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Free Clinic of Southwest Washington 2020 Week of Giving Donation Form

The Free Clinic of Southwest Washington is one of the largest free clinics in the state of Washington. Services include basic medical care, urgent dental care, diabetes care and self-management, insurance and Medicaid navigation, and coordinating specialty medical and oral health services in the community for uninsured patients.

This year, our goal is to raise $155,000. These funds will make it possible to support current services and new service development, evolve technologies including telemedicine and electronic medical records, and staff/volunteer training and certifications.

Prefer to pay by check? Please enter the discount code freeclinic below and comment on the next page.

Fields marked * require an entry.

Package Name	Amount	Subtotal

Fund-A-Need $10,000	$10,000.00	$0.00



Fund-A-Need $5,000	$5,000.00	$0.00



Fund-A-Need $2,500	$2,500.00	$0.00



Fund-A-Need $1,000	$1,000.00	$0.00



Fund-A-Need $500	$500.00	$0.00



Fund-A-Need $250	$250.00	$0.00

Custom Amount

Donation Amount:

By accepting the Credit Card Fees you allow the Free Clinic to retain more fundraising dollars.:

4.10%

Total:

$0.00

Discount Code:
(displayed on Confirmation Page)

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Prefer to pay by check? Please enter the discount code freeclinic below and comment on the next page.

Exciting Opportunities!

Every donor that donates $500 or more will be entered to win the beautiful 18 carat white gold Emerald and Diamond ring below. Every donor that donates $100 or more will have the chance to win one of the amazing art pieces below!