DMAN Group Vacation Sign-Up
The D-MAN Foundation will be accepting applications towards our Assisted Travel Group Trip until August 31 2018. At the end of the deadline, all online submissions will be reviewed and carefully selected by our Board of Directors. You will be notified whether you have been approved or not. Please give at least 30 days for a response back. If you are not accepted, you are able to re-apply the following year
Name *
Email *
Address *
Phone number *
Are you are nominating someone else for a trip? *
Are you nominating yourself for this trip? *
Injury Summary *
Are you or the person you are nominating on a ventilator? *
Write a brief description on why you feel D-MAN should grant this trip for you/them? *
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