Registration
For individual or group - more than one day, walking - 2010

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Important Notes:
1.
Important Note: If arriving after 9:00 p.m. on Tuesday, Sept. 21 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, as well as 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, as well as your name, address and date in the other fields indicated.
More than 1 day, walking
My Name
Age
Cost
 $80
Address
 City
ST / PR
Zip / Postal Code
 Phone
Country
E -Mail
 
Joining me more than one day are the following pilgrims:
 
 
Name
Age
Postal Address & e-mail
  
2
$80
3
$80
4
$50*
5
$50*
6
$50*
7
$50*
* Applies ONLY to the fourth and subsequent members of a group all registering on the same form, online or by mail, postmarked no later than August 31. The first three of a group always pay $80 each. A volunteer may register on the same form, but his/her inclusion may not be used to calculate the discounted fees for the group. Registrations postmarked after August are not eligible for group discounts. Family rates are different. Please see Family Rates Schedule. Registrations postmarked after Sept. 7 and walk-ons, $100/pilgrim.

Registrations for more than one day postmarked before September 1
receive, on request, a free Documentary on DVD.

I am registering before September 1, please send me the new Documentary on
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.
     
Registration & payment must be postmarked no later than August 31 in order to avail of group discounts.

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 2010 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 2010.
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
(dd/mm/yy)
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 2010 in the same events as our child/children.
 
Parent / Guardian 1
(dd/mm/yy)
Initials
Full Name
 Date
Parent / Guardian 2
Initials
Full Name
 Date