Individual Team Member

Please fill out or print the form below and send in your registration dontation

Register as an individual member of a team. Remember to invite 3 other players to make up your team.  The individual team member donation is $125.

Please tell us about yourself, Register By Mail or Register Online.  You may submit your donation via check, in person or right here via credit card.  See Payment Options for instructions.

Register By Mail

Or Register Online

    Please tell us about yourself


    Select your donation options
    Donate OnlineBy MailIn Person
    if donating online, remember to click the donate button on the right when you have submitted this form

    Remember to send in your donation.

    Remember to invite 3 other teammates to join you.

    Payment Options

    Donate online

    Just click the button and pay with a credit card or your paypal account.

    Team Member Donation: $125





    Donate by Mail

    Make Checks Payable to “The Free Medical Clinic” and mail to:

    The Free Medical Clinic
    6209 Chapman hwy.
    Knoxville TN 37920
    ** remember to include your printed registration form

    Donate in person

    Just stop by the clinic anytime.