Please complete the required information below in order to process your BIPP orientation fee, evaluation fee or weekly group payment. For questions or assistance with this form, please contact AVDA's BIPP department at 713-224-9911 or Carolyn Burks

BIPP Client Information

First Name
Middle Initial
Last Name
Date Of Birth

Please enter the total amount of your BIPP payment in the box titled "Donation Amount". If you are paying for mulitple classes or fees you will need to make separate transactions.

Donation Amount*
$

Payee Information

Country*
Email*
Confirm Email*
Phone*

Credit Card Information

Amount*
$
Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
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