

Use Paypal "Make a Donation" button below to pay registration fee, or mail registration fees to
NCCL
621 Jordan Circle
Whitehall, PA 18052-7119
     
Family registration & payment must be postmarked no later than August 15 in order to avail of family discount.

Secure payment online
with PayPal
Use a Credit Card or
a PayPal Account
 

Back to Pilgrimage Home

Transportation Request Form must be submitted immediately after registering.

RELEASE OF LIABILITY to be signed by all adult pilgrims:
All pilgrims participate and wall in the Pilgrimage for Restoration 2011 at their own risk. "National Coalition of Clergy & Laity" is not liable or responsible for any injury, illness, death or other mishap incurred or suffered by any pilgrim at any time or in any part of the Pilgrimage for Restoration 2011.
I/we, the undersigned, residing at this
address, , agree to the above,
and release NCCL and pilgrimage organizers from all liability to/for myself/ourselves and/or our children under age 18.
Person 1
(dd/mm/yy)
Initials
Full Name
 Date
Person 2
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country
Person 3
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country
Person 4
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country
Person5
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country

To submit additional signatures, submit additional forms.
PARENTAL AUTHORIZATION FOR MINOR CHILDREN:
We, the undersigned, residing at
authorize the "National Coalition of Clergy & Laity"
to make all necessary arrangements for any surgical or urgent hospitalization for our child/children
and/or in our absence place all
or said child/children, in the care of Mr./Mrs. , residing at
who is participating in
the Pilgrimage for Restoration 2011 in the same events as our child/children.
 
Parent / Guardian 1
(dd/mm/yy)
Initials
Full Name
 Date
Parent / Guardian 2
Initials
Full Name
 Date

 

Posted: [date] [time] by DK
Last Updated: Apr 3, 2013  14:29  by gpl
Last Reviewed: Mar 5, 2011 20:08 by gpl
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