Donation

Hidden Fields

Campaign ID - Prefill

Campaign ID - Selected

Recurring Donation Campaign

Payment Details

Donation Amount

Campaign

I choose to pay every

You have the option to help BCBS by agreeing to cover the cost of the transaction fees.

Amount Due

Donation + Fee Covered

% Fees

% Donation Amount

Billing Address

First Name

Last Name

Street Address

Address Line 2

(Optional)

City

State/Province

Country

Postal/Zip Code

Phone

Payment

Payment Type

Credit Card

US Bank Account

Credit Card

Name on Card

Card Number

CVV Code

I understand that this charge will appear as "The Barre Center" on my credit card.

Bank Account (ACH/eCheck)

To pay by debit to a US bank account you will be redirected to Stripe, our secure payment processor, after you hit submit.