CROATIAN MIR CENTER REGISTRATION FORM
(Please click here for printable form and mail to address at the bottom)

I want to join on the following pilgrimage:_________________________________________________

Departure date:__________________ Departing from: _____________________________________

FIRST NAME (as per passport): _______________________________________________________

LAST NAME (as per passport): ________________________________________________________

DATE OF BIRTH: ___________ SINGLE ROOM: YES NO (circle one)

ROOMING WITH: __________________________________________________________________

STREET ADDRESS:_________________________________________________________________

____________________________________________________________________________________

CITY: _____________________________________ STATE: ___________ ZIP: ________________

Home Phone: (____)_____________________ Business Phone: (___)___________________________

Fax number: (____)______________________ E-mail address: ________________________________

PROMOTER'S NAME: (if any)________________________________________________________
(Promoters, Travel agents are not agents, employees or authorized representatives of CMC)

PAYMENT: I enclose my deposit check for $400.00 or full balance for a total of $______________.
I understand that the full balance is due not less than 60 days prior to departure, plus airport taxes. Checks should be made payable to "Croatian Mir Center" (Sorry, Credit Cards are not accepted, except for credit card checks).
OTHER INFORMATION:
__ I advise that my passport is valid and has not expired.
__ I am obtaining a new passport.
__ I am a Non-US Citizen, a National of ______________, and hold a re-entry visa or green card.
Passport number: _____________________________

NOTES:____________________________________________________________________________

____________________________________________________________________________________

My signature indicates that I have read and agree to the Terms and Conditions included on this website.

Signature_____________________________ Date______________

Mail to: "Croatian Mir Center"
20855 N.E. 16th Avenue #35 - Miami, Florida 33179
Phone (305)653-0144 or 1-800-220-PRAY
Fax (248)485-6290
E-mail: croatia@mircenter.com

Click here for Terms & Conditions