Gregory Center for Medical Missions Travel

Use this form to make payments towards your GCMM travel.

Refer to your Via application portal for specific payment amounts and due dates for your trip, then adjust the PRICE section of this form accordingly.

For additional questions related to payment requirements, contact Kyle_May@pba.edu

For any difficulty with this payment form, contact RCEL@pba.edu

Fields with asterisk are required.

Traveler's Name *
Specify the Travel Program Name / Destination / Dates (e.g. GCMM-Costa Rica-July) *
Enter an email address for your payment receipt. *
Specify what this payment is for -- confirmation deposit, airfare, balance, etc. *

Please enter your price:

The price must be from $0.00 to $5,000.00

Qty:

Use this form to make payments towards your GCMM travel.

Refer to your Via application portal for specific payment amounts and due dates for your trip, then adjust the PRICE section of this form accordingly.

For additional questions related to payment requirements, contact Kyle_May@pba.edu

For any difficulty with this payment form, contact RCEL@pba.edu