Registration Type*-Member RegistrationNon-Member RegistrationTotal $ 0.00 CAD Name*Email* Address*City*Province*Postal Code*Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 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.PhoneThis field is for validation purposes and should be left unchanged.
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