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***

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Today's Date is Sep. 23, 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 ______________________________________