Pilgrimage to Penfield 2018 Registration Form
Pilgrimage to Penfield will be held on Sunday, October 21, 2018. Please fill out all required pieces of information on this form if you are planning on attending. It is highly suggested that you block out the whole day for Pilgrimage. More details on specific timings to be announced later. In the event that Pilgrimage gets canceled on October 21st, a backup date will be announced.

*If anyone has any questions please contact Clark Myers, Heritage Life Committee Chair, at mercer.hlc@gmail.com

First Name *
Your answer
Last Name *
Your answer
MU ID Number *
Your answer
Phone Number (no dashes, ex. 7708881111) *
Your answer
Email Address *
Your answer
Classification at Mercer *
If applicable, please state the name of your PA. (PEER ADVISORS: please select “Not Applicable”) *
Are you a member of SGA? *
Are you a Peer Advisor? *
Do you have an UNLIMITED meal plan (the "freshman" meal plan)?
Emergency Contact Name? *
Your answer
Relation to emergency contact *
Emergency contact's phone number *
Your answer
Do you have any special dietary needs/allergies? Please list them all. *
Do you have any chronic or acute medical conditions? If yes, then please list them all. *
Do you take any daily medications (prescription or over the counter)? If so, please list them all. *
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