Umrah Interest Form | Refined Heart

Please fill out the form below if you are interested in joining Refined Heart's Immersive Umrah. Once the trip details are confirmed and depending on availability, we will ask you to confirm your formal interest by registering and providing a deposit.

Note: Applicants will be sent a registration form based on the following criteria:

Date of submission of this interest form
Responses to questions and level of interest
Prior travel for umrah and/or hajj
Previous involvement or attendance in Refined Heart activities

First Name *

Last Name *

Email Address *

Phone *

City *

State/Province *

ZIP / Postal Code *

Birth Year *

Gender *

How did you hear about the umrah trip? *

Have you performed hajj or umrah previously? *

How many times have you performed hajj or umrah? *

When was the last time you performed hajj or umrah? *

How many additional individuals will be joining you for umrah? *

Additional family members

First Name *

Last Name *

Age *

Email Address *

Have they performed umrah or hajj previously *

Joining us on this journey requires completion of a 6 week pre-trip curriculum (consisting of weekly meetings and review of online preparatory materials). We estimate this will require 2-3 hours per week. Are you able to commit to this? *

Please share what interests you about the Refined Heart Immersive Umrah, and, what you hope to gain from the experience. *

Please share anything else you would like about you or your family.