Pilgrimage Registration Form

"PLEASE PRINT THIS FORM, FILL OUT AND MAIL TO:
           St. RAPHAEL MINISTRIES       IF PAYING WITH CREDIT CARD
           P.O. BOX 160                             E-MAIL TO: srm.inc@juno.com
           HALF MOON BAY, CA 94019     FAX   (650)726-5394

December 8-14, 2008 - 7 Days

PAYMENT IN FULL $1595 PER PERSON UNTIL 10/25/08
$1695 AFTER 10/25
Cost may increase if Airfare cost increases after 10/25/08.
Credit Cards Add 3%
PLEASE RESERVE ______SEATS.

NAME(S) (Full name)_________________________________________________________

HOME ADDRESS(Not P .O. Box)_______________________________________________

CITY___________________________________________________________

STATE__________ZIP_________________

HOME PHONE(____)______________________WORK(_____)_______________________

FAX (____)_______________________E-MAIL____________________________________

( ) SINGLE ROOM SUPPLEMENT $350 ( ) PLEASE ASSIGN ME A ROOMMATE

( ) I PREFER TO SHARE A ROOM WITH________________________________________
***If a roommate can not be found, a single supplement must be paid.***
*
***AIRPORT TAXES, TIPS TO GUIDE & DRIVER ARE NOT INCLUDED***

(800) 456-4197 FAX (650) 726-5394

VISA MASTERCARD DISCOVER AMERICAN EXPRESS

CARD NO._____________________________________________EXP. DATE______________

SIGNATURE__________________________________________________________

E-Mail: srm.inc@juno.com (800)456-4197