Please fill in one form per person. We also require a jpg or pdf of your passport. (This can be emailed)
Alternatively you can send a copy to Fr Max Bowers, PO Box 484 Brighton. SA 5048.

Surname as per passport The name and spelling MUST be exact.
Christian Name(s) as per passport
Preferred name to be called
Preffix Mr     Mrs     Ms     Miss     Rev'd     Fr   Bishop
Address including post code
Email Address
Phone Home Mobile
Passport Number
Date Passport Expires
Date of Birth
Birth City (As per passport) City where you were born.
Nationality on Passport
If married and partner still alive, wedding anniversary date
Contact person while you are overseas - Name/Address/phone



Phone(Home) Phone (Mobile)

Phone (Work)

Contact relationship to you
Other Info

Smoker Yes No

Vegetarian     Yes No

If you have any special dietary requirements for meals, please indicate here.
Sleeping arrangements

Single beds (Two to a room)


Double bed (Normally a queen size)

Single room accommodation (Additional cost $1500)

I wish to share a room with...

I wish to share with

I have no preference and happy to share with anyone

Add Capital city you will be leaving Australia from

Airline information

I/We will be travelling back with the group to Australia

I/We are considering staying longer or travelling on to Europe or other locations. (If this be the case there is an additional cost and Fr Max can obtain an accurate costing for you - Or if preferred you can just pay for land costs and arrange your own flights to Jordan and elsewhere)

Currently we are working with Emirates Airlines

If you are a member of a Frequent Flyer program, you may like to list the details here.

Airline and Number.

Travel Insurance I understand this is my personal responsibility and the company I use is my own choice. Anglican Tours can offer suggestions if asked.

I understand that all monies paid are non refundable from ANGLICAN TOURS and should there be a need to cancel or withdraw from the tour for what ever reason, the 'possible' refund would be a matter between yourself and the insurance company you select.

I agree that refunds are a matter between the insurance company I choose and myself and not claimable from Anglican Tours Australia.

How did you hear about the Israel Pilgrimage
Give details of any medical background that may be useful if you need medical treatment in Israel.

Direct Money Transfer Details
ANZ Bank
Grassroots Resources
BSB: 015 259
A/c: 304976571
Reference: Name OR Postcode

Any Cheques MUST be made out in the name of "Grassroots Resources"

PO Box 484  Brighton SA 5048    08 8387 9993   or  0409 441 246

Please send to Fr Max a digital copy of your passport plus a photo of yourself (Preferably not a boring passport photo) or Send by snail mail.