Intake form

Help us serve you better

Name *

Email address *

What is your affiliation with washington regional medical center?

Please select at least one option.

Patient

Donor

Volunteer

Employee

Community Member

What motivates you to participate in climb for care?

How did you hear about climb for care?

Are you interested in fundraising for the event?

Do you have any prior climbing experience?

What is your preferred method of communication?

Please select at least one option.

Phone

Text

In-Person

Would you like to receive updates about the event?

Additional questions or comments

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Climb for Care