Chocola, October 30-November 6, 2011

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Please use the form below to make a donation toward our medical mission trip to Chocola, Guatemala from October 30 - November 6, 2011.

We wish to recognize the volunteer in whose honor you are making your donation to Refuge! Please be sure to write the name of the volunteer in the appropriate field below.

First Name	*
Last Name	*
Billing Address:
Country:
Address 1:	*
Address 2:	(optional)
City:	*
State:
Postal Code:	*(5 or 9 digits)
Phone/Ext:	*
Email:	*
Name of the volunteer in whose honor you are donating:
*Amount:	US
Comments:

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Chocola, October 30-November 6, 2011

Donate Today