2018 Journey to the Holy Land
2018 Journey to the Holy Land July 25th - August 6th
$500 Deposit Due: March 15th Remaining Balance Due: May 15th
Limited to the first 25 reservations to submit deposit
Personal Information
**Please complete one registration form per person** Full Name (as it appears on your passport): Preferred Name:
Gender:
Male
Home Address: City:
State:
Cell: ( Email:
)
Home:
-
Congregation (if applicable): Rooming:
Zip: (
)
-
Please include city
*I would prefer a DOUBLE room at a rate of $4,165 I would prefer a SINGLE room at a rate of $4,765
*Name of Travel Companion:
Person you are sharing a room with
Passport Information
**Passport must be valid for 6 months beyond dates of travel** Passport Number: Place of Issue: Date of Issue:
Date Passport Expires:
Date of Birth:
Citizenship:
Place of Birth:
Female
Trip Insurance
**We strongly encourage the purchase of Trip Insurance. If you have purchased Trip Insurance please provide the following information (this can be added later if need be)** Insurance Company: Policy Number: Phone Number for Insurance Company:
(
)
-
Emergency Contact Information **Someone NOT traveling with you**
Full Name: Home Address: City:
State:
Cell: (
)
Email:
Zip: Home:
-
(
)
-
Additional Contact Information:
Please make your check out to “the Episcopal Diocese of Oklahoma” with “2018 Holy Land Trip” in the memo line, and mail it to: Attn: Marcia Crawford The Episcopal Diocese of Oklahoma 924 North Robinson Oklahoma City, OK 73102
For Office Use Only Deposit: Payment: Payment: Payment:
$
$ $ $
.
Date:
.
Date:
.
Date:
.
Date:
/
/
/
/
/ /
/ /
$500 Deposit Due: March 15th Remaining Balance Due: May 15th
Limited to the first 25 reservations to submit deposit
Personal Information
**Please complete one registration form per person** Full Name (as it appears on your passport): Preferred Name:
Gender:
Male
Home Address: City:
State:
Cell: ( Email:
)
Home:
-
Congregation (if applicable): Rooming:
Zip: (
)
-
Please include city
*I would prefer a DOUBLE room at a rate of $4,165 I would prefer a SINGLE room at a rate of $4,765
*Name of Travel Companion:
Person you are sharing a room with
Passport Information
**Passport must be valid for 6 months beyond dates of travel** Passport Number: Place of Issue: Date of Issue:
Date Passport Expires:
Date of Birth:
Citizenship:
Place of Birth:
Female
Trip Insurance
**We strongly encourage the purchase of Trip Insurance. If you have purchased Trip Insurance please provide the following information (this can be added later if need be)** Insurance Company: Policy Number: Phone Number for Insurance Company:
(
)
-
Emergency Contact Information **Someone NOT traveling with you**
Full Name: Home Address: City:
State:
Cell: (
)
Email:
Zip: Home:
-
(
)
-
Additional Contact Information:
Please make your check out to “the Episcopal Diocese of Oklahoma” with “2018 Holy Land Trip” in the memo line, and mail it to: Attn: Marcia Crawford The Episcopal Diocese of Oklahoma 924 North Robinson Oklahoma City, OK 73102
For Office Use Only Deposit: Payment: Payment: Payment:
$
$ $ $
.
Date:
.
Date:
.
Date:
.
Date:
/
/
/
/
/ /
/ /
