Mission Registration — mending faces

PAY YOUR MEDICAL MISSION DEPOSIT (CLICK HERE!)

Name

First Name

Last Name

Email

Cell Phone

Country

(###)

###

####

Room Type

$600 Single/ $400 Double (Includes on-the-ground transportation, breakfast, lunch, snacks, and two dinners)

SINGLE

DOUBLE

FLIGHT DETAILS

ADD: DATE, FLIGHT TIME, FLIGHT NUMBER, AIRLINE FOR ARRIVAL AND DEPARTURE FLIGHT

FOOD ALLERGIES/ PREFERENCES

YES

NO

IF YOU MARKED YES, PLEASE EXPLAIN

ANYTHING ELSE WE SHOULD KNOW?