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Parish Info

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Iraq Trip 2025 Registration

Iraq Trip 2025 Registration

Iraq Trip 2025 RegistrationNoor Atisha2024-11-25T21:22:45-05:00

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Emergency Contact Name(Required)

First Last

Emergency Contact Phone Number(Required)

Any medical conditions (if none please write NONE)(Required)

Do you have any problems walking long distances?(Required)

Yes

No

Other

Do you have any special accomodations?

First time to Iraq?(Required)

Yes

No

Will you be traveling with anyone else? If so please write who below

Do you have a valid US Passport that will not expire within 6 months of the travel time?(Required)

Yes

No

Applying for a passport

Deposit

Price:

If you would like to help the church in paying for the 3.5% processing fees please click YES below

YES

CC Processing Fees

Price: $0.00

Total

Address(Required)

Street Address City State ZIP Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Consent(Required)

I agree to the non-refundable deposit and understand that if I decide to back out I know that I will not be able to request for a refund.

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