Amount:	$1    $2    $5    $10    Other $
Your Message:	Send us a message. Let us know if you're donating in honor of a loved one, a hibm patient, for another purpose, or just to make a general comment/suggestion. The form does not automatically save your text, so you may wish to compose it in a word processor and copy/paste here. Thank you.

In the next page, the Secure Server will ask for your Address and Phone Number for authenticity reasons in case they need to contact you (the credit card holder). Your information remains confidential. We know inputting this information can be an inconvenience for donating small amounts, but we hope this will reduce any chance of others using your credit card without your permission. To see the url of the Secure Server, you may reach this page directly at "http://hibm.org/arm/lib/tpl/dollar/donate-form" then click on the button "Proceed to Secure Server".