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Donation
*
Mandatory fields
*
First name
Middle Name
*
Last name
*
Email
Phone
*
Address
*
City
*
State
*
Zip
Organization
*
Preferred Method of Contact
Email
Mail
Society Interests
*
Amount ($USD)
Comment
Payment frequency
One-time
Annually
*
I would like my donation to go towards:
General Operations
Clara Barton
Do not wish to specify
Donation in honor of:
Please note the name of the person being honored with your donation
Donation in memory of:
Please note the person you are remembering.
In-Kind Donation
Clear selection
Yes
No
In-Kind Donation Amount
In-Kind Donation Description
Describe the type in in-kind donation
*
BHS acknowledgment of your donation on website
Yes
Prefer to remain anonymous
