Cuba 2

Mission-Chiropractic Trip to Cuba!! Limited spots
available!!! Mark your calendar Wednesday February 8 through
Sunday February 12, 2012.

CUBA MISSION TRIP

If you have never been on a chiropractic mission trip, then it is time to embark on an incredible Mission-Chiropractic Trip to Cuba!! Limited spots available!!!   There will be three meals a day, there will be accommodations for all missionaries; there will be transportation to all sites throughout the country. There will be many patients who need your love and miracle hands. We have many people in Cuba to adjust in October 2009. We will be in serving in several Cuban cities.

Wednesday (Welcome to Cuba)
Arrive at Airport in Havana, Cuba, proceed through customs and be picked up by our staff. You will be driven to our accommodations where you will have a nice and relaxing typical Cuban day. Welcome dinner and the most awesome chiropractic philosophy to follow.

Thursday  (Full Day Mission) We will be serving the Cuban people with chiropractic.  Begin the day by providing chiropractic at community centers, prayer houses, and schools. We will see people for 4-5 hours and then break for lunch. In the afternoon we will be at schools, orphanages and churches. Besides adjusting we will perform Scoliosis Screenings and teach our new program Straighten up Cuba.

Friday (Full Day Mission). Begin the day with introduction adjusting session at several schools and prayer houses. We will see people for 4-5 hours and then break for lunch. In the afternoon we will be at, schools orphanages and churches.

Saturday (Full Day Mission)
Armed with love and generosity you will meet, care for and set free both yourself and the warm, wonderful people of the area. All DC's will break up into teams and go to various locations including churches, hospitals and orphanages. At all times you will be accompanied by Mission Chiropractic team members. YOU WILL BREAK THROUGH TO A NEW YOU.  Call or write me!! Peter Morgan, DC for more information.   646-323-9254 chirorye@aol.com

MISSION-CHIROPRACTIC

APPLICATION FOR MISSIONARY SERVICE

The information received through this questionnaire will be held in confidence and reviewed by the Mission Chiropractic Board. Additional information is requested on the application for emergency references.

Please return this application to: Fax: 914-381-3199 or Email: Chirorye@aol.com

Cuba Mission Trip ¨C 

Name: ___________________________ Male Female:

Doctor of Chiropractic Spouse Volunteer

Chiropractic Assistant Student

Office Address: _______________________________________________

City: ____________________ State: ________ Zip Code: __________

Work Ph: (____)-______________ Fax #: (____)-_____________

E-Mail: ________________________________

Residence Address:

City: State: Zip Code:

City: ____________________ State: ________ Zip Code: __________

Home Ph: (____)-______________ Passport #: ____________________

Date of Birth: __________________

*IN CASE OF EMERGENCY NOTIFY:

Name: ________________________________ / Relationship: _________________

Address: ________________________________

Ph: (____)-__________________

*FAMILY:

Marital Status: ___________________ Spouse's Name: _______________________

Number of Children: __________

EDUCATION:

Chiropractic College Year of Graduation: ____________________________________

HEALTH CONCERNS: As this mission trip will involve physical activity in a Third World country it is vital that we are made fully aware of any Health Issues that may prohibit you from certain activities. Do you have?

Heart Disease Equilibrium Challenges Diabetes

Hearing Loss Asthma Hypoglycemia Herniated Disc

If you checked any of the items above please give a brief explanation:

List any current Medications you rely on:

Disclaimer: Mission-Chiropractic is an organization that only wishes to provide the opportunity for all Dc's to partake in a life changing experience for the benefit of the DC and those you help on the Mission. During your trip you will be in a third world country and you will voluntarily partake in physical activities such as walking, climbing, swimming, and adjusting. By signing the line below, you agree that anything that happens to you while on this mission is on your own accord and will not hold Mission Chiropractic liable for any injuries or misfortune.

X Signature: ­____________________________________ Date: ____________________

FEES

Fees include three meals a day, accommodations for all chiromissionaries; and transportation to all sites throughout the country:

See refund policy below.

Full Name: _______________________________ License #: ____________ State: _________

Payment: VISA MC American Express

Credit Card #: ______________________________________ Exp Date: _____/_____

Enter Four Digits for Amex Card: __________

Total $2250

X Signature: _______________________

Credit Card Users May Fax Completed Registration with payment information to (914)-381-3199 or e mail to chirorye@aol.com; you may also mail completed registration form with credit card information to:

Peter Morgan, DC 931 E. Boston Post Rd. Mamaroneck, NY 10543