Black Madonna Pilgrimages: Enrollment Form

Contact Information

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Enter Email Confirm Email

Phone*

Phone: Alternate

Conference and Room Options

Black Madonna Pilgrimage to Spain, May 2018*

Single Room, $6,420
Upgrade in Pyrenees, Tower Room, $6,975
Upgrade in Pyrenees, Classic Room, $6,915
Double Room, $5,920
Upgrade in Pyrenees, Tower Room, $6,250
Upgrade in Pyrenees, Classic Room, $6,175

Roommate Preference

Please assign me a roommate
I prefer the following roommate

Roommate Choice

Payment Methods*

Pay Online (Deposits or Full Payment)
Other Payment Options

Choosing Pay Online allows you to pay online using PayPal’s secure online payment system. You do not need a PayPal account to use this and you may use your choice of credit card. You will be able to pay deposit(s), payments as per the Payment Schedule, or the full amount due at any time. Choosing Other Payment Options allows you to pay without using the online system. You can pay with credit card, check, money order, or wire transfer. Contact us to make arrangements for alternate forms of payment.

Payment

Online Payment Methods

Pay Deposit(s)
Pay in Full

Please choose whether you prefer to Pay Deposit(s) only at this time, or Pay for the Full conference.

Option A - Pay Deposit(s) Online

The following Payment Schedule is for a single room, total fee $6,420 less $750 deposit. If you reserved a double room, payment dates will be the same but amounts due will different; we will send updated payment schedule to you. If you requested room upgrades, additional fees will be added. Details will be confirmed upon receipt of deposits.

$1,135 – July 14, 2017
$1,135 – September 14, 2017
$1,135 – November 14, 2017
$1,135 – January 14, 2018
$1,130 – March 14, 2018

Deposit, Black Madonna Pilgrimages*

Black Madonna Pilgrimages , single room, deposit: $750
Black Madonna Pilgrimages , double room, deposit: $750

Additional Payment

You may make additional payments towards the conference without paying for the whole thing today. Enter additional amount you would like to pay today (i.e. 1000 will become $1000)

Total

$0.00

Option B - Make Full Payment (online)

Black Madonna Pilgrimages

Black Madonna Pilgrimages , single room: $6,420
Black Madonna Pilgrimages , double room: $5,920

Total

$0.00

Payment

Other Payment Options

Pay Deposit(s)
Pay in Full

Please choose whether you prefer to Pay Deposit(s) only at this time, or Pay for the Full conference.

Option A - Pay Deposit(s) via offline method (check, money order, etc.)

The following Payment Schedule is for a single room, total fee $5,820 less $750 deposit. If you reserved a double room, payment dates will be the same but amounts due will different; we will send updated payment schedule to you. If you requested room upgrades, additional fees will be added. Details will be confirmed upon receipt of deposits.

$1,135 – July 14, 2017
$1,135 – September 14, 2017
$1,135 – November 14, 2017
$1,135 – January 14, 2018
$1,130 – March 14, 2018

Deposit, Black Madonna Pilgrimages*

Black Madonna Pilgrimages , deposit: $750
Black Madonna Pilgrimages , double room, deposit: $750

Additional Payment

You may make additional payments towards the conference without paying for the whole thing today. Enter additional amount you would like to pay today (i.e. 1000 will become $1000)

Total

$0.00

Offline Payment Methods*

Option B - Make Full Payment via offline method (check, money order, etc.)

Black Madonna Pilgrimages - Select Room Type

Black Madonna Pilgrimages, single room: $6,420.00
Upgrade in Pyrenees, Tower Room $6,975
Upgrade in Pyrenees, Classic Room, $6,915
Double room: $5,920
Upgrade in Pyrenees, Tower Room $6,250
Upgrade in Pyrenees, Classic Room, $6,175

Total

$0.00

Offline Payment Methods*

May 14 – 27, 2018