Youth Pilgrimage to Malta Booking Form

CONTACT DETAILS

Full Name as it appears on your passport (if you already have one) *

Name you like to be known by *

Gender *

Address *

Date of birth *

Mobile Phone Number *

Email Address *

What parish do you usually attend?
(If you are studying away from home, we realise that often you won't be there.) *

PASSPORT DETAILS (if you don't currently have a passport, please leave blank)

Passport Number

Nationality

Issuing Country

Passport Issue Date

Passport Expiry Date

Gender

MEDICAL & EMERGENCY CONTACT INFORMATION

Do you have any medical or dietary issues relevant to the trip or that you think the organisers should know about? This information will be treated in confidence.

Name of person to contact in an emergency *

Relationship to you *

Emergency Contact landline phone number *

Emergency Contact mobile phone no. *

FURTHER INFORMATION

What size T shirt would you like? *

Do you have any skills that may be useful during WYD e.g. can you speak Spanish, are you medically trained?

In what ways are your already involved or might you be interested in being involved in your parish or the diocese? (please tick as many as you like)

If you have any questions, please ring Hamish on 07812004934.

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