Adult Clinic Package Sign Up
By signing up for a monthly clinic package this give you a 10% discount on drop-in clinic packages. Please select the month that you wish to sign up for below.
Participant's Full Name
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First Name
Last Name
Participant's Date of Birth
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Month
-
Day
Year
Participant's Gender
*
Male
Female
Non-Binary
Prefer not to say
Participant's Phone Number
*
Participant's Email
*
Emergency Contact: Full Name + Phone Number
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January Adult Clinic Monthly Package
Please select member or non-member pricing
$
Free
Please Select
Member Clinic
Non-Member Clinic
February Adult Clinic Monthly Package
Please select member or non-member pricing
$
Free
Please Select
Member Clinic
Non-Member Clinic
March Adult Clinic Monthly Package
Please select member or non-member pricing
$
Free
Please Select
Member Clinic
Non-Member Clinic
April Adult Clinic Monthly Package
Please select member or non-member pricing
$
Free
Please Select
Member Clinic
Non-Member Clinic
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Signature
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