MARIE REINE DU CANADA

100 km Pilgrimage to Our Lady of the Cape

September 2, 3 4, 2006

REGISTRATION FORM

To reserve your place in the pilgrimage, please fill out and return both sides of this form as soon as possible, cash or cheque to “Our Lady of the Cape Pilgrimage”.  Applications without signed release/consent form (on the back of this form) will be rejected. Pilgrims are responsible for their own transportation to Lanoraie on Friday, 1 Sept.

NAME: _________________________________________________________________________

ADDRESS: ______________________________________________________________________

TELEPHONE: ____________________________________________________________________

E-MAIL: _________________________________________________________________________

DATE OF BIRTH:__________________________________________________________________

NEXT OF KIN (name, coordinates): __________________________________________________

I WISH TO BE A:                                                     WALKING PILGRIM  o

WORKING PILGRIM             o (a non-walking pilgrim who assists with heavy lifting, organization, driving and support. Same fee applies.)

I WILL BRING A TENT                   o      TOTAL TENT CAPACITY IS _______ , AND I AM WILLING TO SHARE MY TENT SPACE  o

I REQUIRE A SPACE IN A SHARED TENT          o

I HAVE FILLED OUT MY SIGNED RELEASE / CONSENT FORM (see reverse)   o

FEE: Includes basic meals, water, access to campsites. Full payment due before August 15.

§         Total registration is $55 ($45 for students). A second parent in the same family pays $45. A second, third, fourth, fifth student, etc. in the same immediate family pays $35. Maximum per family: $200.

§         Double-Pilgrim Deal: Sign up a brand new, first-time pilgrim and you pay only $35. (New pilgrim pays full price).

NOTE: In signing this form, I understand that this pilgrimage is a rigorous feat of physical endurance and that I will be walking 100 kilometres in three days.      

SIGNATURE: ____________________________. DATE: ________________________.

SIGNATURE OF PARENT (if under 18 yrs old): _______________________________.

Information: http://ladycape.tripod.com  E-mail: NDduCap@hotmail.com

Marie, Reine du Canada

100 km Pilgrimage to Notre-Dame-du-Cap

September 1 to 4, 2006

Terms and Conditions

Note: Pilgrims (or, if they are under 18, their Parent/Guardian) must read, sign and return this document in order to participate in the pilgrimage.

Pilgrims (walkers/workers) assume responsibility for their health and the organizing committee of the pilgrimage shall not be liable to the pilgrim (walker/worker) for any injury, sickness, or death to the pilgrim (walker/worker) out of any act, omission, or neglect on the part of the pilgrim (walker/worker).  

The organizing committee of Our Lady of the Cape Pilgrimage from Lanoraie to Notre-Dame-du-Cap reserves the right to accept, or reject, any person as a pilgrim, to expel any pilgrim from the pilgrimage, and to make changes in the itinerary whenever it is deemed necessary to the comfort, convenience or safety of the other participants. The organizers are not responsible for any criminal conduct by third parties.

I, ________________________________________ assume all responsibility for any losses, damages, claims, personal injury, sickness, or death and shall indemnify and hold harmless Our Lady of the Cape Pilgrimage and all of its organizers (the committee and chaplains) from any such losses, damages, claims, personal injury, sickness, or death.

SIGNATURE OF PILGRIM                                                           DATE (mm,dd,yyyy)

PLEASE PRINT YOUR NAME

SIGNATURE OF PARENT OR GUARDIAN IF UNDER 18                  DATE (mm,dd,yyyy)

Please complete and return to:   ‘Marie, Reine du Canada’ Pilgrimage

          87 Mann Avenue, Ottawa, ON  K1N 6Y8

No pilgrim may participate in the pilgrimage without completing both forms