Nota bene:
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 individual or group - more than one day, walking - 2011

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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
My Name
Age
Cost
 $80*
Address
 City
ST / PR
Zip / Postal Code
 Phone
Country
E-Mail

 
Joining me more than one day are the following pilgrims:
 
 
Name
Age
Postal Address & E-MAIL (e-address is CRITICAL)
  
2
$80*
3
$50+
4
$50+
5
$50+
6
$50+
7
$50+
+ Discount applies ONLY to the third and subsequent members of a group all registering on the same form, online or by mail, postmarked no later than August 15. The first two of a group always pay $80 each.
* Registrations postmarked after August 15 are not eligible for group discounts.
Registrations postmarked August 16-31 cost $80/pilgrim.
Registrations postmarked September 1-14 cost $100/pilgrim.
Registrations postmarked after September 14 and all 'walk-ons' cost $120/pilgrim.

A volunteer may register on the same form, but his/her inclusion may not be used to calculate the discounted fees for the group. See this page for more info.

Family rates are different. Please see Family Rates Schedule.

 

I am registering before August 15, please send me GRATIS the Documentary on
DVD

Use Paypal "Make a Donation" button below to pay registration fee,
or mail registration fee(s) to NCCL, 621 Jordan Circle, Whitehall, PA 18052-7119.
    
Registration & payment must be postmarked no later than August 15 to avail of group discounts.
 

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

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Transportation Request Form must be submitted immediately after registering.

RELEASE OF LIABILITY to be signed by all adult pilgrims:
All pilgrims participate and walk 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: Mar 18, 2011 11:11 by gpl
Last Reviewed: Mar 18, 2011 11:12 by gpl