Trinity Episcopal Church, Upperville, VA
Pilgrimage Registration Form
2025 Pilgrimage to Wales & Herefordshire
Monday, May 26th to Tuesday, June 10th, 2025
Introduction
Our pilgrimage schedule is based on overnight flights from Dulles (Washington DC) departing early evening 5/26 to Dublin. On arrival we catch a connecting flight to Bristol International Airport, England arriving at 8:00am on 5/27, before a transfer by coach takes us to our first hotel.
Arrangement of and the cost of flights are not included within this tour package. Recommended flight routes / airline will be provided to you, but you are welcome to make your own travel plans and arrange to connect or leave this tour at the beginning or end by arrangement with the tour leader
Payment
Registration is considered complete upon submission of registration form and reception of the first deposit. Deposit payments are non-refundable. Total price is based on two people sharing a double or twin (two bed) room, with en-suite bathroom. For single occupancy please ask for details of additional charges.
Payments per person of $3080 are to be made no later than:
o · First deposit due date: September 30th, 2024: $1130.00
o · Second payment due date: January 30th, 2025: $1000.
o · Final payment of balance due date: April 11th, 2025: $950.00
Checks to “Trinity Episcopal Church” (mailed to Trinity Episcopal Church, PO Box 127, Upperville, 20185) or payment by Debit/Credit Card* by telephone to the Trinity Church Office on 540-592.3343. *Card payments will incur an additional transaction fee.
Booking Registration form - Please complete all fields.
Details required from your passport:
First Name on Passport
Middle name(s) on Passport (if given)
Last Name on Passport
Gender
Birth Date mm- dd-yyyy
Place of Birth (As on Passport)
Passport Country
Passport Number
Passport Expiration Date
Your contact details:
Home address (line 1)
Home address (line 2)
City State
Zip
Telephone (Home)
Telephone (Cell)
Will you be travelling with this cell phone on this tour?
E-Mail address (please write clearly)
Your emergency contact details:
(Someone who is not also on the tour)
Full name
Relationship to you (family, friend, etc. )
Home address (line 1)
Home address (line 2)
City State
Zip
Telephone (Home)
Telephone (Cell)
E-Mail address (please write clearly)
Your medical details:
(these will remain confidential to the tour leader and only shared in the event of a medical emergency)
Please complete additional fields for each condition or medication. If none please leave blank or strike through.
Condition
Medication
Medication dosage
Any other useful information
Yes / No (Please circle)
Condition
Medication
Medication dosage
Any other useful information
Condition
Medication
Medication dosage
Any other useful information
Condition
Medication
Medication dosage
Any other useful information
Condition
Medication
Medication dosage
Any other useful information
Dietary needs:
Please specify vegetarian, vegan, glutton free, or diabetic requirements, If none please leave blank or strike through.
Dietary need 1
Dietary need 2
Dietary need 3
Dietary need 4
| 3
Allergies:
Please specify allergy and reaction.
Allergy 1:
Allergy 2:
Allergy 3:
Reaction:
Reaction:
Reaction:
Allergy 4: Reaction:
Health Insurance:
Name of policyholder
Name of Insurer
Address of Insurer
Telephone number of Insurer
Policy name
Policy number
Travel Insurance:
Name of policyholder
Name of Insurer
Address of Insurer
Telephone number of Insurer
Policy name
Policy number
Hotel accommodation:
Room required (please check)
Double (king or queen shared bed)
Twin (two beds sharing a room)
Single occupancy
(Incurs a surcharge. Please ask us for pricing)
If double or twin room selected, please state the name of the person you are sharing with
Please address any further questions to Richard D. Jones, Director of Operations & Communications, Trinity Episcopal Church, Upperville, VA. 540.592.3343 or richard@trinityupperville.org
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