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MARCH FOR LIFE REGISTRATION FORM

Name *
Name
Gender *
If registering for multiple individuals or family please list NAMES and AGES below:
Clergy/Religious
Cell Phone Number *
Cell Phone Number
Address *
Address
(Note: we will make every effort to accommodate your requests. We ask for flexibility with quad occupancy requests as you may be placed with another pilgrim of the same gender.)
Please provide the name of your chaperone. (If 18 or older, you may skip this field.)
Yes! I will be serving as a Chaperone of:
Payment Options *
Each travel package covers roundtrip fare on PLW chartered bus, and two-night hotel accommodations. Prices change based on number of individuals per room occupancy. Please select your travel package:
Preferred Payment *
Special Accommodations
Acknowledge: *
Youth Rally Acknowledgement: *
Photo Release

ONLINE PAYMENT OPTION: 
AFTER SUBMITTING THE FORM, PROCEED TO PAYMENT BY CLICKING “PAYMENT INFORMATION” BUTTON. 

IF YOU PREFER TO PAY BY CHECK, MAIL CHECK TO:
PLW ETF, MFL-DC 2020
15850 W. BLUEMOUND RD, SUITE 311,
BROOKFIELD, WI 53005. 

IF YOU PREFER TO PAY BY CC OVER THE PHONE:
CALL 262-796-1111 EXT 14 DURING REGULAR BUSINESS HOURS 9AM-5PM.