RESERVATION/DEPOSIT FORM

Liias Israel DT11044

Minimum 15 participants
$2,999.00 per person double occupancy
Pricing excludesairline taxes and fuel surcharges currently over $500.00. These may change.
Please include a copy of your passport with the reservation form.

Name:  Mr.  Mrs.  Ms.  Dr.  Rev.:__________________________________________ __

(As appears on your passport)
Address:__________________________City:__________________State:______Zip:_________ _
(Please no P.O. Box)
Phone: Home (______)________________________ Work (______)__________________________ _
Email:_______________ _______Roommate Request:____________________________ _________

Date of Birth _______________ _______ Please send a copy of your passport with the
application.

Single Supplement $899.00 Airline Seating: Aisle  Window

Worldwide provides basic emergency medical and accident insurance. This does NOT include trip
cancellation. Worldwide Pilgrimage highly recommends you purchase additional insurance. Please visit our web
page, www.worldwidepilgrimage.com and on the home page click the Travelex button at the bottom of the page. You
will need the location/policy number 09-1983. If you have further questions, you can call Travelex at 1-800-228-9792.
Please note: In order to be eligible for the Pre-Existing Exclusion Waiver, the purchase date must be within 21
days of the traveler's initial deposit.

□ Roommate needed. If no roommate can be found, I will be charged the single

supplement.

Deposit of $200.00 per person due with application

Final payment due July 20, 2011
1. PRICES ARE CASH. AMERICAN EXPRESS ACCEPTED FOR FINALPAYMENT ONLY FOR ADD'L 3%.
2. Airline taxes and surcharges are NOT included. These will be added to final invoice.
3. Names as on passport. If name is incorrect & tickets reissued, $50 fee plus change fees from airline.
4. $100 deviation fee plus any additional airfare, hotel, tour or admission charges.

Cancellation penalties: Until July 19, 2011 - $100.00 per person

July 20, 2011 or later – No Refund

I agree to all terms and conditions as stated above_______________________________________

(Signature)

Please make $200.00 deposit check payable to Worldwide Pilgrimage Ministries and mail with your reservation form to:
Worldwide Pilgrimage Ministries • 1131 N. Laura St. • P.O. Box 13296 • Jacksonville, FL 32206-3296