Registration
For participation Saturday ONLY

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Important Notes:
1. 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.
2.
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.

Saturday only
My Name
Age
 
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
 
3
 
4
 
5
 
Mail separate sheet for more names.

As a token of gratitude for my gift of $15 or more,
please send me the new Documentary on DVD.
Please send your registration for Saturday (only) by September 10.
Registration is possible in person Saturday before events begin, but very difficult, due to the tight time-table, which includes check-in for all pilgrims - even those who have pre-registered.
To register or/and to donate by mail, print this page and post it to:
NCCL
621 Jordan Circle
Whitehall, PA 18052-7119 USA
     

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