Hospitalité de Miami Pilgrim Registration Form (June 2025)

Hospitalité de Miami Pilgrim Registration Form (June 2025)

Last Name as listed in your passport.*

First Name*

Today's Date*

What is your Date of Birth? DD/MM/YYYY*

What is your cellphone number?*

What is the best email for you?*

What is your address? (street,city,state,zip code)*

What is your passport number?*

What is the expiration date of your passport?*

In what country was your passport issued?*

Health Insurance Provider Information. (Name and Member ID)*

Who is the Health Insurance Policyholder?*

What parish do you belong to?*

Who is the person that we can contact in case of an emergency? (Someone not traveling with you)*

What is the relationship to the emergency contact?*

What is the phone number to the emergency contact?*

What languages do you speak fluently?*

English.

Spanish.

French.

Other

What is the month of your trip?*

June

September

Travel Acommodation*

Single Occupancy ($300 Extra Charge)

Double Occupancy

Triple Occupancy

Travel Package:*

Air & Land Package

Land Package

Are you traveling with a companion?*

Yes

No

What is the name of your travel companion?

Will you be serving at The Sanctuary with The Hospitalité Notre Dame de Lourdes?*

Yes

No

In what country were you born?*

Are you traveling as?*

HDM Logistics.

HDM Medical.

HDM Pilgrim.

HDM Youth & Young Adult.

HDM Special Needs.

Clergy.

What service will you be doing?*

This is my first year of Service.

Service at St. John The Baptist.

Service at St. Joseph.

Service at Notre-Dame.

Service at St. Bernardette.

Service at Marie St. Frai.

What year of service will this be for you?*

First year.

Second year.

Third year.

Fourth year.

Fifth year.

More than five years.

I am a Hospitalier(e).

Have you completed Virtus training?*

Yes

No

Have you completed your background check?*

Yes

No

Please upload your passport.

Drag and drop files here or

Send me a copy of my responses

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