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Pilgrimage Registration Form
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* Indicates required question
Last Name
*
Your answer
First and Middle Name
*
Your answer
Address
*
Your answer
Languages you speak fluently:
*
English
Spanish
French
Other
Required
What parish do you belong to?
*
Your answer
How did you hear about us?
*
Parish
Social Media
Internet
Friend
Other
Required
Health Insurance
Insurance Company and Policy#/ Group IP
*
Your answer
Insurance subscriber's Name.
*
Your answer
Emergency Contact: (person not traveling with you)
*
Your answer
How many times have you traveled with us?
*
This is my first time
This is my 2nd time
This is my 3rd time
This is my 4th time
This is my 5th time
This is my 6th time
This is my 7th time
I've travelled more than 7 times to Lourdes with The Hospitalité de Miami
Are you serving the Sanctuary?
*
No, I am not serving the Sanctuary
I am serving for the 1st time
I am serving for the 2nd time
I am serving for the 3rd time
I am serving for the 4th time
I am serving for the 5th time
I am a hospitalier(e)
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