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 individual. * Required Fields
The TOTAL COST for this trip is $800.00/each participant.
Deposit is non-refundable.
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Patch Adams MD & Gesundheit Institute, P.O. Box 307, Urbana, IL 61803
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