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Haiti International Youth Development (IYD) STM - July 13 - 20, 2019

*
(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Continue".
Please enter a Username to create an account. If you already have an account please login before completing this form.
New Individual
Service Trip Registration Information

Passport Information

Emergency Contact Information

Spiritual Information

 
 

Medical Information

       

Cross Cultural Experience

 
   
I do hereby give AABMC/Lott Carey Inc., and its representative(s) authority to request and authorize medical and/or hospital treatment for my benefit in the event of any injury or sickness sustained by me while on any such travel, stay or other activity, including, without limitation, while traveling to and from any foreign country. I agree reimburse Lott Carey for any additional costs and expenses incurred with respect to such treatment that is not covered by (or over and above) the Missions Insurance and my personal health insurance.