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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
* Required Fields
Item
Description
Amount
TaxDeductTrip
BMI Trip Donation
Please enter the amount you would like to apply to your trip donation. Donations are tax-deductible.
Total:
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Security Code
Please enter the security code above.
*
Please enter the security code displayed above.
Please enter the security code displayed above.