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.