Yusurah Travel & Tours - Registration Form

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First Name

Middle Name

Last Name

Address

Cell Phone #

Home/Work Phone #

Email Address

Next of Kin

Relationship

Phone # of Next of Kin

Type of Journey

Hajj

Umrah

Number of Family Members Travelling

Special Needs

Wheelchair

Care Assistant

Name of Referral (Optional)

Mode of Payment

Cash

Check

Cashier Check

Deposit Amount ($)

Full Payment Amount ($)

I WILL ABIDE BY THE RULES AND REGULATIONS OF YUSRAH TRAVELS AND TOURS THROUGHOUT MY TRIP TO THE HOLY LAND.

OPT OUT AFTER REGISTRATION WILL INCUR SERVICE CHARGES FROM $300 AND ABOVE DEPENDS ON THE REASONS.

Signature (Type Full Name)

Date

MAY ALMIGHTY ALLAH MAKE IT EASY (AMEEN) HAJJ MABROOR!!!

Yusrah Travels and Tours, USA