SRM Registration Form

Shrines of Mexico Pilgrimage

December 8 - 14, 2008

Mexico City, Our Lady of Guadalupe - Our Lady of Remedies - Shrine of St. Michael
Shrine of the 5th Apparition (Tulpetlac) - Ocotlan/Tlaxcala - Puebla

Cost: $1595 per person with payment in full by October 25, 2008
$1695 after 10/25/08
****Cost may increase if airfare increases after October 25th. Airport taxes, tips to guide & driver are not included***

Your JavaScript option is not enabled in this browser. To make this form easier to use, please activate your JavaScript option.
Firefox browsers: (Tools (or Edit/Preferences)/Options/Content tab/Enable JavaScript/OK/Reload page)
Internet Explorer: (Tools/Internet Options/Security tab/Custom Level/Scripting/Active Scripting/Enable/OK/OK/Reload page)
Safari browsers: (Preferences/Security/Enable Javascript/Close window/Reload)

Today's Date is Jun. 24, 2017

Please reserve seats for person(s)* * indicates answer required

Name*
2nd Person
3rd Person
4th Person

Address*
(Not a PO Box)

City* State* ZIP Code*

Home Phone Cell/Work Phone FAX Number

E-mail Address

Accommodations* (Please choose one):

Single Room Supplement $350
Please assign me a roommate
I prefer to share a room with: Name

Payment*

Cash / Check / Money Order
Credit Card: Add 3% Choose Credit Card Name on Card

Card # Exp. Date Signature ______________________________________