Request edit access
Registration for Black Madonna Ritual Drumming & Dance Workshop & Pilgrimage in Southern Italy
July 31, 2024 through August 9, 2024
Sign in to Google to save your progress. Learn more
Last Name as it appears on your passport
*
First Name as it appears on your passport
*
E-mail Address *
Phone number *
Please enter the number that is best to contact you throughout the day.
Please enter Emergency Contact information here:  Name, Phone number, Email, Relationship to Traveler *
Please indicate your room choice
*
If applicable: Name of the person you would like to room with
$200  due now. Non-refundable *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy