Dominican Republic

MISSION-CHIROPRACTIC HAITI & DOMINICAN REPUBLIC

          

    HAITI & DOMINICAN REPUBLIC 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 Haiti or the Dominican Republic!! Limited spots available!!! Mark your calendar January 2 through January 6, 2010 in Haiti and January 6 through 10, 2010 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 Haiti and the Dominican Republic to adjust in January 2010. We will be in serving in several cities. We will be accompanied by a professional photographer and video crew. Our goals will be to get published in National Geographic and make a PBS type film.

January 2, 2010 (Welcome to Haiti)
Arrive at Airport in Port of Prince, proceed through customs and be picked up by our staff. You will be driven to our accommodations where you will have a wonderful Haitian day. Welcome dinner and the most awesome chiropractic philosophy to follow.

January 3, 2010 - (Full Day Mission)  We will be serving the Haitian people with chiropractic. We intend to help over 70,000 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 Haiti”

January 4, 2010 - (Full Day Mission).

Depart for Institute Univers, a school of 1,500 students in the town of Ouanaminthe, Haiti. 

We will be staying in dormitory rooms at the Institute Univers. There will be three meals a day, there will be transportation to all sites throughout the country. There will be thousands of patients who need your love and miracle hands. 

January 5^th 2010 (Full Day Mission)
All DC's will break up into teams and go to  the facility at Universe Medical Centre.We will also go to various locations including churches, and orphanages. At all times you will be accompanied by Mission-Chiropractic team members that speak both French, Creole and English.

January 6, 2010  For some the Mission Trip will be ending, for some the Mission strip will be starting and for others this will be the half way mark in your Mission Trip.

January 6, 2010 (Welcome to the Dominican Republic)
Arrive at Airport in Puerta Plata, 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 Dominican  day. Welcome dinner and the most awesome chiropractic philosophy to follow.

January 7, 2010 - (Full Day Mission) We will be serving the Haitian people with chiropractic. We intend to help over 70,000 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 Haiti”

January 8, 2010 - (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.

January 9, 2010 (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

Haiti Mission Trip – January 2-6^th, 2010

Dominican Republic mission Trip January 6-10^th, 2009

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: __________

Please Check one: Haiti Total $999 (before October 2009, $1099 after October 15^th, 2009) □ $1199 (after November 15^th, 2009) □ $1299 (after December 15^th, 2009)

Please Check one: Dominican Republic Total $999 (before October 2009, $1099 after October 15^th, 2009) □ $1199 (after November 15^th, 2009) □ $1299 (after December 15^th, 2009)

Please Check one: Combined Haiti and Dominican RepublicTotal $1499 (before October 2009, $1599 after October 15^th, 2009) □ $1699 (after November 15^th, 2009) □ $1799 (after December 15^th, 2009)

                                        YOU ARE RESPONSIBLE FOR AIRFARE.
     

X Signature:  _______________________

 

Credit Card Users May Fax Completed Registration with payment information to (914)-381-3199
you may also mail completed registration form with credit card information to:

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

*** REFUND POLICY: In order to prevent last minute changes due to uncertainty we have adapted the following policies: All applicants may receive a 50% refund of monies paid prior to the date of June 15^sth, 2009. All applicants remaining as registered and paid applicants on or after the date of June 15^sth, 2009 waive their rights to receiving a refund.

Call or write me!! Peter Morgan, DC for more information.   646-323-9254     chirorye@aol.com