Diocese of Madison pilgrimage to
World Youth Day 2011
Initial Registration

Each individual should complete this form once and then click the 'Submit' button at the bottom of the page.
Do not use the 'Enter' key.

If you have questions, please call 608-821-3160 or e-mail us at OEC@straphael.org.


First Name:
Last Name:
Parish:
City where parish is located:
Your preferred mailing address:
     Street address:
     City:
     State:
     Zip:
Email Address:
Daytime phone:
Birthdate (mm/dd/yyyy):


Which trip do you hope to join?