Donation

Hidden Fields

Campaign ID - Prefill

Campaign ID - Selected

Recurring Donation Campaign

Payment Details

Donation Amount

Campaign

I choose to pay every

Please describe the items you purchased from our bookshop here (e.g., Mindfulness of Breathing, 1 copy):

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

US residents, use state abbreviations.

Country

US residents, type out "United States".

Postal/Zip Code

Do not include special characters, spaces, or punctuation.

Phone

Please include the + sign and the country code. Do not include special characters, spaces, or punctuation.

Payment

Payment Type

Credit Card

US Bank Account

Credit Card

Name on Card

Card Number

Do not include special characters, spaces, or punctuation.

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.