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One-Time Donation
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First, you'll enter some basic information about you and any additional members on your plan. Next you can select your plan, and then be forwarded to our secure payment page.
Personal Information
First Name
Last Name
Birthday
Email
Phone
Address
Address
Address 2
City
State
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Zip Code
Additional Members (if applicable)
Full name and DOB for each additional member
Subscription Details
Please select a Direct E-Care Clinic:
Select a clinic
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Subscription Type
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$35 Monthly (per person)
$370 Annually (per person)
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Terms & Conditions
Submit & Go to Payment
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