Italy 2018 Which Trip Italy 2018 Spain 2017 Brazil 2015 Please make sure your name matches that on your passport. First Name * Last Name * Title (LVN, RN, MD, Other) Address * Address Address City * State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Telephone Email address * Preferred Departure City * San FranciscoLos AngelesChicagoDallasNew YorkAtlanta License Special Needs * NoneWheelchairOxygenDiabetesOther Occupancy : DoubleSingle "An additional fee will apply for Single Occupancy" Travel Insurance : Yes No You must agree "I have read and accept the "Reservations, Payments, Cancellations and Changes policy on the website at www.medicaleducationinternational.net." Yes NoMust Choose Yes to Register "I understand that it is my responsibility to obtain correct travel documents (passport, visa, ID) for the destination to be visited" Yes NoMust Choose Yes to Register "I understand that the names submitted must exactly match those on each passport. Discrepancies may result in cancellation, additional fees, or denial of service" Yes NoMust Choose Yes to Register "I understand I have the option to purchase travel insurance and the benefits of doing so. I understand that I will assume any and all risks associated with not having travel insurance" Yes NoMust Choose Yes to Register "My registration and payment constitute acceptance of all of the above terms" Yes NoMust Choose Yes to Register Please attach a copy of your Passport Number of places left: Please click Submit to process Registration before paying 1 98 We are sorry. This trip is now full. Please email us if you wish to be notified about our upcoming trips.