Pilgrimage Form — In Your Name Lord Pilgrimages

In order for a space to be reserved, the full amount must be sent in along with completing this form.

By filling out and submitting the form, you agree to send or charge your $200 deposit.

Checks should be made to In Your Name Lord Pilgrimages.
Send the check to: In Your Name Pilgrimages P.O. Box 56732, Chicago IL 60656-0732.

Each person signing up must fill out an individual form.

Name

First Name

Last Name

Date of birth

Address

City, State, and Zip Code

Home Phone

Work Phone

Email Address

Desired Roommate

Would you like us to assign a roommate to you or would you like a single supplement ($500) ?

Single Supplement

Roommate (assigned)

If you are traveling in a group, what is the name of the group?

Emergency Contact

Destination and Dates of Pilgrimage