Please take a moment to complete this form and ensure your information is correct. If registering multiple participants, please fill out an individual registration form and payment infomation for each one.
The TOTAL COST for this trip is $2400.00/each participant.
$750.00 Deposit is non-refundable.
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Patch Adams MD & Gesundheit Institute, P.O. Box 307, Urbana, IL 61803
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