www.providencelifeservices.com
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67.225.178.139
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Submitted URL: https://www.donatetoprovidence.com/
Effective URL: https://www.providencelifeservices.com/giving
Submission: On December 10 via api from US — Scanned from US
Effective URL: https://www.providencelifeservices.com/giving
Submission: On December 10 via api from US — Scanned from US
Form analysis 3 forms found in the DOM
<form id="mongo-form">
<script type="text/javascript">
var script = document.createElement("script");
script.async = true;
script.src = "https://payments.blackbaud.com/Checkout/bbCheckout.2.0.js";
document.getElementsByTagName("head")[0].appendChild(script);
</script>
<div id="bboxdonation_BBEmbeddedForm" class="BBFormContainer" data-bbox-part-id="c42005d4-4cad-497c-a79d-dfe71ff609fe">
<div id="bboxdonation_divForm">
<div id="divClientError" class="BBFormErrorBlock" style="display: none"></div>
<div class="BBFormSection BBDFormSectionGiftInfo">
<fieldset>
<legend>
<div class="BBFormSectionHeading">
<label id="bboxdonation_gift_lblHeadingDonation" class="BBFormFieldLabelEdit">Donation</label>
</div>
</legend>
<div id="bboxdonation_gift_fldAmountWithLevels" class="BBFormFieldContainer BBFormFieldContainerGivingLevels BBFormErrorNoMargin" data-style="Narrow_Buttons">
<span id="bboxdonation_gift_lblGivingLevels" class="BBFormFieldLabelGivingLevel BBFormFieldLabel BBFormFieldLabelEdit" style="display:none;">Gift amount:</span>
<div id="bboxdonation_gift_rdlstGivingLevels" class="BBFormRadioList">
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="100" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel1" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel1" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$100</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="250" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel2" checked="checked"
class="BBFormRadioButton BBFormRadioGivingLevel BBFormRadioGivingLevelSelected"><label for="bboxdonation_gift_rdGivingLevel2" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelSelected"><span
class="BBFormRadioAmount">$250</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="500" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel3" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel3" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$500</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="1000" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel4" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel4" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$1,000</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="1500" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel5" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel5" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$1,500</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="5000" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel6" class="BBFormRadioButton BBFormRadioGivingLevel"><label
for="bboxdonation_gift_rdGivingLevel6" class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected"><span class="BBFormRadioAmount">$5,000</span></label></div>
</div>
<div class="BBFormRadioItem BBFormRadioGivingLevelItem" tabindex="0">
<div class="BBFormRadioButtonContainer"><input value="rdGivingLevel7" name="bboxdonation$gift$GivingLevel" type="radio" id="bboxdonation_gift_rdGivingLevel7" data-min-payment="10" title="Other gift amount"
class="BBFormRadioButton BBFormRadioGivingLevel BBFormRadioGivingLevelOther"><label for="bboxdonation_gift_rdGivingLevel7" title="Other gift amount" aria-labelledby="bboxdonation_gift_rdGivingLevel7"
class="BBFormRadioLabel BBFormRadioLabelGivingLevel BBFormRadioLabelGivingLevelNotSelected BBFormRadioLabelGivingLevelOther"><span class="BBFormRadioDescriptionOther">Other</span><input
name="bboxdonation$gift$txtOtherAmountButtons" type="text" id="bboxdonation_gift_txtOtherAmountButtons" class="BBFormTextbox BBFormGiftOtherAmount BBFormCurrency" placeholder="$" data-culture="en-US"
aria-labelledby="bboxdonation_gift_rdGivingLevel7" title="Other gift amount"></label></div>
</div>
</div>
<div class="BBClearFix">
</div>
</div>
<div id="bboxdonation_gift_fldPledgeAmountWhenNoLevels" class="BBFormFieldContainer BBFormNoLevels BBFormPledgeFields" style="display: none;">
<label for="bboxdonation_gift_txtAmountPledge" id="bboxdonation_gift_lblAmountPledge" class="BBFormFieldLabel BBFormFieldLabelAmount BBFormFieldLabelEdit">Amount:</label>
<input name="bboxdonation$gift$txtAmountPledge" type="text" id="bboxdonation_gift_txtAmountPledge" class="BBFormTextbox BBFormCurrency" required="required" placeholder="$" data-culture="en-US" data-min-payment="10.0000">
</div>
</fieldset>
</div>
<input name="bboxdonation$gift$hdnGivingLevelButtonsEnabled" type="hidden" id="bboxdonation_gift_hdnGivingLevelButtonsEnabled" class="hdnGivingLevelButtonsEnabled" value="true">
<input name="bboxdonation$gift$hdnPledgeDuration" type="hidden" id="bboxdonation_gift_hdnPledgeDuration" class="hdnPledgeDuration">
<input name="bboxdonation$gift$hdnPledgePayment" type="hidden" id="bboxdonation_gift_hdnPledgePayment" class="hdnPledgePayment">
<input name="bboxdonation$gift$hdnGiftButtonsStyle" type="hidden" id="bboxdonation_gift_hdnGiftButtonsStyle" class="hdnGiftButtonsStyle">
<div id="bboxdonation_designation_divSection" class="BBFormSection BBDFormSectionDesignationInfo">
<fieldset>
<legend>
<div class="BBFormSectionHeading">
<label id="bboxdonation_designation_lblHeadingDesignation" class="BBFormFieldLabelEdit">Designation</label>
</div>
</legend>
<div class="BBFormFieldContainer">
<label for="bboxdonation_designation_ddDesignations" id="bboxdonation_designation_lblDesignation" class="BBFormFieldLabel BBFormFieldLabelEdit">Designation:</label>
<select name="bboxdonation$designation$ddDesignations" id="bboxdonation_designation_ddDesignations" class="BBFormSelectList">
<option value="79">Where needed most</option>
<option value="107">Hospice Gifts (Illinois)</option>
<option value="109">Hospice Gifts (Indiana)</option>
<option value="88">Providence Open</option>
<option value="82">Chaplains Program</option>
<option value="91">Torchlight Celebration</option>
<option value="86">Hallmark of Caring</option>
<option value="85">Pastors Masters</option>
<option value="90">Hunt Club</option>
<option value="83">Employee Giving/Helping Hand Fund</option>
</select>
<label for="bboxdonation_designation_txtOtherDesignation" id="bboxdonation_designation_lblOtherDesignation" style="display: none;">other Designation:</label>
<input name="bboxdonation$designation$txtOtherDesignation" type="text" id="bboxdonation_designation_txtOtherDesignation" class="BBFormTextbox BBFormOtherDesignation" placeholder="other designation (optional)" style="display: none;">
</div>
<div class="BBFormFieldContainer BBFormOtherDesignationContatiner" style="display: none;">
</div>
</fieldset>
</div>
<div class="BBFormSection BBDFormSectionComments">
<fieldset>
<legend></legend>
<div id="bboxdonation_comment_fldComments" class="BBFormFieldContainer">
<label for="bboxdonation_comment_txtComments" id="bboxdonation_comment_lblComments" class="BBFormFieldLabel BBFormFieldLabelEdit">Leave a comment (optional):</label>
<textarea name="bboxdonation$comment$txtComments" id="bboxdonation_comment_txtComments" class="BBFormTextArea" rows="2" cols="30" maxlength="255" placeholder="optional"></textarea>
</div>
</fieldset>
</div>
<div class="BBFormSection BBDFormSectionTributeInfo BBFormAddressBlock">
<fieldset>
<legend>
<div class="BBFormSectionHeading">
<label id="bboxdonation_tribute_lblHeadingTribute" class="BBFormFieldLabelEdit">Tribute Gift</label>
</div>
</legend>
<div id="bboxdonation_tribute_divTributeGeneral">
<div class="BBFormFieldContainer">
<input name="bboxdonation$tribute$chkTributeGift" type="checkbox" id="bboxdonation_tribute_chkTributeGift">
<label for="bboxdonation_tribute_chkTributeGift" id="bboxdonation_tribute_lblTributeGift" class="BBFormFieldLabel BBFormCheckbox BBFormCheckboxLabel BBFormFieldLabelEdit">This gift is in honor, memory, or support of someone</label>
</div>
<div id="divGeneralTributeInfo" style="display: none;">
<div class="BBFormFieldContainer BBFormFieldTributeInfo">
<span id="bboxdonation_tribute_lblGeneralTributeInfo" class="BBFormFieldLabel BBFormFieldLabelEdit">This gift is</span>
<select name="bboxdonation$tribute$ddTributeTypes" id="bboxdonation_tribute_ddTributeTypes" class="BBFormSelectList">
<option value="530">in loving memory of</option>
<option value="532">celebrating the birthday of</option>
<option value="929">in appreciation of care</option>
<option value="529">in honor of</option>
<option value="533">in honor of the anniversary of</option>
</select>
</div>
<div class="BBFormFieldContainer BBFormFieldTributeInfo">
<label for="bboxdonation_tribute_txtTributeRecordName" id="bboxdonation_tribute_lblTributeRecordName" class="BBFormFieldLabel BBAccessibilityOnly">Tribute honoree name:</label>
<input name="bboxdonation$tribute$txtTributeRecordName" type="text" id="bboxdonation_tribute_txtTributeRecordName" class="BBFormTextbox" required="required" placeholder="full name" maxlength="150">
</div>
</div>
</div>
<div id="divTributeAcknowledge" class="BBFormTributeAcknowledgeContainer" style="display: none;">
<div class="BBFormFieldContainer">
<input name="bboxdonation$tribute$hdnAllowTributeNotification" type="hidden" id="bboxdonation_tribute_hdnAllowTributeNotification" value="1">
<input name="bboxdonation$tribute$chkTributeAcknowledgee" type="checkbox" id="bboxdonation_tribute_chkTributeAcknowledgee">
<label for="bboxdonation_tribute_chkTributeAcknowledgee" id="bboxdonation_tribute_lblTributeAcknowledgee" class="BBFormFieldLabel BBFormCheckbox BBFormCheckboxLabel BBFormFieldLabelEdit">Please notify the following person of my
gift</label>
</div>
<div id="divTributeAcknowledgeeInfo" class="BBFormTributeAcknowledgeeContainer" style="display: none;">
<div class="BBFormIndivFields">
<div class="BBFormFieldContainer BBFormFieldContainerRequired BBTwoFields">
<label for="bboxdonation_tribute_txtFirstName" id="bboxdonation_tribute_lblName" class="BBFormFieldLabel BBFormFieldLabelEdit ">Name:</label>
<div aria-describedby="bboxdonation_tribute_txtFirstName">
<span id="bboxdonation_tribute_lblFirstName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly ">First name:</span>
</div>
<input name="bboxdonation$tribute$txtFirstName" type="text" id="bboxdonation_tribute_txtFirstName" class="BBFormTextbox" required="required" maxlength="50" placeholder="first name">
<label for="bboxdonation_tribute_txtLastName" id="bboxdonation_tribute_lblLastName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Last name:</label>
<input name="bboxdonation$tribute$txtLastName" type="text" id="bboxdonation_tribute_txtLastName" class="BBFormTextbox" required="required" maxlength="100" placeholder="last name">
</div>
</div>
<div class="BBFormFieldTributeAcknowledgee BBFormAddressBlock">
<div class="BBFormAddress">
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_tribute_tributeAddress_ddCountry" id="bboxdonation_tribute_tributeAddress_lblCountry" class="BBFormFieldLabel BBFormFieldLabelEdit">Country:</label>
<select name="bboxdonation$tribute$tributeAddress$ddCountry" id="bboxdonation_tribute_tributeAddress_ddCountry" class="BBFormSelectList BBFormCountryDropDown" required="required">
<option selected="selected" value="United States" data-country-format="1" data-short-text="US">United States</option>
<option value="United Kingdom" data-country-format="2" data-short-text="GB">United Kingdom</option>
<option value="Switzerland" data-country-format="1" data-short-text="CH">Switzerland</option>
<option value="New Zealand" data-country-format="5" data-short-text="NZ">New Zealand</option>
<option value="Canada" data-country-format="3" data-short-text="CA">Canada</option>
<option value="Australia" data-country-format="4" data-short-text="AU">Australia</option>
</select>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_tribute_tributeAddress_txtAddress" id="bboxdonation_tribute_tributeAddress_lblAddress" class="BBFormFieldLabel BBFormFieldLabelEdit">Address:</label>
<textarea name="bboxdonation$tribute$tributeAddress$txtAddress" id="bboxdonation_tribute_tributeAddress_txtAddress" class="BBFormTextArea" rows="2" cols="30" required="required" data-country-field="address"
maxlength="150"></textarea>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_tribute_tributeAddress_txtCity" id="bboxdonation_tribute_tributeAddress_lblCity" class="BBFormFieldLabel BBFormFieldLabelEdit">City:</label>
<input name="bboxdonation$tribute$tributeAddress$txtCity" type="text" id="bboxdonation_tribute_tributeAddress_txtCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_tribute_tributeAddress_ddState" id="bboxdonation_tribute_tributeAddress_lblStateZip" class="BBFormFieldLabel BBFormFieldLabelEdit">State & zip:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddState">
<span id="bboxdonation_tribute_tributeAddress_lblState" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">State:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddState" id="bboxdonation_tribute_tributeAddress_ddState" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">state</option>
<option value="AA">AA</option>
<option value="SA">SA</option>
<option value="AE">AE</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AB">AB</option>
<option value="AS">AS</option>
<option value="AP">AP</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CZ">CZ</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FM">FM</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MB">MB</option>
<option value="MH">MH</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NB">NB</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NL">NL</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="MP">MP</option>
<option value="NT">NT</option>
<option value="NS">NS</option>
<option value="NU">NU</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PW">PW</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SK">SK</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VI">VI</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtZip" id="bboxdonation_tribute_tributeAddress_lblZip" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Zip:</label>
<input name="bboxdonation$tribute$tributeAddress$txtZip" type="tel" id="bboxdonation_tribute_tributeAddress_txtZip" class="BBFormTextbox" data-country-field="postcode" data-country-sync="1" required="required" maxlength="12"
placeholder="zip">
</div>
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="2" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtUKCity" id="bboxdonation_tribute_tributeAddress_lblUKCityCounty" class="BBFormFieldLabel BBFormFieldLabelEdit">City & county:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_txtUKCity">
<span id="bboxdonation_tribute_tributeAddress_lblUKCity" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">City:</span>
</div>
<input name="bboxdonation$tribute$tributeAddress$txtUKCity" type="text" id="bboxdonation_tribute_tributeAddress_txtUKCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50"
placeholder="city">
<label for="bboxdonation_tribute_tributeAddress_ddUKCounty" id="bboxdonation_tribute_tributeAddress_lblUKCounty" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">County:</label>
<select name="bboxdonation$tribute$tributeAddress$ddUKCounty" id="bboxdonation_tribute_tributeAddress_ddUKCounty" class="BBFormSelectList GhostText" data-country-field="county">
<option selected="selected" value="" default="default">county (optional)</option>
<option value="Albemarle">Albemarle</option>
<option value="Allegany">Allegany</option>
<option value="Anchorage">Anchorage</option>
<option value="Anderson">Anderson</option>
<option value="Bartholomew">Bartholomew</option>
<option value="Benewah">Benewah</option>
<option value="Bullitt">Bullitt</option>
<option value="Buncombe">Buncombe</option>
<option value="Burlington">Burlington</option>
<option value="Butts">Butts</option>
<option value="Calloway">Calloway</option>
<option value="Cambria">Cambria</option>
<option value="Canyon">Canyon</option>
<option value="Cape Girardeau">Cape Girardeau</option>
<option value="Carver">Carver</option>
<option value="Cheboygan">Cheboygan</option>
<option value="Chester">Chester</option>
<option value="Chowan">Chowan</option>
<option value="Claiborne">Claiborne</option>
<option value="Clayton">Clayton</option>
<option value="Colonial Heights City">Colonial Heights City</option>
<option value="Columbus">Columbus</option>
<option value="Custer">Custer</option>
<option value="De Soto">De Soto</option>
<option value="Delta">Delta</option>
<option value="East Baton Rouge">East Baton Rouge</option>
<option value="Edgefield">Edgefield</option>
<option value="El Dorado">El Dorado</option>
<option value="Fauquier">Fauquier</option>
<option value="Freeborn">Freeborn</option>
<option value="Fresno">Fresno</option>
<option value="Goodhue">Goodhue</option>
<option value="Grand">Grand</option>
<option value="Granite">Granite</option>
<option value="Gregg">Gregg</option>
<option value="Habersham">Habersham</option>
<option value="Hamblen">Hamblen</option>
<option value="Hampton City">Hampton City</option>
<option value="Hanover">Hanover</option>
<option value="Hendricks">Hendricks</option>
<option value="Henrico">Henrico</option>
<option value="Highland">Highland</option>
<option value="Hillsdale">Hillsdale</option>
<option value="Horry">Horry</option>
<option value="Houghton">Houghton</option>
<option value="Humboldt">Humboldt</option>
<option value="Iredell">Iredell</option>
<option value="Jo Daviess">Jo Daviess</option>
<option value="Kauai">Kauai</option>
<option value="Kern">Kern</option>
<option value="Kitsap">Kitsap</option>
<option value="La Plata">La Plata</option>
<option value="Laramie">Laramie</option>
<option value="Lehigh">Lehigh</option>
<option value="Lexington City">Lexington City</option>
<option value="Lincoln">Lincoln</option>
<option value="Lowndes">Lowndes</option>
<option value="Mackinac">Mackinac</option>
<option value="Macoupin">Macoupin</option>
<option value="McDonough">McDonough</option>
<option value="Meagher">Meagher</option>
<option value="Mecklenburg">Mecklenburg</option>
<option value="Meeker">Meeker</option>
<option value="Mobile">Mobile</option>
<option value="Morgan">Morgan</option>
<option value="Moultrie">Moultrie</option>
<option value="Muscatine">Muscatine</option>
<option value="Muscogee">Muscogee</option>
<option value="Natrona">Natrona</option>
<option value="Norfolk City">Norfolk City</option>
<option value="Northampton">Northampton</option>
<option value="Oconee">Oconee</option>
<option value="Okeechobee">Okeechobee</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Onslow">Onslow</option>
<option value="Ontario">Ontario</option>
<option value="Otsego">Otsego</option>
<option value="Pacific">Pacific</option>
<option value="Parker">Parker</option>
<option value="Pender">Pender</option>
<option value="Phelps">Phelps</option>
<option value="Pickens">Pickens</option>
<option value="Pike">Pike</option>
<option value="Poweshiek">Poweshiek</option>
<option value="Queens">Queens</option>
<option value="Rankin">Rankin</option>
<option value="Rio Grande">Rio Grande</option>
<option value="Saint Johns">Saint Johns</option>
<option value="Sarpy">Sarpy</option>
<option value="Schoolcraft">Schoolcraft</option>
<option value="Sharp">Sharp</option>
<option value="Somerset">Somerset</option>
<option value="Spalding">Spalding</option>
<option value="Stafford">Stafford</option>
<option value="Sumner">Sumner</option>
<option value="Tompkins">Tompkins</option>
<option value="Troup">Troup</option>
<option value="Vernon">Vernon</option>
<option value="Wagoner">Wagoner</option>
<option value="Warrick">Warrick</option>
<option value="Wasatch">Wasatch</option>
<option value="Watauga">Watauga</option>
<option value="Webster">Webster</option>
<option value="Westmoreland">Westmoreland</option>
<option value="Wilson">Wilson</option>
<option value="Winona">Winona</option>
<option value="Yancey">Yancey</option>
<option value="Yellow Medicine">Yellow Medicine</option>
<option value="Yolo">Yolo</option>
<option value="Zapata">Zapata</option>
<option value="Ada">Ada</option>
<option value="Adams">Adams</option>
<option value="Addison">Addison</option>
<option value="Aiken">Aiken</option>
<option value="Alachua">Alachua</option>
<option value="Alamance">Alamance</option>
<option value="Alameda">Alameda</option>
<option value="Alexandria City">Alexandria City</option>
<option value="Allegan">Allegan</option>
<option value="Allegheny">Allegheny</option>
<option value="Allen">Allen</option>
<option value="Alpena">Alpena</option>
<option value="Angelina">Angelina</option>
<option value="Anoka">Anoka</option>
<option value="Antrim">Antrim</option>
<option value="Arapahoe">Arapahoe</option>
<option value="Arlington">Arlington</option>
<option value="Ashe">Ashe</option>
<option value="Baldwin">Baldwin</option>
<option value="Baltimore">Baltimore</option>
<option value="Baltimore City">Baltimore City</option>
<option value="Barron">Barron</option>
<option value="Barry">Barry</option>
<option value="Baxter">Baxter</option>
<option value="Bayfield">Bayfield</option>
<option value="Beaufort">Beaufort</option>
<option value="Beaver">Beaver</option>
<option value="Benton">Benton</option>
<option value="Benzie">Benzie</option>
<option value="Bergen">Bergen</option>
<option value="Berkeley">Berkeley</option>
<option value="Bernalillo">Bernalillo</option>
<option value="Berrien">Berrien</option>
<option value="Bexar">Bexar</option>
<option value="Black Hawk">Black Hawk</option>
<option value="Blount">Blount</option>
<option value="Boone">Boone</option>
<option value="Boulder">Boulder</option>
<option value="Branch">Branch</option>
<option value="Brevard">Brevard</option>
<option value="Bristol">Bristol</option>
<option value="Broomfield">Broomfield</option>
<option value="Broward">Broward</option>
<option value="Brown">Brown</option>
<option value="Brunswick">Brunswick</option>
<option value="Bucks">Bucks</option>
<option value="Bureau">Bureau</option>
<option value="Burleigh">Burleigh</option>
<option value="Butler">Butler</option>
<option value="Calhoun">Calhoun</option>
<option value="Camden">Camden</option>
<option value="Cameron">Cameron</option>
<option value="Canadian">Canadian</option>
<option value="Cape May">Cape May</option>
<option value="Carroll">Carroll</option>
<option value="Cass">Cass</option>
<option value="Chaffee">Chaffee</option>
<option value="Champaign">Champaign</option>
<option value="Charles Mix">Charles Mix</option>
<option value="Charleston">Charleston</option>
<option value="Charlotte">Charlotte</option>
<option value="Chatham">Chatham</option>
<option value="Cheatham">Cheatham</option>
<option value="Cherokee">Cherokee</option>
<option value="Chesapeake City">Chesapeake City</option>
<option value="Chippewa">Chippewa</option>
<option value="Chisago">Chisago</option>
<option value="Chittenden">Chittenden</option>
<option value="Christian">Christian</option>
<option value="Citrus">Citrus</option>
<option value="Clackamas">Clackamas</option>
<option value="Clallam">Clallam</option>
<option value="Clark">Clark</option>
<option value="Clay">Clay</option>
<option value="Clermont">Clermont</option>
<option value="Clinton">Clinton</option>
<option value="Cobb">Cobb</option>
<option value="Coles">Coles</option>
<option value="Collier">Collier</option>
<option value="Collin">Collin</option>
<option value="Columbia">Columbia</option>
<option value="Contra Costa">Contra Costa</option>
<option value="COOK">COOK</option>
<option value="Cooper">Cooper</option>
<option value="Craven">Craven</option>
<option value="Crawford">Crawford</option>
<option value="Crow Wing">Crow Wing</option>
<option value="Cumberland">Cumberland</option>
<option value="Curry">Curry</option>
<option value="Cuyahoga">Cuyahoga</option>
<option value="Dakota">Dakota</option>
<option value="Dallas">Dallas</option>
<option value="Dane">Dane</option>
<option value="Dare">Dare</option>
<option value="Davidson">Davidson</option>
<option value="Davis">Davis</option>
<option value="Defiance">Defiance</option>
<option value="Dekalb">Dekalb</option>
<option value="Delaware">Delaware</option>
<option value="Denton">Denton</option>
<option value="Denver">Denver</option>
<option value="Des Moines">Des Moines</option>
<option value="Deschutes">Deschutes</option>
<option value="Dickson">Dickson</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Dodge">Dodge</option>
<option value="Door">Door</option>
<option value="Dorchester">Dorchester</option>
<option value="Dougherty">Dougherty</option>
<option value="Douglas">Douglas</option>
<option value="Du Page">Du Page</option>
<option value="Dubois">Dubois</option>
<option value="Dubuque">Dubuque</option>
<option value="DUPAGE">DUPAGE</option>
<option value="Durham">Durham</option>
<option value="Dutchess">Dutchess</option>
<option value="Duval">Duval</option>
<option value="Eaton">Eaton</option>
<option value="Eau Claire">Eau Claire</option>
<option value="Echols">Echols</option>
<option value="Ector">Ector</option>
<option value="Effingham">Effingham</option>
<option value="El Paso">El Paso</option>
<option value="Elbert">Elbert</option>
<option value="Elkhart">Elkhart</option>
<option value="Ellis">Ellis</option>
<option value="Emmet">Emmet</option>
<option value="Emmons">Emmons</option>
<option value="Erie">Erie</option>
<option value="Escambia">Escambia</option>
<option value="Essex">Essex</option>
<option value="Fairfax">Fairfax</option>
<option value="Fairfield">Fairfield</option>
<option value="Fayette">Fayette</option>
<option value="Fentress">Fentress</option>
<option value="Flagler">Flagler</option>
<option value="Floyd">Floyd</option>
<option value="Fond Du Lac">Fond Du Lac</option>
<option value="Ford">Ford</option>
<option value="Forsyth">Forsyth</option>
<option value="Fort Bend">Fort Bend</option>
<option value="Franklin">Franklin</option>
<option value="Frederick">Frederick</option>
<option value="Fremont">Fremont</option>
<option value="Fulton">Fulton</option>
<option value="Gage">Gage</option>
<option value="Gallatin">Gallatin</option>
<option value="Galveston">Galveston</option>
<option value="Garfield">Garfield</option>
<option value="Garland">Garland</option>
<option value="Genesee">Genesee</option>
<option value="Gibson">Gibson</option>
<option value="Gloucester">Gloucester</option>
<option value="Glynn">Glynn</option>
<option value="Grand Traverse">Grand Traverse</option>
<option value="Grant">Grant</option>
<option value="Green">Green</option>
<option value="Greene">Greene</option>
<option value="Greenville">Greenville</option>
<option value="Grundy">Grundy</option>
<option value="Guadalupe">Guadalupe</option>
<option value="Guilford">Guilford</option>
<option value="Gwinnett">Gwinnett</option>
<option value="Hall">Hall</option>
<option value="Hamilton">Hamilton</option>
<option value="Hampden">Hampden</option>
<option value="Hancock">Hancock</option>
<option value="Haralson">Haralson</option>
<option value="Hardin">Hardin</option>
<option value="Harford">Harford</option>
<option value="Harris">Harris</option>
<option value="Harrison">Harrison</option>
<option value="Hartford">Hartford</option>
<option value="Harvey">Harvey</option>
<option value="Haywood">Haywood</option>
<option value="Henderson">Henderson</option>
<option value="Hennepin">Hennepin</option>
<option value="Henry">Henry</option>
<option value="Hernando">Hernando</option>
<option value="Hidalgo">Hidalgo</option>
<option value="Highlands">Highlands</option>
<option value="Hillsborough">Hillsborough</option>
<option value="Hinds">Hinds</option>
<option value="Hopkins">Hopkins</option>
<option value="Houston">Houston</option>
<option value="Howard">Howard</option>
<option value="Howell">Howell</option>
<option value="Hudson">Hudson</option>
<option value="Hunt">Hunt</option>
<option value="Huntingdon">Huntingdon</option>
<option value="Indian River">Indian River</option>
<option value="Ingham">Ingham</option>
<option value="Ionia">Ionia</option>
<option value="Iron">Iron</option>
<option value="Iroquois">Iroquois</option>
<option value="Isabella">Isabella</option>
<option value="Isanti">Isanti</option>
<option value="Island">Island</option>
<option value="Jackson">Jackson</option>
<option value="Jasper">Jasper</option>
<option value="Jefferson">Jefferson</option>
<option value="Johnson">Johnson</option>
<option value="Johnston">Johnston</option>
<option value="Josephine">Josephine</option>
<option value="Kalamazoo">Kalamazoo</option>
<option value="Kandiyohi">Kandiyohi</option>
<option value="Kane">Kane</option>
<option value="Kankakee">Kankakee</option>
<option value="Kendall">Kendall</option>
<option value="Kenosha">Kenosha</option>
<option value="Kent">Kent</option>
<option value="Kerr">Kerr</option>
<option value="King">King</option>
<option value="Kings">Kings</option>
<option value="Kleberg">Kleberg</option>
<option value="Knox">Knox</option>
<option value="Kosciusko">Kosciusko</option>
<option value="La Crosse">La Crosse</option>
<option value="La Porte">La Porte</option>
<option value="La Salle">La Salle</option>
<option value="Lagrange">Lagrange</option>
<option value="LAKE">LAKE</option>
<option value="Lake of the Woods">Lake of the Woods</option>
<option value="Lancaster">Lancaster</option>
<option value="Lane">Lane</option>
<option value="Larimer">Larimer</option>
<option value="Lawrence">Lawrence</option>
<option value="Lee">Lee</option>
<option value="Leelanau">Leelanau</option>
<option value="Lenawee">Lenawee</option>
<option value="Leon">Leon</option>
<option value="Lewis and Clark">Lewis and Clark</option>
<option value="Lexington">Lexington</option>
<option value="Linn">Linn</option>
<option value="Livingston">Livingston</option>
<option value="Logan">Logan</option>
<option value="Lorain">Lorain</option>
<option value="Los Alamos">Los Alamos</option>
<option value="Los Angeles">Los Angeles</option>
<option value="Loudon">Loudon</option>
<option value="Loudoun">Loudoun</option>
<option value="Lucas">Lucas</option>
<option value="Lycoming">Lycoming</option>
<option value="Lyon">Lyon</option>
<option value="Macomb">Macomb</option>
<option value="Macon">Macon</option>
<option value="Madison">Madison</option>
<option value="Mahaska">Mahaska</option>
<option value="Manatee">Manatee</option>
<option value="Manistee">Manistee</option>
<option value="Manitowoc">Manitowoc</option>
<option value="Marathon">Marathon</option>
<option value="Maricopa">Maricopa</option>
<option value="Marin">Marin</option>
<option value="Marinette">Marinette</option>
<option value="Marion">Marion</option>
<option value="Marshall">Marshall</option>
<option value="Martin">Martin</option>
<option value="Mason">Mason</option>
<option value="Massac">Massac</option>
<option value="McCracken">McCracken</option>
<option value="McHenry">McHenry</option>
<option value="McKinley">McKinley</option>
<option value="McLean">McLean</option>
<option value="McLennan">McLennan</option>
<option value="Mecosta">Mecosta</option>
<option value="Medina">Medina</option>
<option value="Menard">Menard</option>
<option value="Mendocino">Mendocino</option>
<option value="Merced">Merced</option>
<option value="Mercer">Mercer</option>
<option value="Mesa">Mesa</option>
<option value="Miami">Miami</option>
<option value="Miami-Dade">Miami-Dade</option>
<option value="Middlesex">Middlesex</option>
<option value="Midland">Midland</option>
<option value="Miller">Miller</option>
<option value="Mills">Mills</option>
<option value="Milwaukee">Milwaukee</option>
<option value="Mineral">Mineral</option>
<option value="Minnehaha">Minnehaha</option>
<option value="Missaukee">Missaukee</option>
<option value="Mohave">Mohave</option>
<option value="Monmouth">Monmouth</option>
<option value="Monroe">Monroe</option>
<option value="Montcalm">Montcalm</option>
<option value="Monterey">Monterey</option>
<option value="Montgomery">Montgomery</option>
<option value="Montmorency">Montmorency</option>
<option value="Montrose">Montrose</option>
<option value="Moore">Moore</option>
<option value="Morris">Morris</option>
<option value="Multnomah">Multnomah</option>
<option value="Murray">Murray</option>
<option value="Muskegon">Muskegon</option>
<option value="Nassau">Nassau</option>
<option value="Navajo">Navajo</option>
<option value="Nelson">Nelson</option>
<option value="Nevada">Nevada</option>
<option value="New Castle">New Castle</option>
<option value="New Hanover">New Hanover</option>
<option value="New Haven">New Haven</option>
<option value="New London">New London</option>
<option value="New York">New York</option>
<option value="Newaygo">Newaygo</option>
<option value="Newport News City">Newport News City</option>
<option value="Newton">Newton</option>
<option value="Nobles">Nobles</option>
<option value="Oakland">Oakland</option>
<option value="Obrien">Obrien</option>
<option value="Ocean">Ocean</option>
<option value="Oceana">Oceana</option>
<option value="Ogle">Ogle</option>
<option value="Okaloosa">Okaloosa</option>
<option value="Oldham">Oldham</option>
<option value="Olmsted">Olmsted</option>
<option value="Oneida">Oneida</option>
<option value="Onondaga">Onondaga</option>
<option value="Orange">Orange</option>
<option value="Oregon">Oregon</option>
<option value="Orleans">Orleans</option>
<option value="Osceola">Osceola</option>
<option value="Oscoda">Oscoda</option>
<option value="Ottawa">Ottawa</option>
<option value="Ottowa">Ottowa</option>
<option value="Ouachita">Ouachita</option>
<option value="Ouray">Ouray</option>
<option value="Outagamie">Outagamie</option>
<option value="Ozaukee">Ozaukee</option>
<option value="Page">Page</option>
<option value="Palm Beach">Palm Beach</option>
<option value="Park">Park</option>
<option value="Parke">Parke</option>
<option value="Pasco">Pasco</option>
<option value="Passaic">Passaic</option>
<option value="Penobscot">Penobscot</option>
<option value="Peoria">Peoria</option>
<option value="Pepin">Pepin</option>
<option value="Philadelphia">Philadelphia</option>
<option value="Piatt">Piatt</option>
<option value="Pierce">Pierce</option>
<option value="Pima">Pima</option>
<option value="Pinal">Pinal</option>
<option value="Pinellas">Pinellas</option>
<option value="Pipestone">Pipestone</option>
<option value="Piscataquis">Piscataquis</option>
<option value="Pitkin">Pitkin</option>
<option value="Pitt">Pitt</option>
<option value="Placer">Placer</option>
<option value="Platte">Platte</option>
<option value="Plymouth">Plymouth</option>
<option value="Polk">Polk</option>
<option value="Poquoson City">Poquoson City</option>
<option value="Portage">Portage</option>
<option value="Porter">Porter</option>
<option value="Prince Georges">Prince Georges</option>
<option value="Pueblo">Pueblo</option>
<option value="Pulaski">Pulaski</option>
<option value="Putnam">Putnam</option>
<option value="Racine">Racine</option>
<option value="Ramsey">Ramsey</option>
<option value="Randolph">Randolph</option>
<option value="Rice">Rice</option>
<option value="Richland">Richland</option>
<option value="Riley">Riley</option>
<option value="Riverside">Riverside</option>
<option value="Rock">Rock</option>
<option value="Rock Island">Rock Island</option>
<option value="Rockingham">Rockingham</option>
<option value="Rusk">Rusk</option>
<option value="Rutherford">Rutherford</option>
<option value="Sacramento">Sacramento</option>
<option value="Saint Charles">Saint Charles</option>
<option value="Saint Clair">Saint Clair</option>
<option value="Saint Francois">Saint Francois</option>
<option value="Saint Joseph">Saint Joseph</option>
<option value="Saint Louis">Saint Louis</option>
<option value="Saint Louis City">Saint Louis City</option>
<option value="Saline">Saline</option>
<option value="Salt Lake">Salt Lake</option>
<option value="San Bernardino">San Bernardino</option>
<option value="San Diego">San Diego</option>
<option value="San Francisco">San Francisco</option>
<option value="San Joaquin">San Joaquin</option>
<option value="San Luis Obispo">San Luis Obispo</option>
<option value="San Mateo">San Mateo</option>
<option value="Sandoval">Sandoval</option>
<option value="Sangamon">Sangamon</option>
<option value="Santa Barbara">Santa Barbara</option>
<option value="Santa Clara">Santa Clara</option>
<option value="Santa Cruz">Santa Cruz</option>
<option value="Santa Fe">Santa Fe</option>
<option value="Santa Rosa">Santa Rosa</option>
<option value="Sarasota">Sarasota</option>
<option value="Sauk">Sauk</option>
<option value="Sawyer">Sawyer</option>
<option value="Schenectady">Schenectady</option>
<option value="Schuylkill">Schuylkill</option>
<option value="Scott">Scott</option>
<option value="Scotts Bluff">Scotts Bluff</option>
<option value="Sedgwick">Sedgwick</option>
<option value="Seminole">Seminole</option>
<option value="Sharkey">Sharkey</option>
<option value="Sheboygan">Sheboygan</option>
<option value="Shelby">Shelby</option>
<option value="Sherburne">Sherburne</option>
<option value="Sibley">Sibley</option>
<option value="Sioux">Sioux</option>
<option value="Skagit">Skagit</option>
<option value="Snohomish">Snohomish</option>
<option value="Sonoma">Sonoma</option>
<option value="Spotsylvania">Spotsylvania</option>
<option value="St Joseph">St Joseph</option>
<option value="Stanislaus">Stanislaus</option>
<option value="Stark">Stark</option>
<option value="Starke">Starke</option>
<option value="Stearns">Stearns</option>
<option value="Stephenson">Stephenson</option>
<option value="Steuben">Steuben</option>
<option value="Stone">Stone</option>
<option value="Story">Story</option>
<option value="Strafford">Strafford</option>
<option value="Suffolk">Suffolk</option>
<option value="Sullivan">Sullivan</option>
<option value="Summit">Summit</option>
<option value="Sumter">Sumter</option>
<option value="Sussex">Sussex</option>
<option value="Taney">Taney</option>
<option value="Tarrant">Tarrant</option>
<option value="Tazewell">Tazewell</option>
<option value="Teton">Teton</option>
<option value="Tippecanoe">Tippecanoe</option>
<option value="Travis">Travis</option>
<option value="Trumbull">Trumbull</option>
<option value="Tulare">Tulare</option>
<option value="Tulsa">Tulsa</option>
<option value="Tuscaloosa">Tuscaloosa</option>
<option value="Unicoi">Unicoi</option>
<option value="Union">Union</option>
<option value="Van Buren">Van Buren</option>
<option value="Vance">Vance</option>
<option value="Vanderburgh">Vanderburgh</option>
<option value="Ventura">Ventura</option>
<option value="Vermilion">Vermilion</option>
<option value="Vigo">Vigo</option>
<option value="Vilas">Vilas</option>
<option value="Virginia Beach City">Virginia Beach City</option>
<option value="Volusia">Volusia</option>
<option value="Wabash">Wabash</option>
<option value="Wake">Wake</option>
<option value="Walker">Walker</option>
<option value="Walton">Walton</option>
<option value="Walworth">Walworth</option>
<option value="Ward">Ward</option>
<option value="Warren">Warren</option>
<option value="Washburn">Washburn</option>
<option value="Washington">Washington</option>
<option value="Washoe">Washoe</option>
<option value="Washtenaw">Washtenaw</option>
<option value="Watonwan">Watonwan</option>
<option value="Waukesha">Waukesha</option>
<option value="Waupaca">Waupaca</option>
<option value="Wayne">Wayne</option>
<option value="Weld">Weld</option>
<option value="Westchester">Westchester</option>
<option value="Wexford">Wexford</option>
<option value="Whatcom">Whatcom</option>
<option value="White">White</option>
<option value="Whiteside">Whiteside</option>
<option value="Wichita">Wichita</option>
<option value="WILL">WILL</option>
<option value="Williamson">Williamson</option>
<option value="Windsor">Windsor</option>
<option value="Winnebago">Winnebago</option>
<option value="Wood">Wood</option>
<option value="Woodbury">Woodbury</option>
<option value="Woodford">Woodford</option>
<option value="Worcester">Worcester</option>
<option value="Yamhill">Yamhill</option>
<option value="Yavapai">Yavapai</option>
<option value="York">York</option>
</select>
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="2" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtUKPostCode" id="bboxdonation_tribute_tributeAddress_lblUKPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">Postcode:</label>
<input name="bboxdonation$tribute$tributeAddress$txtUKPostCode" type="text" id="bboxdonation_tribute_tributeAddress_txtUKPostCode" class="BBFormTextbox" data-country-field="postcode" data-country-sync="1" required="required"
maxlength="12">
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="3" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtCACity" id="bboxdonation_tribute_tributeAddress_lblCACity" class="BBFormFieldLabel BBFormFieldLabelEdit">City:</label>
<input name="bboxdonation$tribute$tributeAddress$txtCACity" type="text" id="bboxdonation_tribute_tributeAddress_txtCACity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="3" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddCAProvince" id="bboxdonation_tribute_tributeAddress_lblCAProvincePostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">Province & postal:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddCAProvince">
<span id="bboxdonation_tribute_tributeAddress_lblCAProvince" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Province:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddCAProvince" id="bboxdonation_tribute_tributeAddress_ddCAProvince" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">province</option>
<option value="AA">AA</option>
<option value="SA">SA</option>
<option value="AE">AE</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AB">AB</option>
<option value="AS">AS</option>
<option value="AP">AP</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CZ">CZ</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FM">FM</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MB">MB</option>
<option value="MH">MH</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NB">NB</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NL">NL</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="MP">MP</option>
<option value="NT">NT</option>
<option value="NS">NS</option>
<option value="NU">NU</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PW">PW</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SK">SK</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VI">VI</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtCAPostCode" id="bboxdonation_tribute_tributeAddress_lblCAPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Postal:</label>
<input name="bboxdonation$tribute$tributeAddress$txtCAPostCode" type="text" id="bboxdonation_tribute_tributeAddress_txtCAPostCode" class="BBFormTextbox" required="required" data-country-sync="1" data-country-field="postcode"
maxlength="12" placeholder="postal">
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="4" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_txtAUCity" id="bboxdonation_tribute_tributeAddress_lblAUCity" class="BBFormFieldLabel BBFormFieldLabelEdit">Suburb:</label>
<input name="bboxdonation$tribute$tributeAddress$txtAUCity" type="text" id="bboxdonation_tribute_tributeAddress_txtAUCity" class="BBFormTextbox" data-country-sync="1" data-country-field="city" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="4" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddAUState" id="bboxdonation_tribute_tributeAddress_lblAUStatePostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">State & postcode:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddAUState">
<span id="bboxdonation_tribute_tributeAddress_lblAUState" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">State:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddAUState" id="bboxdonation_tribute_tributeAddress_ddAUState" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">state</option>
<option value="AA">AA</option>
<option value="SA">SA</option>
<option value="AE">AE</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AB">AB</option>
<option value="AS">AS</option>
<option value="AP">AP</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CZ">CZ</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FM">FM</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MB">MB</option>
<option value="MH">MH</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NB">NB</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NL">NL</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="MP">MP</option>
<option value="NT">NT</option>
<option value="NS">NS</option>
<option value="NU">NU</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PW">PW</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SK">SK</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VI">VI</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtAUPostCode" id="bboxdonation_tribute_tributeAddress_lblAUPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Postcode:</label>
<input name="bboxdonation$tribute$tributeAddress$txtAUPostCode" type="tel" id="bboxdonation_tribute_tributeAddress_txtAUPostCode" class="BBFormTextbox" required="required" data-country-sync="1" data-country-field="postcode"
maxlength="12" placeholder="postcode">
</div>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="5" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddNZSuburb" id="bboxdonation_tribute_tributeAddress_lblNZSuburb" class="BBFormFieldLabel BBFormFieldLabelEdit">Suburb:</label>
<select name="bboxdonation$tribute$tributeAddress$ddNZSuburb" id="bboxdonation_tribute_tributeAddress_ddNZSuburb" class="BBFormSelectList GhostText" required="required" data-country-field="nzsuburb">
<option selected="selected" value="" default="default">suburb</option>
<option value="Adelaide">Adelaide</option>
</select>
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="5" style="display: none;">
<label for="bboxdonation_tribute_tributeAddress_ddNZCity" id="bboxdonation_tribute_tributeAddress_lblNZCityPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">City & post code:</label>
<div aria-describedby="bboxdonation_tribute_tributeAddress_ddNZCity">
<span id="bboxdonation_tribute_tributeAddress_lblNZCity" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">City:</span>
</div>
<select name="bboxdonation$tribute$tributeAddress$ddNZCity" id="bboxdonation_tribute_tributeAddress_ddNZCity" class="BBFormSelectList GhostText" required="required" data-country-field="nzcity">
<option selected="selected" value="" default="default">city</option>
<option value="Austrailia">Austrailia</option>
</select>
<label for="bboxdonation_tribute_tributeAddress_txtNZPostCode" id="bboxdonation_tribute_tributeAddress_lblNZPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Post code:</label>
<input name="bboxdonation$tribute$tributeAddress$txtNZPostCode" type="tel" id="bboxdonation_tribute_tributeAddress_txtNZPostCode" class="BBFormTextbox" required="required" data-country-sync="1" data-country-field="postcode"
maxlength="12" placeholder="post code">
</div>
</div>
</div>
</div>
</div>
</div>
</fieldset>
</div>
<div class="BBFormSection BBDFormSectionPaymentInfo">
<fieldset>
<legend>
</legend>
<div id="bboxdonation_payment_BBFormConfirmationBoxWrapper" class="BBFormConfirmationBoxWrapper" style="display: none;">
<div id="bboxdonation_payment_BBFormDDConfirmationBox" class="BBFormDDConfirmationBox">
<div class="BBFormBoxHeader">Is the information you entered to set up the Direct Debit Instruction correct?</div>
<div class="BBFormBoxContent">
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="DDAccountHolder" id="lblDDAccountHolder" class="BBFormFieldLabel"> Account holder: </label>
<span id="bboxdonation_payment_DDAccountHolder" class="BBFormFieldValueLabel"></span>
<br>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="DDSortCode" id="lblDDSortCode" class="BBFormFieldLabel"> Sort Code: </label>
<span id="bboxdonation_payment_DDSortCode" class="BBFormFieldValueLabel"></span>
<br>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="DDAccountNumber" id="lblDDAccountNumber" class="BBFormFieldLabel"> Account number: </label>
<span id="bboxdonation_payment_DDAccountNumber" class="BBFormFieldValueLabel"></span>
<br>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="DDDebitAmount" id="lblDDDebitAmount" class="BBFormFieldLabel"> Amount to be debited: </label>
<span id="bboxdonation_payment_DDDebitAmount" class="BBFormFieldValueLabel"></span>
<br>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="DDFrequency" id="lblDDFrequency" class="BBFormFieldLabel"> Collection frequency: </label>
<span id="bboxdonation_payment_DDFrequency" class="BBFormFieldValueLabel"></span>
<br>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="DDDateOfFirstGift" id="lblDDDateOfFirstGift" class="BBFormFieldLabel"> Date of first gift: </label>
<span id="bboxdonation_payment_DDDateOfFirstGift" class="BBFormFieldValueLabel"></span>
<br>
</div>
</div>
<div class="BBFormFieldContainer BBFormBoxActionButtons">
<input name="bboxdonation$payment$btnDonateNow" type="button" id="bboxdonation_payment_btnDonateNow" class="BBFormSubmitbutton BBFormSubmitbuttonEdit" value="Yes, donate now">
<input name="bboxdonation$payment$btnBackToForm" type="button" id="bboxdonation_payment_btnBackToForm" class="BBFormSubmitbutton BBFormBackbutton" value="Back to form">
</div>
</div>
</div>
</fieldset>
</div>
<input name="bboxdonation$payment$hdnMerchantAccountId" type="hidden" id="bboxdonation_payment_hdnMerchantAccountId" class="hdnMerchantAccountId" value="ba1b2d6c-62cf-4b68-b21a-0109a7f04011">
<div id="bboxdonation_billing_divBillingSection" class="BBFormSection BBDFormSectionBillingInfo BBFormAddressBlock" data-section="Billing">
<fieldset>
<legend>
<div id="bboxdonation_billing_divBillingHeader" class="BBFormSectionHeading">
<label id="bboxdonation_billing_lblHeadingContact" class="BBFormFieldLabelEdit">Billing Address</label>
</div>
</legend>
<div id="bboxdonation_billing_fldOrgGift" class="BBFormFieldContainer">
<input name="bboxdonation$billing$chkOrgGift" type="checkbox" id="bboxdonation_billing_chkOrgGift">
<label for="bboxdonation_billing_chkOrgGift" id="bboxdonation_billing_lblOrgGift" class="BBFormFieldLabel BBFormCheckbox BBFormCheckboxLabel BBFormFieldLabelEdit">Make this gift on behalf of an organization</label>
</div>
<div id="fldOrgInfo" class="BBFormOrgFields" style="display: none;">
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_billing_txtOrgName" id="bboxdonation_billing_lblOrgName" class="BBFormFieldLabel BBFormFieldLabelEdit ">Organization name:</label>
<input name="bboxdonation$billing$txtOrgName" type="text" id="bboxdonation_billing_txtOrgName" class="BBFormTextbox" required="required" data-billing-field="orgname" maxlength="60">
</div>
</div>
<div id="fldIndivInfo" class="BBFormIndivFields">
<div id="divName" class="BBFormFieldContainer BBFormFieldContainerRequired BBTwoFields">
<span id="bboxdonation_billing_lblFullName" class="BBFormFieldLabel BBFormFieldLabelEdit">Name:</span>
<label for="bboxdonation_billing_ddTitle" id="bboxdonation_billing_lblTitle" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Title:</label>
<label for="bboxdonation_billing_txtFirstName" id="bboxdonation_billing_lblFirstName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">First name:</label>
<input name="bboxdonation$billing$txtFirstName" type="text" id="bboxdonation_billing_txtFirstName" class="BBFormTextbox" data-billing-field="firstname" maxlength="50" required="required" placeholder="first name">
<label for="bboxdonation_billing_txtLastName" id="bboxdonation_billing_lblLastName" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Last name:</label>
<input name="bboxdonation$billing$txtLastName" type="text" id="bboxdonation_billing_txtLastName" class="BBFormTextbox" data-billing-field="lastname" maxlength="100" required="required" placeholder="last name">
</div>
</div>
<div id="bboxdonation_billing_divEmail" class="BBFormFieldContainer BBFormFieldContainerRequired BBFormBillingEmail">
<label for="bboxdonation_billing_txtEmail" id="bboxdonation_billing_lblEmail" class="BBFormFieldLabel BBFormFieldLabelEdit">Email:</label>
<input name="bboxdonation$billing$txtEmail" type="email" id="bboxdonation_billing_txtEmail" class="BBFormTextbox" data-billing-field="email" required="required">
</div>
<div id="bboxdonation_billing_divPhone" class="BBFormFieldContainer BBFormBillingPhone BBFormFieldContainerRequired">
<label for="bboxdonation_billing_txtPhone" id="bboxdonation_billing_lblPhone" class="BBFormFieldLabel BBFormFieldLabelEdit">Phone:</label>
<input name="bboxdonation$billing$txtPhone" type="tel" id="bboxdonation_billing_txtPhone" class="BBFormTextbox" data-billing-field="phone" required="required">
</div>
<div class="BBFormAddress">
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_billing_billingAddress_ddCountry" id="bboxdonation_billing_billingAddress_lblCountry" class="BBFormFieldLabel BBFormFieldLabelEdit">Country:</label>
<select name="bboxdonation$billing$billingAddress$ddCountry" id="bboxdonation_billing_billingAddress_ddCountry" class="BBFormSelectList BBFormCountryDropDown" required="required">
<option selected="selected" value="United States" data-country-format="1" data-short-text="US">United States</option>
<option value="United Kingdom" data-country-format="2" data-short-text="GB">United Kingdom</option>
<option value="Switzerland" data-country-format="1" data-short-text="CH">Switzerland</option>
<option value="New Zealand" data-country-format="5" data-short-text="NZ">New Zealand</option>
<option value="Canada" data-country-format="3" data-short-text="CA">Canada</option>
<option value="Australia" data-country-format="4" data-short-text="AU">Australia</option>
</select>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired">
<label for="bboxdonation_billing_billingAddress_txtAddress" id="bboxdonation_billing_billingAddress_lblAddress" class="BBFormFieldLabel BBFormFieldLabelEdit">Address:</label>
<textarea name="bboxdonation$billing$billingAddress$txtAddress" id="bboxdonation_billing_billingAddress_txtAddress" class="BBFormTextArea" rows="2" cols="30" required="required" data-country-field="address" maxlength="150"></textarea>
</div>
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_billing_billingAddress_txtCity" id="bboxdonation_billing_billingAddress_lblCity" class="BBFormFieldLabel BBFormFieldLabelEdit">City:</label>
<input name="bboxdonation$billing$billingAddress$txtCity" type="text" id="bboxdonation_billing_billingAddress_txtCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50">
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="1">
<label for="bboxdonation_billing_billingAddress_ddState" id="bboxdonation_billing_billingAddress_lblStateZip" class="BBFormFieldLabel BBFormFieldLabelEdit">State & zip:</label>
<div aria-describedby="bboxdonation_billing_billingAddress_ddState">
<span id="bboxdonation_billing_billingAddress_lblState" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">State:</span>
</div>
<select name="bboxdonation$billing$billingAddress$ddState" id="bboxdonation_billing_billingAddress_ddState" class="BBFormSelectList GhostText" data-country-sync="1" data-country-field="state" required="required">
<option selected="selected" value="" default="default">state</option>
<option value="AA">AA</option>
<option value="SA">SA</option>
<option value="AE">AE</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AB">AB</option>
<option value="AS">AS</option>
<option value="AP">AP</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="BC">BC</option>
<option value="CA">CA</option>
<option value="CZ">CZ</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FM">FM</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="GU">GU</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MB">MB</option>
<option value="MH">MH</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NB">NB</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NL">NL</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="MP">MP</option>
<option value="NT">NT</option>
<option value="NS">NS</option>
<option value="NU">NU</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="ON">ON</option>
<option value="OR">OR</option>
<option value="PW">PW</option>
<option value="PA">PA</option>
<option value="PE">PE</option>
<option value="PR">PR</option>
<option value="QC">QC</option>
<option value="RI">RI</option>
<option value="SK">SK</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VI">VI</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="YT">YT</option>
</select>
<label for="bboxdonation_billing_billingAddress_txtZip" id="bboxdonation_billing_billingAddress_lblZip" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">Zip:</label>
<input name="bboxdonation$billing$billingAddress$txtZip" type="tel" id="bboxdonation_billing_billingAddress_txtZip" class="BBFormTextbox" data-country-field="postcode" data-country-sync="1" required="required" maxlength="12"
placeholder="zip">
</div>
</div>
<div class="BBTwoFields BBFieldBillingStateZip">
<div class="BBFormFieldContainer BBFormFieldContainerRequired" data-country-format-for="2" style="display: none;">
<label for="bboxdonation_billing_billingAddress_txtUKCity" id="bboxdonation_billing_billingAddress_lblUKCityCounty" class="BBFormFieldLabel BBFormFieldLabelEdit">City & county:</label>
<div aria-describedby="bboxdonation_billing_billingAddress_txtUKCity">
<span id="bboxdonation_billing_billingAddress_lblUKCity" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">City:</span>
</div>
<input name="bboxdonation$billing$billingAddress$txtUKCity" type="text" id="bboxdonation_billing_billingAddress_txtUKCity" class="BBFormTextbox" data-country-field="city" data-country-sync="1" required="required" maxlength="50"
placeholder="city">
<label for="bboxdonation_billing_billingAddress_ddUKCounty" id="bboxdonation_billing_billingAddress_lblUKCounty" class="BBFormFieldLabel BBFormFieldLabelEdit BBAccessibilityOnly">County:</label>
<select name="bboxdonation$billing$billingAddress$ddUKCounty" id="bboxdonation_billing_billingAddress_ddUKCounty" class="BBFormSelectList GhostText" data-country-field="county">
<option selected="selected" value="" default="default">county (optional)</option>
<option value="Albemarle">Albemarle</option>
<option value="Allegany">Allegany</option>
<option value="Anchorage">Anchorage</option>
<option value="Anderson">Anderson</option>
<option value="Bartholomew">Bartholomew</option>
<option value="Benewah">Benewah</option>
<option value="Bullitt">Bullitt</option>
<option value="Buncombe">Buncombe</option>
<option value="Burlington">Burlington</option>
<option value="Butts">Butts</option>
<option value="Calloway">Calloway</option>
<option value="Cambria">Cambria</option>
<option value="Canyon">Canyon</option>
<option value="Cape Girardeau">Cape Girardeau</option>
<option value="Carver">Carver</option>
<option value="Cheboygan">Cheboygan</option>
<option value="Chester">Chester</option>
<option value="Chowan">Chowan</option>
<option value="Claiborne">Claiborne</option>
<option value="Clayton">Clayton</option>
<option value="Colonial Heights City">Colonial Heights City</option>
<option value="Columbus">Columbus</option>
<option value="Custer">Custer</option>
<option value="De Soto">De Soto</option>
<option value="Delta">Delta</option>
<option value="East Baton Rouge">East Baton Rouge</option>
<option value="Edgefield">Edgefield</option>
<option value="El Dorado">El Dorado</option>
<option value="Fauquier">Fauquier</option>
<option value="Freeborn">Freeborn</option>
<option value="Fresno">Fresno</option>
<option value="Goodhue">Goodhue</option>
<option value="Grand">Grand</option>
<option value="Granite">Granite</option>
<option value="Gregg">Gregg</option>
<option value="Habersham">Habersham</option>
<option value="Hamblen">Hamblen</option>
<option value="Hampton City">Hampton City</option>
<option value="Hanover">Hanover</option>
<option value="Hendricks">Hendricks</option>
<option value="Henrico">Henrico</option>
<option value="Highland">Highland</option>
<option value="Hillsdale">Hillsdale</option>
<option value="Horry">Horry</option>
<option value="Houghton">Houghton</option>
<option value="Humboldt">Humboldt</option>
<option value="Iredell">Iredell</option>
<option value="Jo Daviess">Jo Daviess</option>
<option value="Kauai">Kauai</option>
<option value="Kern">Kern</option>
<option value="Kitsap">Kitsap</option>
<option value="La Plata">La Plata</option>
<option value="Laramie">Laramie</option>
<option value="Lehigh">Lehigh</option>
<option value="Lexington City">Lexington City</option>
<option value="Lincoln">Lincoln</option>
<option value="Lowndes">Lowndes</option>
<option value="Mackinac">Mackinac</option>
<option value="Macoupin">Macoupin</option>
<option value="McDonough">McDonough</option>
<option value="Meagher">Meagher</option>
<option value="Mecklenburg">Mecklenburg</option>
<option value="Meeker">Meeker</option>
<option value="Mobile">Mobile</option>
<option value="Morgan">Morgan</option>
<option value="Moultrie">Moultrie</option>
<option value="Muscatine">Muscatine</option>
<option value="Muscogee">Muscogee</option>
<option value="Natrona">Natrona</option>
<option value="Norfolk City">Norfolk City</option>
<option value="Northampton">Northampton</option>
<option value="Oconee">Oconee</option>
<option value="Okeechobee">Okeechobee</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Onslow">Onslow</option>
<option value="Ontario">Ontario</option>
<option value="Otsego">Otsego</option>
<option value="Pacific">Pacific</option>
<option value="Parker">Parker</option>
<option value="Pender">Pender</option>
<option value="Phelps">Phelps</option>
<option value="Pickens">Pickens</option>
<option value="Pike">Pike</option>
<option value="Poweshiek">Poweshiek</option>
<option value="Queens">Queens</option>
<option value="Rankin">Rankin</option>
<option value="Rio Grande">Rio Grande</option>
<option value="Saint Johns">Saint Johns</option>
<option value="Sarpy">Sarpy</option>
<option value="Schoolcraft">Schoolcraft</option>
<option value="Sharp">Sharp</option>
<option value="Somerset">Somerset</option>
<option value="Spalding">Spalding</option>
<option value="Stafford">Stafford</option>
<option value="Sumner">Sumner</option>
<option value="Tompkins">Tompkins</option>
<option value="Troup">Troup</option>
<option value="Vernon">Vernon</option>
<option value="Wagoner">Wagoner</option>
<option value="Warrick">Warrick</option>
<option value="Wasatch">Wasatch</option>
<option value="Watauga">Watauga</option>
<option value="Webster">Webster</option>
<option value="Westmoreland">Westmoreland</option>
<option value="Wilson">Wilson</option>
<option value="Winona">Winona</option>
<option value="Yancey">Yancey</option>
<option value="Yellow Medicine">Yellow Medicine</option>
<option value="Yolo">Yolo</option>
<option value="Zapata">Zapata</option>
<option value="Ada">Ada</option>
<option value="Adams">Adams</option>
<option value="Addison">Addison</option>
<option value="Aiken">Aiken</option>
<option value="Alachua">Alachua</option>
<option value="Alamance">Alamance</option>
<option value="Alameda">Alameda</option>
<option value="Alexandria City">Alexandria City</option>
<option value="Allegan">Allegan</option>
<option value="Allegheny">Allegheny</option>
<option value="Allen">Allen</option>
<option value="Alpena">Alpena</option>
<option value="Angelina">Angelina</option>
<option value="Anoka">Anoka</option>
<option value="Antrim">Antrim</option>
<option value="Arapahoe">Arapahoe</option>
<option value="Arlington">Arlington</option>
<option value="Ashe">Ashe</option>
<option value="Baldwin">Baldwin</option>
<option value="Baltimore">Baltimore</option>
<option value="Baltimore City">Baltimore City</option>
<option value="Barron">Barron</option>
<option value="Barry">Barry</option>
<option value="Baxter">Baxter</option>
<option value="Bayfield">Bayfield</option>
<option value="Beaufort">Beaufort</option>
<option value="Beaver">Beaver</option>
<option value="Benton">Benton</option>
<option value="Benzie">Benzie</option>
<option value="Bergen">Bergen</option>
<option value="Berkeley">Berkeley</option>
<option value="Bernalillo">Bernalillo</option>
<option value="Berrien">Berrien</option>
<option value="Bexar">Bexar</option>
<option value="Black Hawk">Black Hawk</option>
<option value="Blount">Blount</option>
<option value="Boone">Boone</option>
<option value="Boulder">Boulder</option>
<option value="Branch">Branch</option>
<option value="Brevard">Brevard</option>
<option value="Bristol">Bristol</option>
<option value="Broomfield">Broomfield</option>
<option value="Broward">Broward</option>
<option value="Brown">Brown</option>
<option value="Brunswick">Brunswick</option>
<option value="Bucks">Bucks</option>
<option value="Bureau">Bureau</option>
<option value="Burleigh">Burleigh</option>
<option value="Butler">Butler</option>
<option value="Calhoun">Calhoun</option>
<option value="Camden">Camden</option>
<option value="Cameron">Cameron</option>
<option value="Canadian">Canadian</option>
<option value="Cape May">Cape May</option>
<option value="Carroll">Carroll</option>
<option value="Cass">Cass</option>
<option value="Chaffee">Chaffee</option>
<option value="Champaign">Champaign</option>
<option value="Charles Mix">Charles Mix</option>
<option value="Charleston">Charleston</option>
<option value="Charlotte">Charlotte</option>
<option value="Chatham">Chatham</option>
<option value="Cheatham">Cheatham</option>
<option value="Cherokee">Cherokee</option>
<option value="Chesapeake City">Chesapeake City</option>
<option value="Chippewa">Chippewa</option>
<option value="Chisago">Chisago</option>
<option value="Chittenden">Chittenden</option>
<option value="Christian">Christian</option>
<option value="Citrus">Citrus</option>
<option value="Clackamas">Clackamas</option>
<option value="Clallam">Clallam</option>
<option value="Clark">Clark</option>
<option value="Clay">Clay</option>
<option value="Clermont">Clermont</option>
<option value="Clinton">Clinton</option>
<option value="Cobb">Cobb</option>
<option value="Coles">Coles</option>
<option value="Collier">Collier</option>
<option value="Collin">Collin</option>
<option value="Columbia">Columbia</option>
<option value="Contra Costa">Contra Costa</option>
<option value="COOK">COOK</option>
<option value="Cooper">Cooper</option>
<option value="Craven">Craven</option>
<option value="Crawford">Crawford</option>
<option value="Crow Wing">Crow Wing</option>
<option value="Cumberland">Cumberland</option>
<option value="Curry">Curry</option>
<option value="Cuyahoga">Cuyahoga</option>
<option value="Dakota">Dakota</option>
<option value="Dallas">Dallas</option>
<option value="Dane">Dane</option>
<option value="Dare">Dare</option>
<option value="Davidson">Davidson</option>
<option value="Davis">Davis</option>
<option value="Defiance">Defiance</option>
<option value="Dekalb">Dekalb</option>
<option value="Delaware">Delaware</option>
<option value="Denton">Denton</option>
<option value="Denver">Denver</option>
<option value="Des Moines">Des Moines</option>
<option value="Deschutes">Deschutes</option>
<option value="Dickson">Dickson</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Dodge">Dodge</option>
<option value="Door">Door</option>
<option value="Dorchester">Dorchester</option>
<option value="Dougherty">Dougherty</option>
<option value="Douglas">Douglas</option>
<option value="Du Page">Du Page</option>
<option value="Dubois">Dubois</option>
<option value="Dubuque">Dubuque</option>
<option value="DUPAGE">DUPAGE</option>
<option value="Durham">Durham</option>
<option value="Dutchess">Dutchess</option>
<option value="Duval">Duval</option>
<option value="Eaton">Eaton</option>
<option value="Eau Claire">Eau Claire</option>
<option value="Echols">Echols</option>
<option value="Ector">Ector</option>
<option value="Effingham">Effingham</option>
<option value="El Paso">El Paso</option>
<option value="Elbert">Elbert</option>
<option value="Elkhart">Elkhart</option>
<option value="Ellis">Ellis</option>
<option value="Emmet">Emmet</option>
<option value="Emmons">Emmons</option>
<option value="Erie">Erie</option>
<option value="Escambia">Escambia</option>
<option value="Essex">Essex</option>
<option value="Fairfax">Fairfax</option>
<option value="Fairfield">Fairfield</option>
<option value="Fayette">Fayette</option>
<option value="Fentress">Fentress</option>
<option value="Flagler">Flagler</option>
<option value="Floyd">Floyd</option>
<option value="Fond Du Lac">Fond Du Lac</option>
<option value="Ford">Ford</option>
<option value="Forsyth">Forsyth</option>
<option value="Fort Bend">Fort Bend</option>
<option value="Franklin">Franklin</option>
<option value="Frederick">Frederick</option>
<option value="Fremont">Fremont</option>
<option value="Fulton">Fulton</option>
<option value="Gage">Gage</option>
<option value="Gallatin">Gallatin</option>
<option value="Galveston">Galveston</option>
<option value="Garfield">Garfield</option>
<option value="Garland">Garland</option>
<option value="Genesee">Genesee</option>
<option value="Gibson">Gibson</option>
<option value="Gloucester">Gloucester</option>
<option value="Glynn">Glynn</option>
<option value="Grand Traverse">Grand Traverse</option>
<option value="Grant">Grant</option>
<option value="Green">Green</option>
<option value="Greene">Greene</option>
<option value="Greenville">Greenville</option>
<option value="Grundy">Grundy</option>
<option value="Guadalupe">Guadalupe</option>
<option value="Guilford">Guilford</option>
<option value="Gwinnett">Gwinnett</option>
<option value="Hall">Hall</option>
<option value="Hamilton">Hamilton</option>
<option value="Hampden">Hampden</option>
<option value="Hancock">Hancock</option>
<option value="Haralson">Haralson</option>
<option value="Hardin">Hardin</option>
<option value="Harford">Harford</option>
<option value="Harris">Harris</option>
<option value="Harrison">Harrison</option>
<option value="Hartford">Hartford</option>
<option value="Harvey">Harvey</option>
<option value="Haywood">Haywood</option>
<option value="Henderson">Henderson</option>
<option value="Hennepin">Hennepin</option>
<option value="Henry">Henry</option>
<option value="Hernando">Hernando</option>
<option value="Hidalgo">Hidalgo</option>
<option value="Highlands">Highlands</option>
<option value="Hillsborough">Hillsborough</option>
<option value="Hinds">Hinds</option>
<option value="Hopkins">Hopkins</option>
<option value="Houston">Houston</option>
<option value="Howard">Howard</option>
<option value="Howell">Howell</option>
<option value="Hudson">Hudson</option>
<option value="Hunt">Hunt</option>
<option value="Huntingdon">Huntingdon</option>
<option value="Indian River">Indian River</option>
<option value="Ingham">Ingham</option>
<option value="Ionia">Ionia</option>
<option value="Iron">Iron</option>
<option value="Iroquois">Iroquois</option>
<option value="Isabella">Isabella</option>
<option value="Isanti">Isanti</option>
<option value="Island">Island</option>
<option value="Jackson">Jackson</option>
<option value="Jasper">Jasper</option>
<option value="Jefferson">Jefferson</option>
<option value="Johnson">Johnson</option>
<option value="Johnston">Johnston</option>
<option value="Josephine">Josephine</option>
<option value="Kalamazoo">Kalamazoo</option>
<option value="Kandiyohi">Kandiyohi</option>
<option value="Kane">Kane</option>
<option value="Kankakee">Kankakee</option>
<option value="Kendall">Kendall</option>
<option value="Kenosha">Kenosha</option>
<option value="Kent">Kent</option>
<option value="Kerr">Kerr</option>
<option value="King">King</option>
<option value="Kings">Kings</option>
<option value="Kleberg">Kleberg</option>
<option value="Knox">Knox</option>
<option value="Kosciusko">Kosciusko</option>
<option value="La Crosse">La Crosse</option>
<option value="La Porte">La Porte</option>
<option value="La Salle">La Salle</option>
<option value="Lagrange">Lagrange</option>
<option value="LAKE">LAKE</option>
<option value="Lake of the Woods">Lake of the Woods</option>
<option value="Lancaster">Lancaster</option>
<option value="Lane">Lane</option>
<option value="Larimer">Larimer</option>
<option value="Lawrence">Lawrence</option>
<option value="Lee">Lee</option>
<option value="Leelanau">Leelanau</option>
<option value="Lenawee">Lenawee</option>
<option value="Leon">Leon</option>
<option value="Lewis and Clark">Lewis and Clark</option>
<option value="Lexington">Lexington</option>
<option value="Linn">Linn</option>
<option value="Livingston">Livingston</option>
<option value="Logan">Logan</option>
<option value="Lorain">Lorain</option>
<option value="Los Alamos">Los Alamos</option>
<option value="Los Angeles">Los Angeles</option>
<option value="Loudon">Loudon</option>
<option value="Loudoun">Loudoun</option>
<option value="Lucas">Lucas</option>
<option value="Lycoming">Lycoming</option>
<option value="Lyon">Lyon</option>
<option value="Macomb">Macomb</option>
<option value="Macon">Macon</option>
<option value="Madison">Madison</option>
<option value="Mahaska">Mahaska</option>
<option value="Manatee">Manatee</option>
<option value="Manistee">Manistee</option>
<option value="Manitowoc">Manitowoc</option>
<option value="Marathon">Marathon</option>
<option value="Maricopa">Maricopa</option>
<option value="Marin">Marin</option>
<option value="Marinette">Marinette</option>
<option value="Marion">Marion</option>
<option value="Marshall">Marshall</option>
<option value="Martin">Martin</option>
<option value="Mason">Mason</option>
<option value="Massac">Massac</option>
<option value="McCracken">McCracken</option>
<option value="McHenry">McHenry</option>
<option value="McKinley">McKinley</option>
<option value="McLean">McLean</option>
<option value="McLennan">McLennan</option>
<option value="Mecosta">Mecosta</option>
<option value="Medina">Medina</option>
<option value="Menard">Menard</option>
<option value="Mendocino">Mendocino</option>
<option value="Merced">Merced</option>
<option value="Mercer">Mercer</option>
<option value="Mesa">Mesa</option>
<option value="Miami">Miami</option>
<option value="Miami-Dade">Miami-Dade</option>
<option value="Middlesex">Middlesex</option>
<option value="Midland">Midland</option>
<option value="Miller">Miller</option>
<option value="Mills">Mills</option>
<option value="Milwaukee">Milwaukee</option>
<option value="Mineral">Mineral</option>
<option value="Minnehaha">Minnehaha</option>
<option value="Missaukee">Missaukee</option>
<option value="Mohave">Mohave</option>
<option value="Monmouth">Monmouth</option>
<option value="Monroe">Monroe</option>
<option value="Montcalm">Montcalm</option>
<option value="Monterey">Monterey</option>
<option value="Montgomery">Montgomery</option>
<option value="Montmorency">Montmorency</option>
<option value="Montrose">Montrose</option>
<option value="Moore">Moore</option>
<option value="Morris">Morris</option>
<option value="Multnomah">Multnomah</option>
<option value="Murray">Murray</option>
<option value="Muskegon">Muskegon</option>
<option value="Nassau">Nassau</option>
<option value="Navajo">Navajo</option>
<option value="Nelson">Nelson</option>
<option value="Nevada">Nevada</option>
<option value="New Castle">New Castle</option>
<option value="New Hanover">New Hanover</option>
<option value="New Haven">New Haven</option>
<option value="New London">New London</option>
<option value="New York">New York</option>
<option value="Newaygo">Newaygo</option>
<option value="Newport News City">Newport News City</option>
<option value="Newton">Newton</option>
<option value="Nobles">Nobles</option>
<option value="Oakland">Oakland</option>
<option value="Obrien">Obrien</option>
<option value="Ocean">Ocean</option>
<option value="Oceana">Oceana</option>
<option value="Ogle">Ogle</option>
<option value="Okaloosa">Okaloosa</option>
<option value="Oldham">Oldham</option>
<option value="Olmsted">Olmsted</option>
<option value="Oneida">Oneida</option>
<option value="Onondaga">Onondaga</option>
<option value="Orange">Orange</option>
<option value="Oregon">Oregon</option>
<option value="Orleans">Orleans</option>
<option value="Osceola">Osceola</option>
<option value="Oscoda">Oscoda</option>
<option value="Ottawa">Ottawa</option>
<option value="Ottowa">Ottowa</option>
<option value="Ouachita">Ouachita</option>
<option value="Ouray">Ouray</option>
<option value="Outagamie">Outagamie</option>
<option value="Ozaukee">Ozaukee</option>
<option value="Page">Page</option>
<option value="Palm Beach">Palm Beach</option>
<option value="Park">Park</option>
<option value="Parke">Parke</option>
<option value="Pasco">Pasco</option>
<option value="Passaic">Passaic</option>
<option value="Penobscot">Penobscot</option>
<option value="Peoria">Peoria</option>
<option value="Pepin">Pepin</option>
<option value="Philadelphia">Philadelphia</option>
<option value="Piatt">Piatt</option>
<option value="Pierce">Pierce</option>
<option value="Pima">Pima</option>
<option value="Pinal">Pinal</option>
<option value="Pinellas">Pinellas</option>
<option value="Pipestone">Pipestone</option>
<option value="Piscataquis">Piscataquis</option>
<option value="Pitkin">Pitkin</option>
<option value="Pitt">Pitt</option>
<option value="Placer">Placer</option>
<option value="Platte">Platte</option>
<option value="Plymouth">Plymouth</option>
<option value="Polk">Polk</option>
<option value="Poquoson City">Poquoson City</option>
<option value="Portage">Portage</option>
<option value="Porter">Porter</option>
<option value="Prince Georges">Prince Georges</option>
<option value="Pueblo">Pueblo</option>
<option value="Pulaski">Pulaski</option>
<option value="Putnam">Putnam</option>
<option value="Racine">Racine</option>
<option value="Ramsey">Ramsey</option>
<option value="Randolph">Randolph</option>
<option value="Rice">Rice</option>
<option value="Richland">Richland</option>
<option value="Riley">Riley</option>
<option value="Riverside">Riverside</option>
<option value="Rock">Rock</option>
<option value="Rock Island">Rock Island</option>
<option value="Rockingham">Rockingham</option>
<option value="Rusk">Rusk</option>
<option value="Rutherford">Rutherford</option>
<option value="Sacramento">Sacramento</option>
<option value="Saint Charles">Saint Charles</option>
<option value="Saint Clair">Saint Clair</option>
<option value="Saint Francois">Saint Francois</option>
<option value="Saint Joseph">Saint Joseph</option>
<option value="Saint Louis">Saint Louis</option>
<option value="Saint Louis City">Saint Louis City</option>
<option value="Saline">Saline</option>
<option value="Salt Lake">Salt Lake</option>
<option value="San Bernardino">San Bernardino</option>
<option value="San Diego">San Diego</option>
<option value="San Francisco">San Francisco</option>
<option value="San Joaquin">San Joaquin</option>
<option value="San Luis Obispo">San Luis Obispo</option>
<option value="San Mateo">San Mateo</option>
<option value="Sandoval">Sandoval</option>
<option value="Sangamon">Sangamon</option>
<option value="Santa Barbara">Santa Barbara</option>
<option value="Santa Clara">Santa Clara</option>
<option value="Santa Cruz">Santa Cruz</option>
<option value="Santa Fe">Santa Fe</option>
<option value="Santa Rosa">Santa Rosa</option>
<option value="Sarasota">Sarasota</option>
<option value="Sauk">Sauk</option>
<option value="Sawyer">Sawyer</option>
<option value="Schenectady">Schenectady</option>
<option value="Schuylkill">Schuylkill</option>
<option value="Scott">Scott</option>
<option value="Scotts Bluff">Scotts Bluff</option>
<option value="Sedgwick">Sedgwick</option>
<option value="Seminole">Seminole</option>
<option value="Sharkey">Sharkey</option>
<option value="Sheboygan">Sheboygan</option>
<option value="Shelby">Shelby</option>
<option value="Sherburne">Sherburne</option>
<option value="Sibley">Sibley</option>
<option value="Sioux">Sioux</option>
<option value="Skagit">Skagit</option>
<option value="Snohomish">Snohomish</option>
<option value="Sonoma">Sonoma</option>
<option value="Spotsylvania">Spotsylvania</option>
<option value="St Joseph">St Joseph</option>
<option value="Stanislaus">Stanislaus</option>
<option value="Stark">Stark</option>
<option value="Starke">Starke</option>
<option value="Stearns">Stearns</option>
<option value="Stephenson">Stephenson</option>
<option value="Steuben">Steuben</option>
<option value="Stone">Stone</option>
<option value="Story">Story</option>
<option value="Strafford">Strafford</option>
<option value="Suffolk">Suffolk</option>
<option value="Sullivan">Sullivan</option>
<option value="Summit">Summit</option>
<option value="Sumter">Sumter</option>
<option value="Sussex">Sussex</option>
<option value="Taney">Taney</option>
<option value="Tarrant">Tarrant</option>
<option value="Tazewell">Tazewell</option>
<option value="Teton">Teton</option>
<option value="Tippecanoe">Tippecanoe</option>
<option value="Travis">Travis</option>
<option value="Trumbull">Trumbull</option>
<option value="Tulare">Tulare</option>
<option value="Tulsa">Tulsa</option>
<option value="Tuscaloosa">Tuscaloosa</option>
<option value="Unicoi">Unicoi</option>
<option value="Union">Union</option>
<option value="Van Buren">Van Buren</option>
<option value="Vance">Vance</option>
<option value="Vanderburgh">Vanderburgh</option>
<option value="Ventura">Ventura</option>
<option value="Vermilion">Vermilion</option>
<option value="Vigo">Vigo</option>
<option value="Vilas">Vilas</option>
<option value="Virginia Beach City">Virginia Beach City</option>
<option value="Volusia">Volusia</option>
<option value="Wabash">Wabash</option>
<option value="Wake">Wake</option>
<option value="Walker">Walker</option>
<option value="Walton">Walton</option>
<option value="Walworth">Walworth</option>
<option value="Ward">Ward</option>
<option value="Warren">Warren</option>
<option value="Washburn">Washburn</option>
<option value="Washington">Washington</option>
<option value="Washoe">Washoe</option>
<option value="Washtenaw">Washtenaw</option>
<option value="Watonwan">Watonwan</option>
<option value="Waukesha">Waukesha</option>
<option value="Waupaca">Waupaca</option>
<option value="Wayne">Wayne</option>
<option value="Weld">Weld</option>
<option value="Westchester">Westchester</option>
<option value="Wexford">Wexford</option>
<option value="Whatcom">Whatcom</option>
<option value="White">White</option>
<option value="Whiteside">Whiteside</option>
<option value="Wichita">Wichita</option>
<option value="WILL">WILL</option>
<option value="Williamson">Williamson</option>
<option value="Windsor">Windsor</option>
<option value="Winnebago">Winnebago</option>
<option value="Wood">Wood</option>
<option value="Woodbury">Woodbury</option>
<option value="Woodford">Woodford</option>
<option value="Worcester">Worcester</option>
<option value="Yamhill">Yamhill</option>
<option value="Yavapai">Yavapai</option>
<option value="York">York</option>
</select>
</div>
</div>
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<label for="bboxdonation_billing_billingAddress_txtUKPostCode" id="bboxdonation_billing_billingAddress_lblUKPostCode" class="BBFormFieldLabel BBFormFieldLabelEdit">Postcode:</label>
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</form>Text Content
Skip to Main Content * Events * News * Resources * Careers * Giving Search (708) 342-8100 Close * Services * ServicesBack * Overview * Care Consulting * In-Home Care * Hospice & Palliative Care * Respite * Transition to Home * Our Story * Our StoryBack * Overview * Leadership * Memberships * Awards * Meet Our CEO * Living Options * Living OptionsBack * Overview * Retirement Living * Assisted Living * Memory Care * Skilled Nursing * Townhome Living * Affordable Housing * Communities * CommunitiesBack * Overview * Park Place of Elmhurst * Park Place St. John * Royal Atrium Inn * Royal Park Place * Victorian Village * Arbor Place * Thomas Place * Contact * ContactBack * Overview * Emergency Contact * Services * ServicesBack * Overview * Care Consulting * In-Home Care * Hospice & Palliative Care * Respite * Transition to Home * Our Story * Our StoryBack * Overview * Leadership * Memberships * Awards * Meet Our CEO * Living Options * Living OptionsBack * Overview * Retirement Living * Assisted Living * Memory Care * Skilled Nursing * Townhome Living * Affordable Housing * Communities * CommunitiesBack * Overview * Park Place of Elmhurst * Park Place St. John * Royal Atrium Inn * Royal Park Place * Victorian Village * Arbor Place * Thomas Place * Contact * ContactBack * Overview * Emergency Contact * Events * News * Resources * Careers * Giving YOUR GIFT: IMPACTING SENIORS FOR GENERATIONS As a 501(c)3 not-for-profit organization, we rely on the generosity of people like you to help us continue the kind of quality care Providence Life Services is known for. Whether it’s a financial gift or a gift of your time and talents, your gifts are an important part of our ministry. Give to Providence Now MAKE A LIFE-CHANGING DONATION Your tax-deductible financial gift will make a difference in the lives of our residents, service-recipients, and those who serve them. Make a Secure Donation Previous 1. Next MAKE A GIFT TO OUR MINISTRY Your tax-deductible gift can make a difference in the lives of our residents. Whether you are helping our benevolent fund, aiding our chaplaincy program, or ensuring our memory care program is innovative, your dollars have a far-reaching impact. You can make a one-time gift, set up recurring donations, or even take part in planned giving through our partnership with the Barnabas Foundation. Make A Gift! VOLUNTEER OPPORTUNITIES ABOUND If you have a heart for older adults in your community, we have a place for you to serve. Your unique gifts are welcome, and we’d love to talk to you about service opportunities. Volunteer at Providence SPONSORSHIP: A GIFT THAT GIVES BACK The generosity of our family of sponsors allows us to provide events that help us get the word out about our ministry, support our programs, and show gratitude to our Providence family. Become a Providence Sponsor MEET THE ADVANCEMENT LEADERSHIP A friendly voice with helpful answers to your giving questions is just a click away! Meet the Team MAKE A GIFT. CHANGE A LIFE. Simply fill out the the form below to support Providence Life Services. 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Harris Harrison Hartford Harvey Haywood Henderson Hennepin Henry Hernando Hidalgo Highlands Hillsborough Hinds Hopkins Houston Howard Howell Hudson Hunt Huntingdon Indian River Ingham Ionia Iron Iroquois Isabella Isanti Island Jackson Jasper Jefferson Johnson Johnston Josephine Kalamazoo Kandiyohi Kane Kankakee Kendall Kenosha Kent Kerr King Kings Kleberg Knox Kosciusko La Crosse La Porte La Salle Lagrange LAKE Lake of the Woods Lancaster Lane Larimer Lawrence Lee Leelanau Lenawee Leon Lewis and Clark Lexington Linn Livingston Logan Lorain Los Alamos Los Angeles Loudon Loudoun Lucas Lycoming Lyon Macomb Macon Madison Mahaska Manatee Manistee Manitowoc Marathon Maricopa Marin Marinette Marion Marshall Martin Mason Massac McCracken McHenry McKinley McLean McLennan Mecosta Medina Menard Mendocino Merced Mercer Mesa Miami Miami-Dade Middlesex Midland Miller Mills Milwaukee Mineral Minnehaha Missaukee Mohave Monmouth Monroe Montcalm Monterey Montgomery Montmorency Montrose Moore Morris 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CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MB MH MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NC ND MP NT NS NU OH OK ON OR PW PA PE PR QC RI SK SC SD TN TX UT VT VI VA WA WV WI WY YT Postcode: Suburb: suburb Adelaide City & post code: City: city Austrailia Post code: I would like this gift to remain anonymous FormField FIND US 18601 North Creek Drive Tinley Park, IL 60477 info@provlife.com (708) 342-8100 Providence Life Services is a 501(c)3 not-for-profit organization. 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