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Date:Title:
Name:
Address: City:
State: Zip Code:
Buisness #: Home #:
Email:
Classifications (please select one)
Individual $20.00 Family $35.00 Lifetime $500.00
Corporate $250.00
Payment Options:
Check Made payable to TFC- Tappahannock Free Clinic. Mail completed from to Tappahannock Free Clinic, PO Box 2313 Tappahannock, VA 22560. Please print and fill out form to include with your payment or click the PayPal button below to make your secure payment.
PayPal (click PayPal button below)
Thank you for your MEMBERSHIP to the TAPPAHANNOCK FREE CLINIC and welcome to an organization that makes a difference in the community. Your new membership pin will be mailed to you directly. Your TFC Membership also provides you with TFC event discounts and is tax deductible to the extent allowed by law.
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