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Healing Haiti Group Trip Request Form
Email address *
Requested Name of Team *
Your answer
Please tell us where your team is from. *
Your answer
What size of team do you anticipate? (Healing Haiti requires a minimum of 6 goers and a maximum of 15 goers) *
Your answer
Contact Name: *
Your answer
Contact Email : *
Your answer
Contact Phone Number : *
Your answer
Dates Requested for Trip *
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Requested Status of Trip *
Please identify how requested team(s) trip costs will be paid *
Is your team a Medical or Dental Group? *
Please describe your team to help us serve you better. (i.e. youth trip, multi-generational, worship team, business, church group, etc)
Your answer
Have you been on a Healing Haiti trip before? *
If you have traveled with Healing Haiti before, who was your last trip leader?
Your answer
How did you hear about Healing Haiti?
Your answer
*Due to high demand in summer months we may only be able to reserve 1 week during this time frame. Additional dates may be requested below
Your answer
Additional Date(s)
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Additional Date(s)
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