Reservation Form

If you have any questions, please email us at: sshawl@medjweb.com

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

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


 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?
    
 Passenger Information:
All accomodations assume 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, check the "Single" box, and if available, the cost is $150 extra in Medjugorje. If overnighting on the return in Frankfurt: $125 extra.
::::: Traveler 1 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid Passport? Yes    Country
Number     Issue Date     Expire Date 		  Room Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 2 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid Passport? Yes    Country
Number     Issue Date     Expire Date 		  Room Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 3 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid Passport? Yes    Country
Number     Issue Date     Expire Date 		  Room Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 4 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid Passport? Yes    Country
Number     Issue Date     Expire Date 		  Room Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 5 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid Passport? Yes    Country
Number     Issue Date     Expire Date 		  Room Accomodation:
Single  Double
Triple
Room with:
::::: Traveler 6 :::::
Passport Name
Name For Nametag
BirthDay           Smoker? Yes
Valid Passport? Yes    Country
Number     Issue Date     Expire Date 		  Room Accomodation:
Single  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.

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

Once your Reservation Form is received we will request flights using the Trip Date, Departure City, and Passport Names provided. We typically receive a flight reservation and confirmed pricing back within 24 hours and will email you all the details. The airlines then give us 48 hours to confirm or cancel your reservation. If you wish to confirm we will need to arrange for payment in full as the airlines will immediately issue your tickets. Please contact us if you are not sure, or have any questions.