Checkout

Please use the description field at the top of this form to identify which trip you will be attending or the number of surgeries you wish to sponsor.

Order Information

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Donation Options

Select a donation option.
US $250.00:   Silver
US $500.00:   Gold
US $1000.00:   Platinum
US $2000.00:   Patron
US $5000.00:   Grand Patron

Total:

Security Code

Please enter the security code above.