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:

Medjugorje Web Pilgrimages
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, and if available, the cost is $150 extra in Medjugorje, and $125 extra in Frankfurt.
::::: 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: 
When we contact you with the flight reservation/details we will advise you of when payment is due.