Enrollment Form Medjogorje

Name: ____________________________________
(As it appears on Government Issued ID)

Date of Birth: ______________________________

Address: __________________________________

_________________________________________

City:______________________________________

State ____________Zip_______________________

Tel: (home) _____________Work_______________

Email: ____________________________________

I wish to room with:__________________________

Please enroll me in ¨ the complete trip-$2495

¨ Medjugorje only- $2049

Please send this information along with your check and a copy of your Photo ID to:
Father John Campoli, I.V.Dei
His Love Ministries
PO Box 1951,
Brick, NJ 08723
908.433.4794
Email: fatherjfc@gmail.com
www.hisloveministries.com

Make Checks payable to: His Love Ministries

Payment Schedule:

$400 on registration

The balance is Due April 1, 2012

You may pay by credit card by clicking the Buy Now link below.

This is the only way we can accept credit card payments.

You must still submit a signed registration form.

The cost is based on the Euro trading at $1.42. Once you have submitted your deposit, the price will hold.

Cancellation Policy and Refunds:
We hope that nothing will prevent you from taking your pilgrimage. However, should you need to cancel, your cancellation must be received in writing, via email or by letter. It will be effective on the date of receipt. If you cancel your tour after you have received your documents, no refund can be made. The following cancellation charges per person will apply:
Up to 90 days prior $200
90 to 61 days prior $500
60 to 1 day prior or no show ~No refund

Once the tour commences there will be no refunds on missed or unused portions of the tour programs.
Purchase of Travel Insurance is strongly recommended. Call Access America at: 866.455.6109

I have read the Cancellation and Refund Policies and agree to them.

Signature: _______________________