Registration

Fields marked * require an entry.

To register for the Virtual Days of Giving, enter the number of tickets you would like to register for in the "Quantity" section.

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

Package Name	Amount	Subtotal
Free Clinic of Southwest Washington Ticket & Registration Form

Days of Giving Registration	$0.00	$0.00

Like to make a donation as well?

Donation Amount:

By checking this box, you agree to pay the convenience fee.:

4.00%

Total:

$0.00

Discount Code:
(displayed on Confirmation Page)