Our Next Chiropractic Mission Trip

Once registered, we will send you an email telling you how to set up your own personal fundraising page. We will show you how you can raise the money to fund your mission trip and how you can raise additional funds for our orphanage. You will be able to track your success and share this amazing trip outside of your comfort zone with your family, patients, coworkers and friends. The money you will raise will be 100% directed to the effort to raise funds for the less fortunate. Mission Life International is an official 501 C (3) Not For Profit Organization and all donations go to the production of this effort and food, housing and education for the less fortunate!

If you have never been on a chiropractic mission trip, then it is time to embark on an incredible Mission-Chiropractic Trip to the Dominican Republic!! Limited spots available!!! Mark your calendar March 28 through April 1, 2012 in the Dominican Republic. There will be three meals a day, there will be accommodations for all chiromissionaries; there will be transportation to all sites throughout the country. There will be thousands of patients who need your love and miracle hands. We have thousands of people in the Dominican Republic to serve in March 2012. We will be in serving in several cities around the Puerta Plata and Santiago area.

WEDNESDAY MARCH 28, 2012 (Welcome to the Dominican Republic)

Arrive at Airport in (POP) Puerto Plata, DR proceed through customs and proceed to the all inclusive resort beautiful resort where you will have a nice and relaxing afternoon/evening enjoying the all inclusive package.

WELCOME DINNER FOLLOWED BY "GIVE AND RECEIVE" PRESENTED BY PETER MORGAN, DC.  CHIROPRACTIC PHILOSOPHY  SEMINAR SHORTLY AFTERWARDS.

THURSDAY MARCH 29, 2012 -"Face Your Fears, Science, Philosophy & Mission Work"
 (Full Day Mission) We will be serving the Dominican people with chiropractic. We intend to help thousands on this trip. Begin the day by providing chiropractic at community centers, prayer houses, and nursing homes. We will see people for 4-5 hours and then break for lunch. In the afternoon we will be at comunity centers, orphanages and churches. Besides adjusting we will perform Scoliosis Screenings and teach our new program "Straighten up Dominican Republic"  SOME OF OUR TEAM WILL BE GOING TO HAITI. IF YOU ARE INTERESTED YOU MUST INTERVIEW WITH DR. MORGAN.

THURSDAY EVENING CHIROPRACTIC PHILOSOPHY SEMINAR.

FRIDAY MARCH 30, 2012 -"Face Your Fears, Science, Philosophy & Mission Work" (Full Day Mission) We will be serving the Dominican people with chiropractic. We intend to help over thousands on this trip. 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 Dominican Republic".

FRIDAY EVENING CHIROPRACTIC PHILOSOPHY SEMINAR.

SATURDAY MARCH 31, 2012 -"Face Your Fears, Science, Philosophy & Mission Work" "All Day Mission and Conch"

Nothing more to say at this point. This is the biggest day of adjusting as the energy and attention has brought everything to this last day. All those who have been adjusted return with all their friends and family. This is a day of Hustle. At the night's end, we will all come together (all teams from Santiago and Puerta Plat included) for our CONCH ceremony where everything is placed into perspective in preparation for the return home where the real work begins. YOU WILL BREAK THROUGH TO A NEW YOU.

SATURDAY EVENING CHIROPRACTIC PHILOSOPHY AND TECHNIQUE SEMINAR.

SUNDAY APRIL 1, 2012 RETURN HOME

We will also have surprise speaker for our philosophy sessions.

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 BY Email: Chirorye@aol.com OR CALL ME AND TELL ME YOU ARE SENDING IT VIA SNAIL MAIL TO PETER MORGAN, DC  49 ADELPHI AVE., HARRISON, N.Y. 10528

Dominican Republic Mission Trip ¨MARCH 28-APRIL 1, 2012

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_______

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 to partake in a life changing experience for the benefit for you 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:


Full Name: _______________________________ License #: ____________ State: _________

Mailing Address: ____________________________ City: __________________ Zip: __________

Daytime Phone: ( ) __________________ Fax #: ( ) ___________________

Email: _____________________________ Website: _________________________________

Payment: ____VISA ____ MC _____American Express

Credit Card #: ______________________________________ Exp Date: _____/_____

Enter Four Digits for Amex Card: __________

Please Check one: Dominican Republic or Haiti Total_________ Student Price D.R. of $649 BEFORE FEBRUARY1,2012  ____$679 AFTER FEBRUARY 1, 2012,   _  $699 AFTER FEBRUARY 15, 2012,    $799 AFTER MARCH 1 2012

Doctors Price of $799 Before  FEBRUARY 1,2012, $899 after MARCH 1, 2012, $999 after MARCH, 2012

YOU ARE RESPONSIBLE FOR AIRFARE.


X Signature: _______________________



Credit Card Users May ALSO Fax Completed Registration with payment information to (212)-781-8859 you may also mail completed registration form with credit card information to:               Peter Morgan, DC 49 ADELPHI AVE  HARRISON, NY 10528  YOU MUST CALL ME IF YOU FAX OR SNAIL MAIL.

*** REFUND POLICY: In order to prevent last minute changes due to uncertainty we have adapted the following policies: NO REFUNDS
Call or write me!! Peter Morgan, DC for more information at chirorye@aol.com

To receive the early registration fee you must register by FEBRUARY 1, 2012.  The fee includes  4 Nights at All Inclusive Resort, Seminar, All Inclusive of food and drink, and Mission Trip (Flight Not Included). See application to view additional options.