BNN x Yuyi Africa presents..
IMMERSION Africa! A 7-day immersion experience for medical professionals that includes safari and hands on clinical service opportunities in Kenya!
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relation
*
Please Select
Mother
Father
Sibling
Spouse
Child
Other
1) How many people are traveling with you? (note:please complete an application for each participant).
*
Solo!
1-2
3-5
5+
2) What is your title?
*
Please Select
RN
LPN
Student
Doctor/Medical Student
Other
Please select the date of your trip arrival.
*
Please Select
Sunday December 10, 2023
Sunday January 14, 2024
Sunday February 11, 2024
Sunday March 10,2024
Sunday April 14, 2024
Sunday May 12, 2024
Sunday June 9, 2024
Sunday July 14, 2024
Sunday August 11, 2024
Sunday September 8, 2024
Sunday October 13, 2024
Sunday November 10, 2024
Sunday December 15, 2024
Please select the payment you agree to. Note: if you pay the initial deposit of $500, your remaining balance of $1495 will be due 3 weeks prior to your trip.
*
Please Select
NON-REFUNDABLE Deposit of $500
NON- REFUNDABLE FULL PAYMENT of $1995
PLEASE SUBMIT PAYMENT OF $500 or $1995 via Zell to Kylie Stores 412-726-1261 at the completion of this application
3) Do you have the following? Please check all that apply, and make arrangements to get the remaining items on the list provided 3 weeks prior to your trip.
*
Passport
Kenya Visa
Malaria Pills
Yellow Fever Vaccine
Flight round trip flight to Kenya and back to your destination
4) Additional Comments or Feedback.
I have read all the terms and conditions of this trip, I understand my payment is non-refundable, and I will pay the balance necessary at the conclusion of this application
*
Continue
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