Registration
For FAMILIES participating more than one day

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Important Notes:
1.
Important Note: If arriving after 9:00 p.m. on Tuesday, Sept. 23 please contact Bob Whealan (in charge of shuttling pilgrims) prior to finalizing your Flight/Train/Bus Reservations to the Albany metro-region.Bob Whealan windedbuffalo@yahoo.com or 973/239-3632.
2. ALL adult pilgrims MUST sign the Release of Liability" form at the bottom of this webpage, and submit it to NCCL either by mail or when clicking the submit button. If signing to submit the form online, please type in your initials at the signature line, and do also type your name, address and date, in the other fields indicated.
3.
Parent or guardian MUST sign the "Parental Authorization of Minor Children" form at the bottom of this webpage. If signing to submit the form online, please type in your initials at the signature line, and do also type your name, address and date, in the other fields indicated.
More than 1 day, walking or 'Modified Pilgrimage'
My Name
Age
Cost
 $75
Address
 City
ST / PR
Zip / Postal Code
 Phone
Country
E -Mail
 
Family joining me more than one day are the following pilgrims:
 
 
Name
Age
Address
  
2
$75
3
*
4
*
5
*
*
See Family Rates Schedule for exact discount amounts. The first two family members, whether adult or/and minor, always pay $75 each. Families registering after Sept. 8 are not eligible for discounted fees; thereafter $80/adult, $50/child - but $160/registration minimum. A volunteer may register on the same form with his/her family, but may not be included to calculate the discounted fee for family. Walk-ons, $95/pilgrim.

Family registrations received by September 8 receive Documentary free on VHS or DVD (Please specify when registering).

My family & I are registering before September 8, please send me the new Documentary on VHS or DVD

Use Paypal "Make a Donation" button below to pay registration fee, or mail registration fee/fees to
NCCL
621 Jordan Circle
Whitehall, PA 18052-7119
     
Family registration & payment must be postmarked no later than September 8 in order to avail of family discount.

Secure payment online
with PayPal
Use a Credit Card or
a PayPal Account
 

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Transportation Request Form must be submitted immediately after registering.

RELEASE OF LIABILITY to be signed by all adult pilgrims:
All pilgrims participate and walk in the Pilgrimage for Restoration 2008 at their own risk. "National Coalition of Clergy & Laity" is not liable or responsible for any injury, illness, death or other mishap incurred or suffered by any pilgrim at any time or in any part of the Pilgrimage
for Restoration 2008.
I/we, the undersigned, residing at this
address, ,agree to the above,
and release NCCL and pilgrimage organizers from all liability to/for myself/ourselves and/or our children under age 18.
Person 1
(01/01/08)
Initials
Full Name
 Date
Person 2
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country
Person 3
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country
Person 4
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country
Person5
Initials
Full Name
 Date
Addr City ST /PR
Zip / Postal Country

To submit additional signatures, submit additional forms.
PARENTAL AUTHORIZATION FOR MINOR CHILDREN:
We, the undersigned, residing at
authorize the "National Coalition of Clergy & Laity"
to make all necessary arrangements for any surgical or urgent hospitalization for our child/children
and/or in our absence place all
or said child/children, in the care of Mr./Mrs. , residing at
who is participating in
the Pilgrimage for Restoration 2008 in the same events as our child/children.
 
Parent / Guardian 1
(01/01/08)
Initials
Full Name
 Date
Parent / Guardian 2
Initials
Full Name
 Date