ROH (GA) Haiti/Dominican Republic Mission Trip

Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Email*
Mission Cost: $2000.00 based on 10 (ten) travelers (includes $350 non-refundable deposit, airfare, housing, ground transportation, meals during Mission, project fees)
Payment Dates
December 18, 2022 ($350 Non-refundable deposit due)
January 22, 2023
February 26, 2023
March 26, 2023
April 30, 2023 (final payment due)
Payment Schedule*
Other payment amount*
Total*
Payment Total

prevnext( X )
USDDescription
Should be Empty: