Italy 2018

Which Trip

Please make sure your name matches that on your passport.



First Name *

Last Name *

Title (LVN, RN, MD, Other)

Address *

Address

Address

City *

State

Zip

Telephone

Email address *

Preferred Departure City *

License

Special Needs *

Occupancy :

"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:

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1

98

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