Registration Type*-Member RegistrationNon-Member RegistrationTotal $ 0.00 CAD Name*Email* Address*City*Province*Postal Code*Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name The Regina Community uses the transaction provider "Stripe" for website transactions. The billing name "Regina Community Clinic" will appear on your credit card statement. We value your privacy. We will use the information you have provided to provide you with a response. We will protect your information and report to you immediately, in case of a breach. We will not sell or divulge your information to any other party. If you have questions about any of this, please direct them to: Regina Community Clinic at 306.543.7880.NameThis field is for validation purposes and should be left unchanged.
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