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EVENT REGISTRATION & DONATIONS
Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
*
Verify Email
*
Phone
*
Event Donation
There is a suggested donation of $250 in lieu of a ticket to attend. All donations will benefit MedWish International's life saving mission.
Donation to MedWish International
$
Donation Acknowledgement
*
In an environmental effort to reduce paper usage, MedWish donors have the option to receive thank you letters/donation receipts via email or hard copy. Please select which manner you would prefer to receive your donation acknowledgement.
select one
Email
Paper
I'd like to cover the 3% fee associated with my donation so more of my contribution goes directly to MedWish.