Reservation Form

 Pilgrimage Information:
Departure Date
Destination
Departure City/Airport

 Reservation Made By:
First Name *
Last Name *
Address *
 
City * State *  Zip *
Telephone
Fax
E-Mail *
How did you hear about us? 

 Pilgrimage Options:
Business Class Upgrade One Way   $1,750
Business Class Upgrade Round Trip $3,500

 Travel Insurance Quote Yes

 Passenger Information:
All accommodations assume two persons per room. If you are traveling alone we will pair you up with someone else traveling alone.
If you prefer a private room, check the "Single" box. The additional cost for this pilgrimage is $599.00
::::: Traveler 1 :::::
Passport Name         *
Name For Nametag  *
Birth Day *         | Smoker? Yes |          Male     Female
Valid Passport? Yes *      Country
Number      Issue Date      Expire Date
Room accommodation:
Single  (Additional $599)
Double   Triple
Room with:
::::: Traveler 2 :::::
Passport Name        
Name For Nametag 
Birth Day          | Smoker? Yes |          Male     Female
Valid Passport? Yes      Country
Number      Issue Date      Expire Date
Room accommodation:
Single  (Additional $599)
Double   Triple
Room with:
::::: Traveler 3 :::::
Passport Name        
Name For Nametag 
Birth Day          | Smoker? Yes |          Male     Female
Valid Passport? Yes      Country
Number      Issue Date      Expire Date
Room accommodation:
Single  (Additional $599)
Double   Triple
Room with:
::::: Traveler 4 :::::
Passport Name        
Name For Nametag 
Birth Day          | Smoker? Yes |          Male     Female
Valid Passport? Yes      Country
Number      Issue Date      Expire Date
Room accommodation:
Single  (Additional $599)
Double   Triple
Room with:
::::: Traveler 5 :::::
Passport Name        
Name For Nametag 
Birth Day          | Smoker? Yes |          Male     Female
Valid Passport? Yes      Country
Number      Issue Date      Expire Date
Room accommodation:
Single  (Additional $599)
Double   Triple
Room with:
::::: Traveler 6 :::::
Passport Name        
Name For Nametag 
Birth Day          | Smoker? Yes |          Male     Female
Valid Passport? Yes      Country
Number      Issue Date      Expire Date
Room accommodation:
Single  (Additional $599)
Double   Triple
Room with:
Emergency Contact Information

In Case of an Emergency please provide us with a name, phone number, and email address of someone we can contact.

Name: *                     Phone: *
Email: *

Enrollment in the tour constitutes your acceptance of the program Terms and Conditions.

Once your Reservation Form is received we will check flight availability, and confirm the total cost of your pilgrimage within 24 hours (excluding weekends).
If you wish to confirm we will provide you with payment details. Please contact us if you have any questions.




Medjugorje Web 772 N Peace Rd. DeKalb, IL 60115
877.Web.Medj (932-6335)
815.333.2338 Fax
Email: sshawl@medjweb.com