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Individual Donor Application
Thanks for your interest in donation to the Black Girl Health Foundation (501)(c)(3). Please click start to submit your donation.
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1
Please provide your full name.
*
This field is required.
First Name
Last Name
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2
Please provide your email.
*
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example@example.com
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3
Please provide your phone number.
*
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Area Code
Phone Number
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4
Would you like this to be an anonymous donation?
*
This field is required.
YES
NO
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5
Please choose or create a donation amount
10
USD
25
USD
50
USD
100
USD
BGH Foundation Donation
USD
+ OR enter a custom value
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
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Expiration Month
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Expiration Year
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