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Famille Notre Dame de Lourdes
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About the Traveler:
Complete Name (Exactly as it appears in your passport):
Date of Birth:
Passport Information:
Passport Number:
Expiration Date:
Country of Issue:
Contact Information:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
Travel partner(s), if any:
What parish/group do you belong to?
How did you hear about us?
Health Insurance Number:
Health Insurance Subscriber's Name:
Emergency Contact: (Person not traveling with you)
Name:
Relationship:
Cell Phone:
About the Travel
I am interested in traveling on:
Jun 21 - Jul 1, 2024
Sep 20 - Sep 30, 2024
as:
Pilgrim
Special Needs Pilgrim
HDM Youth & Young Adult
HDM Logistics
HDM Medical
Travel Package:
Air & Land package
Land package
Language you speak fluently?
English
Spanish
French
Other
Travel companion
Are you Serving the Sanctuary?
Yes
No
If serving the Sanctuary
How many years have you served?
If this is not your first year, what Service would you like?
Service St. John the Baptist
Service St. Joseph
Service Notre-Dame
Have you completed VIRTUS training?
Yes
No
Have you completed your background check?
Yes
No
Additional Comments