R E S E R V A T I O N   F O R M
Please read our Terms & Conditions.
If you have any questions, please email us at: sshawl@medjweb.com



You can pay online by credit card on our secure site: Click Here!

You can also print this form and fax it to (815)333-2338, or mail it to:

The Medjugorje Web
772 North Peace Road
DeKalb, IL 60115 USA
(815)748-0410


xIndicates Required Fields        reservation.pdf

 Tour Information
Departure Date
Destination
Departure City/Airport
    Group Leaders 
 Reservation Made By:
First Name
Last Name
Address
 
City
State   Zip
Telephone
    Fax
    E-Mail
    How did you hear about us?
    
 Please Enter Information Below:
All accomodations are two persons per room. If you are traveling alone we will pair you up with someone close to your age. If you prefer a private room, it is available for $150 extra in Medjugorje, and $100 extra in Frankfurt on our return.
::::: Traveler 1 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid U.S. Passport? Yes       Expires 		  Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 2 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid U.S. Passport? Yes       Expires 		  Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 3 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid U.S. Passport? Yes       Expires 		  Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 4 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid U.S. Passport? Yes       Expires 		 
Single  Double
Triple
Room with:

Enrollment in and payment of the tour constitutes your acceptance
of the program conditions. http://www.medjugorje.org/tconditions.htm

Click Box to Signify that you have read the "Terms and Conditions"

Total number of people:   Deposit $ 
(Full payment due if booking within 60 days of departure)
Click Here To Pay Online Via Credit Card

A $500 per person deposit by check or credit card is due within 7 days of submitting this form. Final payment is due 60 days prior to departure date. Please mail your check to The Medjugorje Web at the address listed above or you can pay via credit card online at: http://www.medjugorje.org/trippayment.htm