support.kpfa.org
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Submission: On June 04 via automatic, source certstream-suspicious — Scanned from DE
Submission: On June 04 via automatic, source certstream-suspicious — Scanned from DE
Form analysis
1 forms found in the DOM#
<form action="#" class="needs-validation">
<h3 class="mb-3 text-uppercase">Billing & Shipping Address</h3>
<div class="form-group">
<div class="form-check col-sm-12"><label class="form-check-label"><input name="showShippingAddress" label="Shipping Address is different from billing address" class="form-check-input" type="checkbox" value="false">Shipping Address is different
from billing address<div class="invalid-feedback"></div></label></div>
</div>
<div class="form-row">
<div class="form-group col-md-6"><label class="">First Name</label><input name="firstName" label="First Name" placeholder="Jane" class="form-control" type="text" value="">
<div class="invalid-feedback"></div>
</div>
<div class="form-group col-md-6"><label class="">Last Name</label><input name="lastName" label="Last Name" placeholder="Smith" class="form-control" type="text" value="">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12"><label class="">Address</label><input name="address1" label="Address" placeholder="123 Main St." class="form-control" type="text" value="">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12"><label class="">Address (continued)</label><input name="address2" label="Address (continued)" placeholder="Apartment 161" class="form-control" type="text" value="">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6"><label class="">City</label><input name="city" label="City" placeholder="Berkeley" class="form-control" type="text" value="">
<div class="invalid-feedback"></div>
</div>
<div class="form-group col-md-6"><label>State</label><select class="form-control" name="state"
options="Alabama,Alaska,American Samoa,Arizona,Arkansas,California,Colorado,Connecticut,Delaware,District Of Columbia,Federated States Of Micronesia,Florida,Georgia,Guam,Hawaii,Idaho,Illinois,Indiana,Iowa,Kansas,Kentucky,Louisiana,Maine,Marshall Islands,Maryland,Massachusetts,Michigan,Minnesota,Mississippi,Missouri,Montana,Nebraska,Nevada,New Hampshire,New Jersey,New Mexico,New York,North Carolina,North Dakota,Northern Mariana Islands,Ohio,Oklahoma,Oregon,Palau,Pennsylvania,Puerto Rico,Rhode Island,South Carolina,South Dakota,Tennessee,Texas,Utah,Vermont,Virgin Islands,Virginia,Washington,West Virginia,Wisconsin,Wyoming"
label="State">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FM">Federated States Of Micronesia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MH">Marshall Islands</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PW">Palau</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6"><label class="">Zip</label><input label="Zip" placeholder="94710" autocomplete="postal-code" class="form-control" type="text" value="">
<div class="invalid-feedback"></div>
</div>
<div class="form-group col-md-6"><label>Country</label><select class="form-control" name="country"
options="Afghanistan,Åland Islands,Albania,Algeria,American Samoa,Andorra,Angola,Anguilla,Antarctica,Antigua and Barbuda,Argentina,Armenia,Aruba,Australia,Austria,Azerbaijan,Bahamas,Bahrain,Bangladesh,Barbados,Belarus,Belgium,Belize,Benin,Bermuda,Bhutan,Bolivia, Plurinational State of,Bonaire, Sint Eustatius and Saba,Bosnia and Herzegovina,Botswana,Bouvet Island,Brazil,British Indian Ocean Territory,Brunei Darussalam,Bulgaria,Burkina Faso,Burundi,Cambodia,Cameroon,Canada,Cape Verde,Cayman Islands,Central African Republic,Chad,Chile,China,Christmas Island,Cocos (Keeling) Islands,Colombia,Comoros,Congo,Congo, the Democratic Republic of the,Cook Islands,Costa Rica,Côte d'Ivoire,Croatia,Cuba,Curaçao,Cyprus,Czech Republic,Denmark,Djibouti,Dominica,Dominican Republic,Ecuador,Egypt,El Salvador,Equatorial Guinea,Eritrea,Estonia,Ethiopia,Falkland Islands (Malvinas),Faroe Islands,Fiji,Finland,France,French Guiana,French Polynesia,French Southern Territories,Gabon,Gambia,Georgia,Germany,Ghana,Gibraltar,Greece,Greenland,Grenada,Guadeloupe,Guam,Guatemala,Guernsey,Guinea,Guinea-Bissau,Guyana,Haiti,Heard Island and McDonald Mcdonald Islands,Holy See (Vatican City State),Honduras,Hong Kong,Hungary,Iceland,India,Indonesia,Iran, Islamic Republic of,Iraq,Ireland,Isle of Man,Israel,Italy,Jamaica,Japan,Jersey,Jordan,Kazakhstan,Kenya,Kiribati,Kosovo,Korea, Democratic People's Republic of,Korea, Republic of,Kuwait,Kyrgyzstan,Lao People's Democratic Republic,Latvia,Lebanon,Lesotho,Liberia,Libya,Liechtenstein,Lithuania,Luxembourg,Macao,North Macedonia,Madagascar,Malawi,Malaysia,Maldives,Mali,Malta,Marshall Islands,Martinique,Mauritania,Mauritius,Mayotte,Mexico,Micronesia, Federated States of,Moldova, Republic of,Monaco,Mongolia,Montenegro,Montserrat,Morocco,Mozambique,Myanmar,Namibia,Nauru,Nepal,Netherlands,Netherlands Antilles,New Caledonia,New Zealand,Nicaragua,Niger,Nigeria,Niue,Norfolk Island,Northern Mariana Islands,Norway,Oman,Pakistan,Palau,Palestine, State of,Panama,Papua New Guinea,Paraguay,Peru,Philippines,Pitcairn,Poland,Portugal,Puerto Rico,Qatar,Réunion,Romania,Russian Federation,Rwanda,Saint Barthélemy,Saint Helena, Ascension and Tristan da Cunha,Saint Kitts and Nevis,Saint Lucia,Saint Martin (French part),Saint Pierre and Miquelon,Saint Vincent and the Grenadines,Samoa,San Marino,Sao Tome and Principe,Saudi Arabia,Senegal,Serbia,Seychelles,Sierra Leone,Singapore,Sint Maarten (Dutch part),Slovakia,Slovenia,Solomon Islands,Somalia,South Africa,South Georgia and the South Sandwich Islands,South Sudan,Spain,Sri Lanka,Sudan,Suriname,Svalbard and Jan Mayen,Swaziland,Sweden,Switzerland,Syrian Arab Republic,Taiwan, Province of China,Tajikistan,Tanzania, United Republic of,Thailand,Timor-Leste,Togo,Tokelau,Tonga,Trinidad and Tobago,Tunisia,Turkey,Turkmenistan,Turks and Caicos Islands,Tuvalu,Uganda,Ukraine,United Arab Emirates,United Kingdom,United States,United States Minor Outlying Islands,Uruguay,Uzbekistan,Vanuatu,Venezuela, Bolivarian Republic of,Viet Nam,Virgin Islands, British,Virgin Islands, U.S.,Wallis and Futuna,Western Sahara,Yemen,Zambia,Zimbabwe"
label="Country">
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia, Plurinational State of</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, the Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Mcdonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="XK">Kosovo</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">North Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine, State of</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6"><label for="phone" class="">Phone</label><input id="phone" label="Phone" placeholder="(510) 123-4567" autocomplete="on" class="form-control" type="text" value="">
<div class="invalid-feedback"></div>
</div>
<div class="form-group col-md-6"><label class="">Email</label><input name="email" type="email" label="Email" placeholder="name@domain.com" class="form-control" value="">
<div class="invalid-feedback"></div>
</div>
</div>
<h3 class="mb-3 mt-4 text-uppercase">Comments</h3>
<div class="form-group"><label>Enter any comments you may have (to contact someone about a KPFA Membership or pledge gift visit our staff directory): </label><textarea name="comment"
label="Enter any comments you may have (to contact someone about a KPFA Membership or pledge gift visit our staff directory): " rows="3"></textarea>
<div class="invalid-feedback"></div>
</div>
<div class="form-group">
<div class="form-check col-sm-12"><label class="form-check-label"><input name="readOnair" label="Check this box if you would like your first name mentioned on air, KPFA social media pages, or our newsletter." class="form-check-input"
type="checkbox" value="false">Check this box if you would like your first name mentioned on air, KPFA social media pages, or our newsletter.<div class="invalid-feedback"></div></label></div>
</div>
<div class="form-group">
<div class="form-check col-sm-12"><label class="form-check-label"><input name="paperless" label="To help KPFA save resources, check this box to receive the end-of-year tax letter via email only." class="form-check-input" type="checkbox"
value="false">To help KPFA save resources, check this box to receive the end-of-year tax letter via email only.<div class="invalid-feedback"></div></label></div>
</div><label class="d-none"></label><input name="acceptTos" placeholder="" class="d-none" type="text" value="">
<div class="invalid-feedback"></div><button type="submit" class="btn btn-primary btn-lg btn-block mb-5 mt-5">Go to next step →</button>
</form>
Text Content
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