Information Request Form

• Please provide the following contact information:
  * Indicates Required Information

  *First Name
  *Last Name
  Middle Initial
  *Street Address
  Address (cont.)
  *City
  *State/Province
  *Zip/Postal Code
  Country
  Work Phone
  *Home Phone
  E-mail
  Your E-mail address is required if you would like to receive notification of future tours or current tour information via E-mail.

Your contact information is used solely to provide you with information about current and future tours.  Your information is never sold, rented or shared with third parties.

• How do you prefer we contact you?                                please select one of the following... E-mail U.S. Mail
    If E-mail is your preference, please be sure to include your E-mail address above. 

• Are you interested in a particular tour?  Yes  No

If yes, please enter the name of the tour:                               Please select from the following list... Just add me to the list for any pilgrimage/tour! Easter 2012 in Rome Sicily 2012

• How many people are in your traveling party? 

• Have you traveled with Fr. John on a past tour? Yes No     If Yes, what year ?   
  Please note, all past clients are automatically notified via a postcard mailing as new tours are announced.

• If traveling alone, are you willing to share a room with someone?  Single rooms have an additional cost and limited availability.
  Yes No

• For planning purposes, please express your level of interest in the tour:

  Please select one of the following... Very interested Somewhat interested Not sure, just would like more information

• Where did you hear about the tour?

  Please select one of the following... WJMJ Radio The Television Mass Received a mailing Crossroads Magazine ORTV/WJMJ Web site The Catholic Transcript Fairfield County Catholic (Bridgeport) Four County Catholic (Norwich) Parish bulletin Other

If you selected parish bulletin or other, please enter your parish's name and city, or where you heard about the tour in the space provided. 

• Would you be interested in an optional roundtrip motor coach transfer to the departure airport, if offered for a particular tour?  Pickup locations are usually in Hartford, Waterbury and Fairfield.  Yes No

• Have you ever been to Italy or Europe before?  Yes No

If yes, please share any brief comments:

• Do you have any special needs?  Yes No
  Please be advised that our European pilgrimages and tours normally include extensive slow paced walking over uneven surfaces and cobblestone streets and walk ways.  Additionally, most European locations, except for major basilicas, cathedrals and museums, are not easily accessible to the handicapped .  If you have difficulty walking, use a wheelchair or need some other type of assistance you should not travel alone.  The tour operator and/or their agents, tour guides, etc. cannot provide any such assistance during the tour.

If yes, please describe them briefly below.