Pilgrim Registration Form
Please fill out this information as completely as possible. The pilgrim fee is $100 per person.

Fees may be paid in advance by using the PayPal link on our registration page: http://www.georgiapresbyterianpilgrimage.com/register.htm

Registration Deadline for the November weekend is October 18, 2018

You may opt to mail a check payable to Georgia Presbyterian Pilgrimage to our Registrar at:

Debi Elkins, GPP Registrar
5226 Lakesprings Drive
Dunwoody, GA 30338

770-458-6415
GPPRegistrar@gmail.com

If you are attending with your spouse, please fill out the form separately for each of you.

Email address *
First Name* *
Please list it as you prefer it to be on your name tag.
Your answer
Last Name *
Your answer
Gender *
Street Address *
Your answer
City *
Your answer
State (xx) *
Your answer
Zip Code *
Your answer
Church you attend *
Your answer
Minister's Name *
Your answer
Address of Church *
Your answer
Home Phone# (xxx-xxx-xxxx) *
If you use your cell as your home number, please enter "none"
Your answer
Cell Phone # (xxx-xxx-xxxx) *
If you don't have a cell phone, enter "none"
Your answer
Birthday (mm/dd) *
Your answer
Weekend you are signing up to Attend *
Who encouraged you or inspired you to sign up for Pilgrimage?
Please include their phone and email address, and home address if you have access to it.
Your answer
Dietary restrictions, allergies, physical limitations, snoring concerns or anything else the staff needs to know to make your weekend more comfortable. *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Registration Fee *
Please indicate if you will be paying via PayPal, mailing a check, or some other form (Scholarship, etc..)
A copy of your responses will be emailed to the address you provided.
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