DT11044Liiasbrochueapplication 2011
DT11044Liiasbrochueapplication 2011
DT11044Liiasbrochueapplication 2011
Date of Birth _______________ _______ Please send a copy of your passport with the
application.
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.
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