Registration
(For those participating only on Saturday)
  

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2. ALL ADULT PILGRIMS MUST PRINT-OUT, SIGN and MAIL
RELEASE OF  LIABLITY FORM AT BOTTOM OF THIS WEBPAGE.
  

 
My Name and Age
Address 
City
 St Zip
Phone
E -Mail
   
 

As a token of gratitude for my gift of $12 or more,
please send me the new Documentary on VHS or DVD

  Mailed is my gift to NCCL in the sum of: $

 
Joining me Saturday are the following pilgrims:
 
  Name & Age Address  
2
3
 
4
 
5
 
  Mail separate sheet for more names.  
 
Please send your registration
for Saturday (only) by September 19,
or register Saturday before events begin.
 
 

To register by mail: print this page and mail it with your check payable to:
NCCL
621 Jordan Circle
Whitehall, PA 18052.

  

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

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RELEASE OF LIABILITY to be signed by all adult pilgrims:
All pilgrims participate and walk in the Pilgrimage for Restoration 2007 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 2007. I/we, __________________ , the undersigned, agree to the above, and release NCCL and pilgrimage organizers from all liability to/for myself/ourselves and/or our children under age18.
 
 
 

SIGNATURE: __________________________________________date: _______________
 
 

SIGNATURE: __________________________________________date: _______________
 
 

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 responsibility for our child/children, ____________________ , in the care of Mr/Mrs _________________ who is participating in thePilgrimage for Restoration 2007 in the same events as our child/children.
 

SIGNATURE: ___________________________________ [parent/guardian]date: _______
 
 

SIGNATURE: ___________________________________ [parent/guardian]date: _______