give.givetopvh.org
Open in
urlscan Pro
2606:4700::6812:7c49
Public Scan
Submitted URL: https://www.supportpvh.org/
Effective URL: https://give.givetopvh.org/give/626808/
Submission: On December 17 via api from US — Scanned from DE
Effective URL: https://give.givetopvh.org/give/626808/
Submission: On December 17 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: FORM —
<form name="FORM" novalidate="novalidate" data-ng-submit="submit()"
class="donation-block_form ng-invalid ng-invalid-required ng-invalid-sc-pattern ng-valid-cp-expiration-date ng-valid-email-address ng-valid-maxlength ng-valid-phone-number ng-valid-parse ng-valid-min ng-valid-max ng-dirty"
data-sc-broadcast-form-errors="">
<!-- Honeypot -->
<input type="hidden" data-ng-model="MODEL.z" autocomplete="off" class="ng-pristine ng-untouched ng-valid ng-empty ng-not-modified">
<!-- Components -->
<!-- ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
<section class="block-component ng-scope" data-ng-repeat="component in list.components | filter:{section:'main'} | orderBy:'order'">
<!-- ngInclude: component.templateUrl -->
<div data-ng-include="component.templateUrl" class="ng-scope">
<section class="donation-welcome ng-scope" data-ng-controller="frsDonationWelcomeCtrl">
<div data-sc-filler-text="{
fontBase: 16,
fontRatio: 14
}" data-title-container="'.donation-welcome_container'" data-parent-container="'.donation-welcome_container'" class="ng-isolate-scope">
<div class="donation-welcome_container">
<div class="sr-only">
<!-- ngIf: META.errorList.length -->
<!-- ngRepeat: error in META.errorList -->
</div>
<!-- ngIf: !editable && !isPreview() -->
<h1 class="donation-welcome_title ng-binding ng-scope" data-ng-if="!editable && !isPreview()" data-ng-bind-html="trustedBlockHeadlineHtml">
<p style="font-size: 40px;"><strong><span style="font-size: 30px; color: rgb(0, 51, 142);">Until midnight December 31, your gift will be MATCHED</span></strong></p>
</h1><!-- end ngIf: !editable && !isPreview() -->
<!-- ngIf: !editable && isPreview() -->
<!-- ngIf: editable && !getLock('headline') -->
<!-- ngIf: editable && getLock('headline') -->
<!-- Appeal -->
<!-- ngIf: !editable -->
<div class="donation-welcome_description ng-scope" data-ng-if="!editable" sc-allow-html="block.description | scImgAssetRef | userLinks" sc-responsive-video="">
<p>Thanks to one generous donor, your donation will be MATCHED, DOLLAR FOR DOLLAR — up to $25,000. Your gift will go twice as far to advance patient care, invest in leading-edge technology, and train the next generation of health care
professionals.</p>
<p><em>Please note: All funds from our matching donor are designated to the area of greatest need.</em></p>
</div><!-- end ngIf: !editable -->
<!-- ngIf: editable && !getLock('description') -->
<!-- ngIf: editable && getLock('description') -->
</div>
</div>
</section>
</div>
</section><!-- end ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
<section class="block-component ng-scope" data-ng-repeat="component in list.components | filter:{section:'main'} | orderBy:'order'">
<!-- ngInclude: component.templateUrl -->
<div data-ng-include="component.templateUrl" class="ng-scope">
<section class="donation-amount ng-scope" data-ng-controller="frsDonationAmountCtrl">
<!-- ngIf: preventRecurringFrequency -->
<!-- ngIf: show.levels() && !displayRecurringExperiment() && preventRecurringFrequency -->
<!-- ngIf: !displayRecurringExperiment() && preventRecurringFrequency -->
<!-- ngIf: showLegacyDonationGrid -->
<!-- ngIf: !showLegacyDonationGrid --><donation-grid ng-if="!showLegacyDonationGrid" donation-context="CONTEXT" frequency="MODEL.frequency" setting-page-frequency="MODEL.frequency" frequency-levels="DonationBlock.current['recurring-level']"
levels="state.levels" recurring-donation-levels="state.recurringDonationLevels" recur_until="MODEL.recur_until" amount="MODEL.items[0].raw_final_price" previous-frequency-price="MODEL.items[0].previous_frequency_price"
new-amount="MODEL.items[0].raw_final_price" preview="globalState.isPreview" currency="MODEL.payment.raw_currency_code" global-state="globalState" iaa-state="IAAState" class="ng-scope ng-isolate-scope">
<div class="donation-grid">
<!-- FREQUENCY TOGGLE-->
<!-- ngIf: !$ctrl.onlyReccurringFrequency($ctrl.frequencyLevels) && $ctrl.recurringLevels($ctrl.frequencyLevels).length > 0 -->
<div data-ng-init="$ctrl.showFreqDropdown()" data-ng-if="!$ctrl.onlyReccurringFrequency($ctrl.frequencyLevels) && $ctrl.recurringLevels($ctrl.frequencyLevels).length > 0" class="donation-grid__switch ng-scope" role="radiogroup"
data-ng-style="$ctrl.ctaStyle" aria-label="Select a donation frequency" style="background-color: rgba(0, 51, 142, 0.12);">
<div data-ng-click="$ctrl.selectFrequency('one-time'); $ctrl.showFreqDropdown('one-time'); $ctrl.isRecurringFrequency($event)" data-ng-keypress="$ctrl.selectFrequency('one-time',$event); $ctrl.isRecurringFrequency($event)"
data-ng-mouseover="$ctrl.toggleHover('one-time',true)" data-ng-mouseout="$ctrl.toggleHover('one-time',false)" data-ng-style="$ctrl.getStylesFrequencyOneTimeBtn('one-time')" class="donation-grid__btn once hover-state_one-time selected"
_spec="one-time" tabindex="0" data-ng-class="{'selected': $ctrl.frequency === 'one-time'}"
style="transition: 0.2s ease-in-out; color: rgb(255, 255, 255); background-color: rgb(0, 51, 142); border-radius: 24px; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px 1px inset, rgba(0, 0, 0, 0.2) 1px 2px 12px inset, rgba(0, 0, 0, 0.2) 1px 2px 2px inset;">
<div class="donation-grid__btn__frequency-label-container">
<i data-ng-show="$ctrl.isOneTime()" class="ci ci-checkmark eg-donation-frequency-switch__icon eg-pr1"></i>
<label for="donation-grid__radio-input" class="donation-grid__btn__frequency-label" tabindex="-1" data-id="cp-donation-form-one-time">
<input type="radio" id="donation-grid__radio-input" role="radio" tabindex="-1" name="donation-frequency" class="donation-grid__btn__frequency-input" aria-checked="true" data-id="onetime-toggle">One-time </label>
</div>
</div>
<div data-ng-click="$ctrl.selectFrequency($ctrl.frequency); $ctrl.showFreqDropdown($ctrl.recurringBtnText()); $ctrl.isRecurringFrequency($event)"
data-ng-keypress="$ctrl.selectFrequency($ctrl.recurringBtnText(),$event); $ctrl.isRecurringFrequency($event)" data-ng-mouseover="$ctrl.toggleHover('recurring',true)" data-ng-mouseout="$ctrl.toggleHover('recurring',false)"
data-ng-style="$ctrl.getStylesFrequencyRecurringBtn($ctrl.frequency)" class="donation-grid__btn monthly hover-state_recurring" _spec="recurring" tabindex="0" data-ng-class="{'selected': $ctrl.recurringBtnSelected($ctrl.frequency)}"
style="transition: 0.2s ease-in-out; color: rgba(0, 0, 0, 0.9); border-radius: 24px; box-shadow: inherit;">
<div class="donation-grid__btn__frequency-label-container">
<i data-ng-show="$ctrl.recurringBtnSelected($ctrl.frequency)" class="ci ci-checkmark eg-donation-frequency-switch__icon eg-pr1 ng-hide"></i>
<label for="donationGrid-donation-amount-monthly__radio-input" class="donation-grid__btn__frequency-label ng-binding" style="text-transform: capitalize" tabindex="-1" data-id="cp-donation-form-recurring">
<input type="radio" role="radio" id="donationGrid-donation-amount-monthly__radio-input" name="donation-frequency" tabindex="-1" class="donation-grid__btn__frequency-input" aria-checked="false" data-id="recurring-toggle"> monthly
</label>
</div>
</div>
</div><!-- end ngIf: !$ctrl.onlyReccurringFrequency($ctrl.frequencyLevels) && $ctrl.recurringLevels($ctrl.frequencyLevels).length > 0 -->
<div class="donation-grid__fields-container">
<!-- ngIf: $ctrl.isFreqDropdown || ($ctrl.onlyReccurringFrequency($ctrl.frequencyLevels) && $ctrl.recurringLevels($ctrl.frequencyLevels).length > 1) -->
<!-- END DATE -->
<!-- ngIf: $ctrl.showRecurringEndDate && $ctrl.frequency !== 'one-time' -->
</div>
<!-- ngIf: !$ctrl.showRecurringDonationArray && (!!$ctrl.frequency && ($ctrl.noOfDonationAmount($ctrl.levels) !== 1 || $ctrl.showCustomAmtField($ctrl.levels))) -->
<p data-ng-if="!$ctrl.showRecurringDonationArray && (!!$ctrl.frequency && ($ctrl.noOfDonationAmount($ctrl.levels) !== 1 || $ctrl.showCustomAmtField($ctrl.levels)))" id="amount-options-label" class="ng-scope"> Choose a
<b class="ng-binding">one-time</b> amount </p><!-- end ngIf: !$ctrl.showRecurringDonationArray && (!!$ctrl.frequency && ($ctrl.noOfDonationAmount($ctrl.levels) !== 1 || $ctrl.showCustomAmtField($ctrl.levels))) -->
<!-- ngIf: $ctrl.showRecurringDonationArray && (!!$ctrl.frequency && ($ctrl.noOfDonationAmount($ctrl.recurringDonationLevels) !== 1 || $ctrl.showCustomAmtField($ctrl.recurringDonationLevels))) -->
<!-- IF MULTIPLE AMOUNT DISPLAYED -->
<!-- ngIf: !$ctrl.showRecurringDonationArray && ($ctrl.noOfDonationAmount($ctrl.levels) > 1 || $ctrl.showCustomAmtField($ctrl.levels)) -->
<ul data-ng-if="!$ctrl.showRecurringDonationArray && ($ctrl.noOfDonationAmount($ctrl.levels) > 1 || $ctrl.showCustomAmtField($ctrl.levels))" class="donation-grid__levels ng-scope" aria-labelledby="amount-options-label"
role="radiogroup" data-ng-class="{'multiple-amount-hidden' : $ctrl.noOfDonationAmount($ctrl.levels) === 1 && !$ctrl.showCustomAmtField($ctrl.levels)}">
<!-- ngRepeat: level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true}) --><!-- ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 -->
<li data-ng-if="level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1" data-ng-repeat="level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true})"
data-ng-click="$ctrl.selectAmount(level.displayAmount)" data-ng-keydown="$ctrl.selectAmount(level.displayAmount, $event)" data-ng-mouseover="$ctrl.toggleHover($index,true)" data-ng-mouseout="$ctrl.toggleHover($index,false)"
class="donation-grid__level-item hover-state_0" role="radio" tabindex="0" aria-checked="false" data-ng-class="{'selected': $ctrl.amount === level.displayAmount && !$ctrl.showCustomAmtSelected}"
data-ng-style="$ctrl.donationLevelStyle(level.displayAmount, $index)" style="color: rgba(0, 0, 0, 0.87); background-color: rgba(0, 51, 142, 0.12); border: none; max-width: 50%; text-shadow: none; box-shadow: inherit;">
<!-- ngIf: !level.loading --><label data-ng-if="!level.loading" for="D-A50" class="donation-grid__level-item__amount-label ng-binding ng-scope">
<input id="{{'D-A'+level.amount}}" type="radio" role="radio" tabindex="-1" aria-hidden="true" name="donationGrid-donation-amount" class="donation-grid__level-item__amount-input"
ng-attr-data-id="cp-donation-form-onetime-preset-{{$index + 1}}" data-amount="50" data-id="cp-donation-form-onetime-preset-1">€48 </label><!-- end ngIf: !level.loading -->
<!-- ngIf: level.loading -->
</li>
<!-- end ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 --><!-- end ngRepeat: level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true}) --><!-- ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 -->
<li data-ng-if="level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1" data-ng-repeat="level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true})"
data-ng-click="$ctrl.selectAmount(level.displayAmount)" data-ng-keydown="$ctrl.selectAmount(level.displayAmount, $event)" data-ng-mouseover="$ctrl.toggleHover($index,true)" data-ng-mouseout="$ctrl.toggleHover($index,false)"
class="donation-grid__level-item hover-state_1 selected" role="radio" tabindex="0" aria-checked="true" data-ng-class="{'selected': $ctrl.amount === level.displayAmount && !$ctrl.showCustomAmtSelected}"
data-ng-style="$ctrl.donationLevelStyle(level.displayAmount, $index)"
style="color: rgb(255, 255, 255); background-color: rgb(0, 51, 142); border: none; max-width: 50%; text-shadow: rgba(0, 0, 0, 0.12) 0px 2px 2px; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px 1px inset, rgba(0, 0, 0, 0.2) 1px 2px 12px inset, rgba(0, 0, 0, 0.2) 1px 2px 2px inset;">
<!-- ngIf: !level.loading --><label data-ng-if="!level.loading" for="D-A150" class="donation-grid__level-item__amount-label ng-binding ng-scope">
<input id="{{'D-A'+level.amount}}" type="radio" role="radio" tabindex="-1" aria-hidden="true" name="donationGrid-donation-amount" class="donation-grid__level-item__amount-input"
ng-attr-data-id="cp-donation-form-onetime-preset-{{$index + 1}}" data-amount="150" data-id="cp-donation-form-onetime-preset-2">€150 </label><!-- end ngIf: !level.loading -->
<!-- ngIf: level.loading -->
</li>
<!-- end ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 --><!-- end ngRepeat: level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true}) --><!-- ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 -->
<li data-ng-if="level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1" data-ng-repeat="level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true})"
data-ng-click="$ctrl.selectAmount(level.displayAmount)" data-ng-keydown="$ctrl.selectAmount(level.displayAmount, $event)" data-ng-mouseover="$ctrl.toggleHover($index,true)" data-ng-mouseout="$ctrl.toggleHover($index,false)"
class="donation-grid__level-item hover-state_2" role="radio" tabindex="0" aria-checked="false" data-ng-class="{'selected': $ctrl.amount === level.displayAmount && !$ctrl.showCustomAmtSelected}"
data-ng-style="$ctrl.donationLevelStyle(level.displayAmount, $index)" style="color: rgba(0, 0, 0, 0.87); background-color: rgba(0, 51, 142, 0.12); border: none; max-width: 50%; text-shadow: none; box-shadow: inherit;">
<!-- ngIf: !level.loading --><label data-ng-if="!level.loading" for="D-A500" class="donation-grid__level-item__amount-label ng-binding ng-scope">
<input id="{{'D-A'+level.amount}}" type="radio" role="radio" tabindex="-1" aria-hidden="true" name="donationGrid-donation-amount" class="donation-grid__level-item__amount-input"
ng-attr-data-id="cp-donation-form-onetime-preset-{{$index + 1}}" data-amount="500" data-id="cp-donation-form-onetime-preset-3">€480 </label><!-- end ngIf: !level.loading -->
<!-- ngIf: level.loading -->
</li>
<!-- end ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 --><!-- end ngRepeat: level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true}) --><!-- ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 -->
<li data-ng-if="level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1" data-ng-repeat="level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true})"
data-ng-click="$ctrl.selectAmount(level.displayAmount)" data-ng-keydown="$ctrl.selectAmount(level.displayAmount, $event)" data-ng-mouseover="$ctrl.toggleHover($index,true)" data-ng-mouseout="$ctrl.toggleHover($index,false)"
class="donation-grid__level-item hover-state_3" role="radio" tabindex="0" aria-checked="false" data-ng-class="{'selected': $ctrl.amount === level.displayAmount && !$ctrl.showCustomAmtSelected}"
data-ng-style="$ctrl.donationLevelStyle(level.displayAmount, $index)" style="color: rgba(0, 0, 0, 0.87); background-color: rgba(0, 51, 142, 0.12); border: none; max-width: 50%; text-shadow: none; box-shadow: inherit;">
<!-- ngIf: !level.loading --><label data-ng-if="!level.loading" for="D-A1000" class="donation-grid__level-item__amount-label ng-binding ng-scope">
<input id="{{'D-A'+level.amount}}" type="radio" role="radio" tabindex="-1" aria-hidden="true" name="donationGrid-donation-amount" class="donation-grid__level-item__amount-input"
ng-attr-data-id="cp-donation-form-onetime-preset-{{$index + 1}}" data-amount="1000" data-id="cp-donation-form-onetime-preset-4">€1,000 </label><!-- end ngIf: !level.loading -->
<!-- ngIf: level.loading -->
</li>
<!-- end ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 --><!-- end ngRepeat: level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true}) --><!-- ngIf: level.amount !== 'Custom' && $ctrl.noOfDonationAmount($ctrl.levels) !== 1 --><!-- end ngRepeat: level in $ctrl.levels | filter: ($ctrl.noOfDonationAmount($ctrl.levels) > 1 && { display_on_page: true}) -->
<!-- ngRepeat: level in $ctrl.levels | filter: { display_on_page: true} --><!-- ngIf: level.amount === 'Custom' && $ctrl.showCustomAmtField($ctrl.levels) && $ctrl.frequency === 'one-time' --><!-- end ngRepeat: level in $ctrl.levels | filter: { display_on_page: true} --><!-- ngIf: level.amount === 'Custom' && $ctrl.showCustomAmtField($ctrl.levels) && $ctrl.frequency === 'one-time' --><!-- end ngRepeat: level in $ctrl.levels | filter: { display_on_page: true} --><!-- ngIf: level.amount === 'Custom' && $ctrl.showCustomAmtField($ctrl.levels) && $ctrl.frequency === 'one-time' --><!-- end ngRepeat: level in $ctrl.levels | filter: { display_on_page: true} --><!-- ngIf: level.amount === 'Custom' && $ctrl.showCustomAmtField($ctrl.levels) && $ctrl.frequency === 'one-time' --><!-- end ngRepeat: level in $ctrl.levels | filter: { display_on_page: true} --><!-- ngIf: level.amount === 'Custom' && $ctrl.showCustomAmtField($ctrl.levels) && $ctrl.frequency === 'one-time' -->
<li data-ng-if="level.amount === 'Custom' && $ctrl.showCustomAmtField($ctrl.levels) && $ctrl.frequency === 'one-time'" data-ng-repeat="level in $ctrl.levels | filter: { display_on_page: true}"
data-ng-click="$ctrl.selectAmount('Custom')" class="donation-grid__level-item hover-state_other donation-grid__level-item__other ng-scope" role="radio" data-ng-class="{'selected': $ctrl.showCustomAmtSelected}">
<label for="D-AOther" class="donation-grid__level-item__amount-label other-rf">
<div id="custom-amount" class="donation-grid__amount currency-picker" data-ng-class="{'has-focus': $ctrl.show.inputFocus === true}" data-sc-form-error="highlight if amount fails" aria-invalid="false">
<donation-grid-currency class="donation-grid-currency hover-state_currency ng-isolate-scope" selected="$ctrl.showCustomAmtSelected" currency-model="$ctrl.currency" disabled="$ctrl.globalState.feeProcessing"
currency-entity="'donation'" data-ng-mouseover="$ctrl.toggleHover('currency',true)" data-ng-mouseout="$ctrl.toggleHover('currency',false)" data-ng-style="$ctrl.getOtherFieldStyles('currency')">
<div class="currency-picker__wrapper eg-pr2 ng-isolate-scope" data-ng-style="getCurrencyWrapperStyles(selected)" data-ng-class="{'no-pick': !showDropdown, 'disabled': disabled}" aria-hidden="false" sc-lock-field="disabled"
tooltip-text="tooltipText" handle-unlock="true" aria-disabled="false" style="border-color: rgb(224, 231, 241); background-color: rgb(224, 231, 241); opacity: 1;">
<div class="currency-picker__select-wrapper">
<select id="dropdown" data-ng-show="showDropdown" data-ng-model="currency" data-ng-change="syncCurrencyModel()" data-ng-options="currency as currency.longText for currency in currencyOptions track by currency.currency"
class="currency-picker__select eg-interact eg-ff ng-pristine ng-untouched ng-valid ng-not-empty ng-not-modified" aria-label="Select a currency" data-ng-disabled="disabled">
<option label="AED | United Arab Emirates Dirham" value="AED">AED | United Arab Emirates Dirham</option>
<option label="AFN | Afghan Afghani" value="AFN">AFN | Afghan Afghani</option>
<option label="ALL | Albanian Lek" value="ALL">ALL | Albanian Lek</option>
<option label="AMD | Armenian Dram" value="AMD">AMD | Armenian Dram</option>
<option label="ANG | Netherlands Antillean Guilder" value="ANG">ANG | Netherlands Antillean Guilder</option>
<option label="AOA | Angolan Kwanza" value="AOA">AOA | Angolan Kwanza</option>
<option label="ARS | Argentine Peso" value="ARS">ARS | Argentine Peso</option>
<option label="AUD | Australian Dollar" value="AUD">AUD | Australian Dollar</option>
<option label="AWG | Aruban Florin" value="AWG">AWG | Aruban Florin</option>
<option label="AZN | Azerbaijani Manat" value="AZN">AZN | Azerbaijani Manat</option>
<option label="BAM | Bosnia And Herzegovina Convertible Mark" value="BAM">BAM | Bosnia And Herzegovina Convertible Mark</option>
<option label="BBD | Barbados Dollar" value="BBD">BBD | Barbados Dollar</option>
<option label="BDT | Bangladeshi Taka" value="BDT">BDT | Bangladeshi Taka</option>
<option label="BGN | Bulgarian Lev" value="BGN">BGN | Bulgarian Lev</option>
<option label="BHD | Bahraini Dinar" value="BHD">BHD | Bahraini Dinar</option>
<option label="BIF | Burundian Franc" value="BIF">BIF | Burundian Franc</option>
<option label="BMD | Bermudian Dollar (customarily Known As Bermuda Dollar)" value="BMD">BMD | Bermudian Dollar (customarily Known As Bermuda Dollar)</option>
<option label="BND | Brunei Dollar" value="BND">BND | Brunei Dollar</option>
<option label="BOB | Boliviano" value="BOB">BOB | Boliviano</option>
<option label="BRL | Brazilian Real" value="BRL">BRL | Brazilian Real</option>
<option label="BSD | Bahamian Dollar" value="BSD">BSD | Bahamian Dollar</option>
<option label="BTN | Bhutanese Ngultrum" value="BTN">BTN | Bhutanese Ngultrum</option>
<option label="BWP | Botswana Pula" value="BWP">BWP | Botswana Pula</option>
<option label="BZD | Belize Dollar" value="BZD">BZD | Belize Dollar</option>
<option label="CAD | Canadian Dollar" value="CAD">CAD | Canadian Dollar</option>
<option label="CDF | Congolese Franc" value="CDF">CDF | Congolese Franc</option>
<option label="CHF | Swiss Franc" value="CHF">CHF | Swiss Franc</option>
<option label="CLF | Unidad De Fomento (funds Code)" value="CLF">CLF | Unidad De Fomento (funds Code)</option>
<option label="CLP | Chilean Peso" value="CLP">CLP | Chilean Peso</option>
<option label="CNY | Chinese Yuan" value="CNY">CNY | Chinese Yuan</option>
<option label="COP | Colombian Peso" value="COP">COP | Colombian Peso</option>
<option label="CRC | Costa Rican Colon" value="CRC">CRC | Costa Rican Colon</option>
<option label="CUC | Cuban Convertible Peso" value="CUC">CUC | Cuban Convertible Peso</option>
<option label="CUP | Cuban Peso" value="CUP">CUP | Cuban Peso</option>
<option label="CVE | Cape Verde Escudo" value="CVE">CVE | Cape Verde Escudo</option>
<option label="CZK | Czech Koruna" value="CZK">CZK | Czech Koruna</option>
<option label="DJF | Djiboutian Franc" value="DJF">DJF | Djiboutian Franc</option>
<option label="DKK | Danish Krone" value="DKK">DKK | Danish Krone</option>
<option label="DOP | Dominican Peso" value="DOP">DOP | Dominican Peso</option>
<option label="DZD | Algerian Dinar" value="DZD">DZD | Algerian Dinar</option>
<option label="EGP | Egyptian Pound" value="EGP">EGP | Egyptian Pound</option>
<option label="ERN | Eritrean Nakfa" value="ERN">ERN | Eritrean Nakfa</option>
<option label="ETB | Ethiopian Birr" value="ETB">ETB | Ethiopian Birr</option>
<option label="EUR | Euro" value="EUR" selected="selected">EUR | Euro</option>
<option label="FJD | Fiji Dollar" value="FJD">FJD | Fiji Dollar</option>
<option label="FKP | Falkland Islands Pound" value="FKP">FKP | Falkland Islands Pound</option>
<option label="GBP | Pound Sterling" value="GBP">GBP | Pound Sterling</option>
<option label="GEL | Georgian Lari" value="GEL">GEL | Georgian Lari</option>
<option label="GHS | Ghanaian Cedi" value="GHS">GHS | Ghanaian Cedi</option>
<option label="GIP | Gibraltar Pound" value="GIP">GIP | Gibraltar Pound</option>
<option label="GMD | Gambian Dalasi" value="GMD">GMD | Gambian Dalasi</option>
<option label="GNF | Guinean Franc" value="GNF">GNF | Guinean Franc</option>
<option label="GTQ | Guatemalan Quetzal" value="GTQ">GTQ | Guatemalan Quetzal</option>
<option label="GYD | Guyanese Dollar" value="GYD">GYD | Guyanese Dollar</option>
<option label="HKD | Hong Kong Dollar" value="HKD">HKD | Hong Kong Dollar</option>
<option label="HNL | Honduran Lempira" value="HNL">HNL | Honduran Lempira</option>
<option label="HTG | Haitian Gourde" value="HTG">HTG | Haitian Gourde</option>
<option label="HUF | Hungarian Forint" value="HUF">HUF | Hungarian Forint</option>
<option label="IDR | Indonesian Rupiah" value="IDR">IDR | Indonesian Rupiah</option>
<option label="ILS | Israeli New Shekel" value="ILS">ILS | Israeli New Shekel</option>
<option label="INR | Indian Rupee" value="INR">INR | Indian Rupee</option>
<option label="IQD | Iraqi Dinar" value="IQD">IQD | Iraqi Dinar</option>
<option label="IRR | Iranian Rial" value="IRR">IRR | Iranian Rial</option>
<option label="ISK | Icelandic Króna" value="ISK">ISK | Icelandic Króna</option>
<option label="JMD | Jamaican Dollar" value="JMD">JMD | Jamaican Dollar</option>
<option label="JOD | Jordanian Dinar" value="JOD">JOD | Jordanian Dinar</option>
<option label="JPY | Japanese Yen" value="JPY">JPY | Japanese Yen</option>
<option label="KES | Kenyan Shilling" value="KES">KES | Kenyan Shilling</option>
<option label="KGS | Kyrgyzstani Som" value="KGS">KGS | Kyrgyzstani Som</option>
<option label="KHR | Cambodian Riel" value="KHR">KHR | Cambodian Riel</option>
<option label="KMF | Comoro Franc" value="KMF">KMF | Comoro Franc</option>
<option label="KPW | North Korean Won" value="KPW">KPW | North Korean Won</option>
<option label="KRW | South Korean Won" value="KRW">KRW | South Korean Won</option>
<option label="KWD | Kuwaiti Dinar" value="KWD">KWD | Kuwaiti Dinar</option>
<option label="KYD | Cayman Islands Dollar" value="KYD">KYD | Cayman Islands Dollar</option>
<option label="KZT | Kazakhstani Tenge" value="KZT">KZT | Kazakhstani Tenge</option>
<option label="LAK | Lao Kip" value="LAK">LAK | Lao Kip</option>
<option label="LBP | Lebanese Pound" value="LBP">LBP | Lebanese Pound</option>
<option label="LKR | Sri Lankan Rupee" value="LKR">LKR | Sri Lankan Rupee</option>
<option label="LRD | Liberian Dollar" value="LRD">LRD | Liberian Dollar</option>
<option label="LSL | Lesotho Loti" value="LSL">LSL | Lesotho Loti</option>
<option label="LYD | Libyan Dinar" value="LYD">LYD | Libyan Dinar</option>
<option label="MAD | Moroccan Dirham" value="MAD">MAD | Moroccan Dirham</option>
<option label="MDL | Moldovan Leu" value="MDL">MDL | Moldovan Leu</option>
<option label="MGA | Malagasy Ariary" value="MGA">MGA | Malagasy Ariary</option>
<option label="MKD | Macedonian Denar" value="MKD">MKD | Macedonian Denar</option>
<option label="MMK | Myanma Kyat" value="MMK">MMK | Myanma Kyat</option>
<option label="MNT | Mongolian Tugrik" value="MNT">MNT | Mongolian Tugrik</option>
<option label="MOP | Macanese Pataca" value="MOP">MOP | Macanese Pataca</option>
<option label="MUR | Mauritian Rupee" value="MUR">MUR | Mauritian Rupee</option>
<option label="MVR | Maldivian Rufiyaa" value="MVR">MVR | Maldivian Rufiyaa</option>
<option label="MWK | Malawian Kwacha" value="MWK">MWK | Malawian Kwacha</option>
<option label="MXN | Mexican Peso" value="MXN">MXN | Mexican Peso</option>
<option label="MYR | Malaysian Ringgit" value="MYR">MYR | Malaysian Ringgit</option>
<option label="MZN | Mozambican Metical" value="MZN">MZN | Mozambican Metical</option>
<option label="NAD | Namibian Dollar" value="NAD">NAD | Namibian Dollar</option>
<option label="NGN | Nigerian Naira" value="NGN">NGN | Nigerian Naira</option>
<option label="NIO | Nicaraguan Córdoba" value="NIO">NIO | Nicaraguan Córdoba</option>
<option label="NOK | Norwegian Krone" value="NOK">NOK | Norwegian Krone</option>
<option label="NPR | Nepalese Rupee" value="NPR">NPR | Nepalese Rupee</option>
<option label="NZD | New Zealand Dollar" value="NZD">NZD | New Zealand Dollar</option>
<option label="OMR | Omani Rial" value="OMR">OMR | Omani Rial</option>
<option label="PAB | Panamanian Balboa" value="PAB">PAB | Panamanian Balboa</option>
<option label="PEN | Peruvian Nuevo Sol" value="PEN">PEN | Peruvian Nuevo Sol</option>
<option label="PGK | Papua New Guinean Kina" value="PGK">PGK | Papua New Guinean Kina</option>
<option label="PHP | Philippine Peso" value="PHP">PHP | Philippine Peso</option>
<option label="PKR | Pakistani Rupee" value="PKR">PKR | Pakistani Rupee</option>
<option label="PLN | Polish Złoty" value="PLN">PLN | Polish Złoty</option>
<option label="PYG | Paraguayan Guaraní" value="PYG">PYG | Paraguayan Guaraní</option>
<option label="QAR | Qatari Riyal" value="QAR">QAR | Qatari Riyal</option>
<option label="RON | Romanian New Leu" value="RON">RON | Romanian New Leu</option>
<option label="RSD | Serbian Dinar" value="RSD">RSD | Serbian Dinar</option>
<option label="RWF | Rwandan Franc" value="RWF">RWF | Rwandan Franc</option>
<option label="SAR | Saudi Riyal" value="SAR">SAR | Saudi Riyal</option>
<option label="SBD | Solomon Islands Dollar" value="SBD">SBD | Solomon Islands Dollar</option>
<option label="SCR | Seychelles Rupee" value="SCR">SCR | Seychelles Rupee</option>
<option label="SDG | Sudanese Pound" value="SDG">SDG | Sudanese Pound</option>
<option label="SEK | Swedish Krona/kronor" value="SEK">SEK | Swedish Krona/kronor</option>
<option label="SGD | Singapore Dollar" value="SGD">SGD | Singapore Dollar</option>
<option label="SHP | Saint Helena Pound" value="SHP">SHP | Saint Helena Pound</option>
<option label="SLL | Sierra Leonean Leone" value="SLL">SLL | Sierra Leonean Leone</option>
<option label="SOS | Somali Shilling" value="SOS">SOS | Somali Shilling</option>
<option label="SRD | Surinamese Dollar" value="SRD">SRD | Surinamese Dollar</option>
<option label="SSP | South Sudanese Pound" value="SSP">SSP | South Sudanese Pound</option>
<option label="STD | São Tomé And Príncipe Dobra" value="STD">STD | São Tomé And Príncipe Dobra</option>
<option label="SYP | Syrian Pound" value="SYP">SYP | Syrian Pound</option>
<option label="SZL | Swazi Lilangeni" value="SZL">SZL | Swazi Lilangeni</option>
<option label="THB | Thai Baht" value="THB">THB | Thai Baht</option>
<option label="TJS | Tajikistani Somoni" value="TJS">TJS | Tajikistani Somoni</option>
<option label="TMT | Turkmenistani Manat" value="TMT">TMT | Turkmenistani Manat</option>
<option label="TND | Tunisian Dinar" value="TND">TND | Tunisian Dinar</option>
<option label="TOP | Tongan Paʻanga" value="TOP">TOP | Tongan Paʻanga</option>
<option label="TRY | Turkish Lira" value="TRY">TRY | Turkish Lira</option>
<option label="TTD | Trinidad And Tobago Dollar" value="TTD">TTD | Trinidad And Tobago Dollar</option>
<option label="TWD | New Taiwan Dollar" value="TWD">TWD | New Taiwan Dollar</option>
<option label="TZS | Tanzanian Shilling" value="TZS">TZS | Tanzanian Shilling</option>
<option label="UAH | Ukrainian Hryvnia" value="UAH">UAH | Ukrainian Hryvnia</option>
<option label="UGX | Ugandan Shilling" value="UGX">UGX | Ugandan Shilling</option>
<option label="USD | United States Dollar" value="USD">USD | United States Dollar</option>
<option label="UYU | Uruguayan Peso" value="UYU">UYU | Uruguayan Peso</option>
<option label="UZS | Uzbekistan Som" value="UZS">UZS | Uzbekistan Som</option>
<option label="VND | Vietnamese Dong" value="VND">VND | Vietnamese Dong</option>
<option label="VUV | Vanuatu Vatu" value="VUV">VUV | Vanuatu Vatu</option>
<option label="WST | Samoan Tala" value="WST">WST | Samoan Tala</option>
<option label="XAF | CFA Franc BEAC" value="XAF">XAF | CFA Franc BEAC</option>
<option label="XCD | East Caribbean Dollar" value="XCD">XCD | East Caribbean Dollar</option>
<option label="XDR | Special Drawing Rights" value="XDR">XDR | Special Drawing Rights</option>
<option label="XOF | CFA Franc BCEAO" value="XOF">XOF | CFA Franc BCEAO</option>
<option label="XPF | CFP Franc" value="XPF">XPF | CFP Franc</option>
<option label="YER | Yemeni Rial" value="YER">YER | Yemeni Rial</option>
<option label="ZAR | South African Rand" value="ZAR">ZAR | South African Rand</option>
</select>
<span class="currency-picker__short eg-ff ng-binding" data-ng-style="getCurrencyLabelStyles(selected)"
style="border-color: rgb(224, 231, 241) white rgb(224, 231, 241) rgb(224, 231, 241); background-color: rgb(224, 231, 241); border-right-width: 1px; border-right-style: solid; background-image: unset;">EUR
<!-- ngIf: !isDisabled() --><i class="fa fa-caret-down ng-scope" ng-if="!isDisabled()"></i><!-- end ngIf: !isDisabled() --></span>
</div>
</div>
</donation-grid-currency>
<donation-grid-custom-amount model="$ctrl.otherAmount" modal-bind-value="$ctrl.amount" selected="$ctrl.showCustomAmtSelected" currency-code="$ctrl.currency" round-currency="false" name="'amount'" label="''" placeholder="'Other'"
data-ng-mouseover="$ctrl.toggleHover('custom_amount',true)" data-ng-mouseout="$ctrl.toggleHover('custom_amount',false)" data-ng-style="$ctrl.getOtherFieldStyles('custom_amount')"
class="currency-field rf donation-grid-custom-amount hover-state_custom_amount ng-isolate-scope" currency-aria-label="Enter an other amount to donate" input-data-id="cp-donation-form-onetime-custom">
<div class="donation-grid-custom-amount-container">
<span ng-class="{'selected': $ctrl.selected}" ng-style="!$ctrl.selected ? $ctrl.getStylesDefault() : $ctrl.getStylesSelected()" class="ng-binding"
style="background-color: rgb(224, 231, 241); border-color: rgb(224, 231, 241);">€</span>
<input ng-model="$ctrl.model" ng-model-options="{ getterSetter: $ctrl.getterSetter }" name="amount" sc-currency="" sc-validity-reporter="" sc-validity-classes="" data-sc-focus="$ctrl.focusWhen"
round-currency="$ctrl.roundCurrency" ng-disabled="$ctrl.disableFlag" ng-required="$ctrl.required" ng-focus="$ctrl.onFocus = true" ng-blur="$ctrl.onBlur()" ng-change="$ctrl.onChange()" max="$ctrl.max" min="$ctrl.min"
autocomplete="off" placeholder="Other" aria-label="Enter an other amount to donate" qa-id="text-input" _spec="input" type="string" inputmode="numeric" ng-class="{'selected': $ctrl.selected}"
class="form__text-input--dark eg-ff eg-bold6 ng-pristine ng-untouched ng-isolate-scope ng-empty sc-valid ng-valid-required ng-not-modified ng-valid-min ng-valid ng-valid-max"
ng-style="!$ctrl.selected ? $ctrl.getStylesDefault() : $ctrl.getStylesSelected()" data-id="cp-donation-form-onetime-custom" style="background-color: rgb(224, 231, 241); border-color: rgb(224, 231, 241);">
</div>
<div style="position: absolute; width: 100%; left: 0; text-align: left" aria-live="polite">
<form-error name="$ctrl.name" messages="$ctrl.errorMessages" _spec="errors" class="ng-isolate-scope">
<p class="form__error" aria-live="polite" role="alert" sc-validity-message="::$ctrl.name" messages="::$ctrl.messages" style="display: none;"></p>
</form-error>
</div>
</donation-grid-custom-amount>
</div>
</label>
</li><!-- end ngIf: level.amount === 'Custom' && $ctrl.showCustomAmtField($ctrl.levels) && $ctrl.frequency === 'one-time' --><!-- end ngRepeat: level in $ctrl.levels | filter: { display_on_page: true} -->
</ul><!-- end ngIf: !$ctrl.showRecurringDonationArray && ($ctrl.noOfDonationAmount($ctrl.levels) > 1 || $ctrl.showCustomAmtField($ctrl.levels)) -->
<!-- IF MULTIPLE RECURRING DONATION AMOUNT DISPLAYED -->
<!-- ngIf: $ctrl.showRecurringDonationArray && ($ctrl.noOfDonationAmount($ctrl.recurringDonationLevels) > 1 || $ctrl.showCustomAmtField($ctrl.recurringDonationLevels)) -->
<!-- IF ONLY SINGLE AMOUNT DISPLAYED-->
<!-- ngIf: !$ctrl.showRecurringDonationArray && ($ctrl.noOfDonationAmount($ctrl.levels) === 1 && !$ctrl.showCustomAmtField($ctrl.levels)) -->
<!-- IF ONLY SINGLE RECURRING AMOUNT DISPLAYED-->
<!-- ngIf: $ctrl.showRecurringDonationArray && ($ctrl.noOfDonationAmount($ctrl.recurringDonationLevels) === 1 && !$ctrl.showCustomAmtField($ctrl.recurringDonationLevels)) -->
</div>
</donation-grid><!-- end ngIf: !showLegacyDonationGrid -->
</section>
</div>
</section><!-- end ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
<section class="block-component ng-scope" data-ng-repeat="component in list.components | filter:{section:'main'} | orderBy:'order'">
<!-- ngInclude: component.templateUrl -->
<div data-ng-include="component.templateUrl" class="ng-scope">
<section class="donation-dedication ng-scope" data-ng-controller="frsDonationDedicationCtrl">
<button type="button" class="sc-checkbox " data-ng-click="toggle()" role="checkbox" aria-checked="false" data-sc-checkbox="" data-ng-model="state.dedicationFormEnabled" name="dedicate"
aria-label="Dedicate my donation in honor or in memory of someone"><span class="sc-checkbox_input"></span><span class="sc-checkbox_label" data-ng-transclude="" aria-hidden="true"> Dedicate my donation <strong class="ng-scope">in honor or in
memory</strong> of someone </span></button>
<div data-ng-show="show.dedicationForm()" data-ng-form="dedicationForm" id="donation-page_checkout_dedication-form" class="ng-pristine ng-hide ng-invalid ng-invalid-required">
<!-- ngInclude: ::template('type') -->
<div data-heap-ignore="true" data-ng-include="::template('type')" class="mp-sensitive ng-scope">
<div class="donation-table ng-scope">
<div class="donation-table-label-type">
<label class="donation-label">Type</label>
</div>
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column">
<radio-group role="radiogroup" aria-label="select dedication type" class="ng-isolate-scope"><ng-transclude>
<radio-control ng-model="dedicationModel.type" name="'type'" value="'honor'" ng-required="true" aria-label="select to donate in honor of someone"
class="ng-pristine ng-untouched ng-valid ng-scope ng-isolate-scope ng-not-empty ng-valid-required ng-not-modified" required="required">
<button class="form__radio-control checked" aria-checked="true" role="radio" tabindex="0" ng-class="{ checked: $ctrl.isChecked() }" ng-click="$ctrl.select()" ng-keydown="$ctrl.onKeyDown($event)" ng-disabled="$ctrl.disabled"
type="button" aria-label="select to donate in honor of someone" _spec="button">
<span class="form__radio-control_input" sc-error-class="$ctrl.ngModelCtrl.$name" ng-style="{ color: $ctrl.color }" _spec="radio" style="color: rgb(0, 51, 142);"></span>
<span class="form__radio-control_label" qa-id="radio-field" ng-transclude="" _spec="label"> In honor of … </span>
</button>
</radio-control>
<radio-control ng-model="dedicationModel.type" name="'type'" value="'memory'" ng-required="true" aria-label="select to donate in memory of someone"
class="ng-pristine ng-untouched ng-valid ng-scope ng-isolate-scope ng-not-empty ng-valid-required ng-not-modified" required="required">
<button class="form__radio-control" aria-checked="false" role="radio" tabindex="0" ng-class="{ checked: $ctrl.isChecked() }" ng-click="$ctrl.select()" ng-keydown="$ctrl.onKeyDown($event)" ng-disabled="$ctrl.disabled"
type="button" aria-label="select to donate in memory of someone" _spec="button">
<span class="form__radio-control_input" sc-error-class="$ctrl.ngModelCtrl.$name" ng-style="{ color: $ctrl.color }" _spec="radio" style="color: rgb(0, 51, 142);"></span>
<span class="form__radio-control_label" qa-id="radio-field" ng-transclude="" _spec="label"> In memory of … </span>
</button>
</radio-control>
</ng-transclude></radio-group>
</div>
</div>
</div>
</div>
</div>
<!-- ngInclude: ::template('honoree') -->
<div data-heap-ignore="true" data-ng-include="::template('honoree')" class="mp-sensitive ng-scope">
<div class="donation-table donation-dedication__honoree ng-scope">
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column half">
<span class="donation-label required" data-sc-form-error="highlight if dedicationForm.honoree_first_name fails">Honoree’s First Name</span>
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-not-modified" data-ng-model="dedicationModel.honoree_first_name" data-sc-retain-focus-validity=""
data-sc-form-error="highlight if dedicationForm.honoree_first_name fails" type="text" name="honoree_first_name" aria-label="honoree's first name" required="" aria-invalid="false">
</div>
<div class="donation-table_column half">
<span class="donation-label required" data-sc-form-error="highlight if dedicationForm.honoree_last_name fails">Honoree’s Last Name</span>
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-not-modified" data-ng-model="dedicationModel.honoree_last_name" data-sc-retain-focus-validity=""
data-sc-form-error="highlight if dedicationForm.honoree_last_name fails" type="text" name="honoree_last_name" aria-label="honoree's last name" required="" aria-invalid="false">
</div>
</div>
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if [dedicationForm.honoree_first_name, dedicationForm.honoree_last_name] fails required" style="display: none;"> Don't forget to give us a name for the dedication.
</span>
</div>
</div>
</div>
</div>
<!-- ngIf: show.emailForm() || state.postcardEnabled -->
<!-- ngIf: show.postcardToggle() -->
<!-- ngIf: show.postcardForm() -->
<!-- ngIf: show.emailForm() || state.postcardEnabled -->
</div>
</section>
</div>
</section><!-- end ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
<section class="block-component ng-scope" data-ng-repeat="component in list.components | filter:{section:'main'} | orderBy:'order'">
<!-- ngInclude: component.templateUrl -->
<div data-ng-include="component.templateUrl" class="ng-scope">
<section class="donation-credit ng-scope no-fundraising" ng-class="{'no-fundraising': !campaign.HAS_FUNDRAISING}" data-ng-controller="frsDonationCreditCtrl">
<!-- ngIf: !campaign.current.disable_donation_attribution && campaign.HAS_FUNDRAISING -->
<!-- ngIf: show.designation() -->
</section>
</div>
</section><!-- end ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
<section class="block-component ng-scope" data-ng-repeat="component in list.components | filter:{section:'main'} | orderBy:'order'">
<!-- ngInclude: component.templateUrl -->
<div data-ng-include="component.templateUrl" class="ng-scope">
<div class="donation-donor ng-scope" data-ng-controller="frsDonationDonorCtrl" aria-labelledby="donationPage_your-information-heading" id="donation-page_checkout_donor-information-form">
<h2 class="donation-subtitle" id="donationPage_your-information-heading">Your Information</h2>
<!-- ngIf: show.prefix() -->
<!-- ngInclude: ::template('name') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('name')">
<div class="donation-table ng-scope">
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column half" data-ng-class="show.middleName() ? 'third' : 'half'">
<span class="donation-label required" data-sc-form-error="highlight if member_first_name fails">First Name</span>
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-not-modified" data-ng-model="META.member_first_name" data-sc-form-error="highlight if member_first_name fails"
data-sc-retain-focus-validity="" type="text" name="member_first_name" aria-label="Please enter your first name" required="" aria-invalid="false">
</div>
<!-- ngIf: show.middleName() -->
<div class="donation-table_column half" data-ng-class="show.middleName() ? 'third' : 'half'">
<span class="donation-label required" data-sc-form-error="highlight if member_last_name fails">Last Name</span>
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-not-modified" data-ng-model="META.member_last_name" data-sc-form-error="highlight if member_last_name fails"
data-sc-retain-focus-validity="" type="text" name="member_last_name" aria-label="Please enter your last name" required="" aria-invalid="false">
</div>
</div>
<div aria-live="assertive">
<span class="donation-error ng-binding" data-sc-form-error="show if [member_first_name,optional_middle_name,member_last_name] fails" ng-bind="build.nameError()" style="display: none;">Be sure to provide your name.</span>
</div>
<!-- ngIf: show.anonymous() || show.anonymousDonationAmounts() -->
</div>
</div>
</div>
<!-- ngIf: show.suffix() -->
<!-- ngInclude: ::template('email') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('email')">
<div class="donation-table ng-scope">
<div class="donation-table_label">
<label class="donation-label required" data-sc-form-error="highlight if member_email_address fails">Email</label>
</div>
<div class="donation-table_row">
<div class="donation-table_columns">
<div class="donation-table_column">
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-valid-email-address ng-invalid ng-invalid-required ng-not-modified" data-ng-model="MODEL.member_email_address"
data-sc-form-error="highlight if member_email_address fails" data-sc-validate-email-address="" data-sc-retain-focus-validity="" type="text" name="member_email_address" aria-label="Email address. Your receipt will be emailed here."
required="" aria-invalid="false">
</div>
</div>
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if member_email_address fails required" style="display: none;"> Don't forget your email address. </span>
<span class="donation-error ng-binding" data-sc-form-error="show if member_email_address fails emailAddress" style="display: none;"> Please enter in the format: name@domain.com. </span>
</div>
<small class="donation-table_row-helper"> Your receipt will be emailed here. </small>
<sc-consent data-show="!campaign.current.hide_contact_opt_in" data-opt-in="MODEL.opt_in" data-language="MODEL.opt_in_wording" name="opt_in" class="ng-isolate-scope">
<!-- ngIf: $ctrl.show -->
</sc-consent>
</div>
</div>
</div>
<div>
<!-- ngInclude: ::template('billing-address1') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('billing-address1')">
<div class="donation-table ng-scope">
<div class="donation-table_label">
<label class="donation-label required" data-sc-form-error="highlight if billing_address1 fails">Address</label>
</div>
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column">
<div data-class="donation-text_input" data-name="billing_address1" ng-model="MODEL.billing_address1" data-sc-retain-focus-validity="" data-sc-address-lookup="" data-parser="parseBillingAddressAutocomplete(response)"
data-aria-label="address 1" data-placeholder="Enter your address" data-required="true" class="ng-pristine ng-untouched ng-isolate-scope ng-empty ng-invalid ng-invalid-required ng-not-modified">
<style>
.prediction-list {
position: absolute;
top: 100%;
left: 0;
right: 0;
max-height: 200px;
overflow-y: auto;
background-color: white;
border: 1px solid #ccc;
border-top: none;
box-shadow: 0px 4px 8px rgba(0, 0, 0, 0.2);
z-index: 1000;
padding: 0;
margin: 0;
list-style-type: none;
}
.prediction-list li {
padding: 10px;
cursor: pointer;
border-bottom: 1px solid #eee;
}
.prediction-list li:last-child {
border-bottom: none;
}
.prediction-list li:hover {
background-color: #f1f1f1;
}
</style>
<div style="position: relative;">
<input type="text" class="donation-text_input" name="billing_address1" placeholder="Enter your address" required="" data-sc-form-error="highlight if billing_address1 fails" aria-invalid="false">
<ul ng-show="showPredictions()" class="prediction-list ng-hide">
<!-- ngRepeat: prediction in predictions -->
</ul>
</div>
</div>
</div>
</div>
<div style="display: flex; justify-content: space-between">
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if billing_address1 fails required" style="display: none;"> Don't forget to provide an address. </span>
</div>
<!-- ngIf: !showAddressLine2 -->
<div style="display: flex; align-items: center" data-ng-if="!showAddressLine2" data-ng-click="handleAddLine2Click()" class="ng-scope">
<img width="22px" height="22x" sc-cdn-src="/static/global/images/add-circle.svg" class="ng-isolate-scope" src="https://prod-frs.content.classy.org/prod/28b9fc010e5ba714a98be1a82341a5c81cdbbf05/static/global/images/add-circle.svg">
<span> Add apt., suite, floor </span>
</div><!-- end ngIf: !showAddressLine2 -->
</div>
</div>
</div>
</div>
<!-- ngInclude: ::template('billing-address2') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('billing-address2')"><!-- ngIf: showAddressLine2 -->
</div>
<!-- ngInclude: ::template('billing-zip-city') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('billing-zip-city')">
<div class="donation-table ng-scope">
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column half">
<span class="donation-label required ng-binding" name="billing_postal_code_label" data-sc-form-error="highlight if billing_postal_code fails">ZIP</span>
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-not-modified" data-ng-model="MODEL.billing_postal_code" data-sc-form-error="highlight if billing_postal_code fails"
data-sc-retain-focus-validity="" type="text" name="billing_postal_code" aria-label="ZIP" required="" aria-invalid="false">
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" name="billing_postal_code_error">
</span>
</div>
</div>
<div class="donation-table_column half">
<div class="donation-table_label">
<label class="donation-label required" data-sc-form-error="highlight if billing_city fails">City</label>
</div>
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-not-modified" data-ng-model="MODEL.billing_city" data-sc-form-error="highlight if billing_city fails"
data-sc-retain-focus-validity="" type="text" name="billing_city" aria-label="billing city" required="" aria-invalid="false">
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if billing_city fails required" style="display: none;"> Don't forget to provide a city. </span>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- ngInclude: ::template('billing-state-country') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('billing-state-country')">
<div class="donation-table ng-scope">
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column half" data-ng-show="show.states()">
<span class="donation-label required" data-sc-form-error="highlight if billing_state fails">State</span>
<select ng-options="state.value as state.label for state in states" qa-id="select-field" aria-label="billing state" class="donation-select ng-empty ng-invalid ng-invalid-required ng-not-modified"
data-ng-model="MODEL.billing_state" data-sc-form-error="highlight if billing_state fails" data-sc-select-states="" data-only-states="true" name="billing_state" required="required" aria-invalid="false">
<option value="" class="">Please Select</option>
<option label="Alabama" value="string:AL">Alabama</option>
<option label="Alaska" value="string:AK">Alaska</option>
<option label="Arizona" value="string:AZ">Arizona</option>
<option label="Arkansas" value="string:AR">Arkansas</option>
<option label="California" value="string:CA">California</option>
<option label="Colorado" value="string:CO">Colorado</option>
<option label="Connecticut" value="string:CT">Connecticut</option>
<option label="Delaware" value="string:DE">Delaware</option>
<option label="District of Columbia" value="string:DC">District of Columbia</option>
<option label="Florida" value="string:FL">Florida</option>
<option label="Georgia" value="string:GA">Georgia</option>
<option label="Hawaii" value="string:HI">Hawaii</option>
<option label="Idaho" value="string:ID">Idaho</option>
<option label="Illinois" value="string:IL">Illinois</option>
<option label="Indiana" value="string:IN">Indiana</option>
<option label="Iowa" value="string:IA">Iowa</option>
<option label="Kansas" value="string:KS">Kansas</option>
<option label="Kentucky" value="string:KY">Kentucky</option>
<option label="Louisiana" value="string:LA">Louisiana</option>
<option label="Maine" value="string:ME">Maine</option>
<option label="Maryland" value="string:MD">Maryland</option>
<option label="Massachusetts" value="string:MA">Massachusetts</option>
<option label="Michigan" value="string:MI">Michigan</option>
<option label="Minnesota" value="string:MN">Minnesota</option>
<option label="Mississippi" value="string:MS">Mississippi</option>
<option label="Missouri" value="string:MO">Missouri</option>
<option label="Montana" value="string:MT">Montana</option>
<option label="Nebraska" value="string:NE">Nebraska</option>
<option label="Nevada" value="string:NV">Nevada</option>
<option label="New Hampshire" value="string:NH">New Hampshire</option>
<option label="New Jersey" value="string:NJ">New Jersey</option>
<option label="New Mexico" value="string:NM">New Mexico</option>
<option label="New York" value="string:NY">New York</option>
<option label="North Carolina" value="string:NC">North Carolina</option>
<option label="North Dakota" value="string:ND">North Dakota</option>
<option label="Ohio" value="string:OH">Ohio</option>
<option label="Oklahoma" value="string:OK">Oklahoma</option>
<option label="Oregon" value="string:OR">Oregon</option>
<option label="Pennsylvania" value="string:PA">Pennsylvania</option>
<option label="Rhode Island" value="string:RI">Rhode Island</option>
<option label="South Carolina" value="string:SC">South Carolina</option>
<option label="South Dakota" value="string:SD">South Dakota</option>
<option label="Tennessee" value="string:TN">Tennessee</option>
<option label="Texas" value="string:TX">Texas</option>
<option label="Utah" value="string:UT">Utah</option>
<option label="Vermont" value="string:VT">Vermont</option>
<option label="Virginia" value="string:VA">Virginia</option>
<option label="Washington" value="string:WA">Washington</option>
<option label="West Virginia" value="string:WV">West Virginia</option>
<option label="Wisconsin" value="string:WI">Wisconsin</option>
<option label="Wyoming" value="string:WY">Wyoming</option>
<option label="Armed Forces (the) Americas" value="string:AA">Armed Forces (the) Americas</option>
<option label="Armed Forces Europe" value="string:AE">Armed Forces Europe</option>
<option label="Armed Forces Pacific" value="string:AP">Armed Forces Pacific</option>
<option label="American Samoa" value="string:AS">American Samoa</option>
<option label="Guam" value="string:GU">Guam</option>
<option label="Northern Mariana Islands" value="string:MP">Northern Mariana Islands</option>
<option label="Puerto Rico" value="string:PR">Puerto Rico</option>
<option label="Virgin Islands" value="string:VI">Virgin Islands</option>
</select>
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if billing_state fails required" style="display: none;"> Don't forget to provide a state. </span>
</div>
</div>
<div class="donation-table_column half ng-hide" data-ng-show="show.provinces()">
<span class="donation-label required" data-sc-form-error="highlight if billing_state fails">Province</span>
<select ng-options="province.value as province.label for province in provinces" class="donation-select ng-empty ng-invalid ng-invalid-required ng-not-modified" data-ng-model="MODEL.billing_state"
data-sc-form-error="highlight if billing_state fails" data-sc-select-provinces="" name="billing_state" aria-label="billing province" required="required" aria-invalid="false">
<option value="?" selected="selected"></option>
<option value="" class="">Please Select</option>
<option label="Alberta (AB)" value="string:AB">Alberta (AB)</option>
<option label="British Columbia (BC)" value="string:BC">British Columbia (BC)</option>
<option label="Manitoba (MB)" value="string:MB">Manitoba (MB)</option>
<option label="New Brunswick (NB)" value="string:NB">New Brunswick (NB)</option>
<option label="Newfoundland and Labrador (NL)" value="string:NL">Newfoundland and Labrador (NL)</option>
<option label="Northwest Territories (NT)" value="string:NT">Northwest Territories (NT)</option>
<option label="Nova Scotia (NS)" value="string:NS">Nova Scotia (NS)</option>
<option label="Nunavut (NU)" value="string:NU">Nunavut (NU)</option>
<option label="Prince Edward Island (PE)" value="string:PE">Prince Edward Island (PE)</option>
<option label="Saskatchewan (SK)" value="string:SK">Saskatchewan (SK)</option>
<option label="Ontario (ON)" value="string:ON">Ontario (ON)</option>
<option label="Quebec (QC)" value="string:QC">Quebec (QC)</option>
<option label="Yukon (YT)" value="string:YT">Yukon (YT)</option>
</select>
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if billing_state fails required" style="display: none;"> Don't forget to provide a province. </span>
</div>
</div>
<div class="donation-table_column half ng-hide" data-ng-show="show.genericLevel1()">
<span class="donation-label required" data-sc-form-error="highlight if billing_state fails">Region</span>
<input class="donation-text_input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-maxlength ng-not-modified" data-ng-model="MODEL.billing_state" data-sc-form-error="highlight if billing_state fails"
data-sc-retain-focus-validity="" type="text" name="billing_state" aria-label="billing region" ng-maxlength="32" maxlength="32" required="" aria-invalid="false">
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if billing_state fails required" style="display: none;"> Don't forget to provide a region. </span>
</div>
</div>
<div class="donation-table_column half">
<div class="donation-table_label">
<label class="donation-label required" data-sc-form-error="highlight if billing_country fails">Country</label>
</div>
<!-- TODO: Exclude SG? -->
<select ng-options="country.value as country.label disable when country.disable for country in countries" qa-id="select-field" class="donation-select ng-not-empty ng-valid ng-valid-required ng-not-modified"
data-ng-model="MODEL.billing_country" data-sc-form-error="highlight if billing_country fails" data-sc-select-countries="" name="billing_country" aria-label="billing country" required="required" aria-invalid="false">
<option value="" class="">Please Select</option>
<option label="Afghanistan" value="string:AF">Afghanistan</option>
<option label="Aland Islands" value="string:AX">Aland Islands</option>
<option label="Albania" value="string:AL">Albania</option>
<option label="Algeria" value="string:DZ">Algeria</option>
<option label="American Samoa" value="string:AS">American Samoa</option>
<option label="Andorra" value="string:AD">Andorra</option>
<option label="Angola" value="string:AO">Angola</option>
<option label="Anguilla" value="string:AI">Anguilla</option>
<option label="Antarctica" value="string:AQ">Antarctica</option>
<option label="Antigua and Barbuda" value="string:AG">Antigua and Barbuda</option>
<option label="Argentina" value="string:AR">Argentina</option>
<option label="Armenia" value="string:AM">Armenia</option>
<option label="Aruba" value="string:AW">Aruba</option>
<option label="Australia" value="string:AU">Australia</option>
<option label="Austria" value="string:AT">Austria</option>
<option label="Azerbaijan" value="string:AZ">Azerbaijan</option>
<option label="Bahamas" value="string:BS">Bahamas</option>
<option label="Bahrain" value="string:BH">Bahrain</option>
<option label="Bangladesh" value="string:BD">Bangladesh</option>
<option label="Barbados" value="string:BB">Barbados</option>
<option label="Belgium" value="string:BE">Belgium</option>
<option label="Belize" value="string:BZ">Belize</option>
<option label="Benin" value="string:BJ">Benin</option>
<option label="Bermuda" value="string:BM">Bermuda</option>
<option label="Bhutan" value="string:BT">Bhutan</option>
<option label="Bolivia" value="string:BO">Bolivia</option>
<option label="Bonaire, Saint Eustatius and Saba " value="string:BQ">Bonaire, Saint Eustatius and Saba </option>
<option label="Bosnia and Herzegovina" value="string:BA">Bosnia and Herzegovina</option>
<option label="Botswana" value="string:BW">Botswana</option>
<option label="Bouvet Island" value="string:BV">Bouvet Island</option>
<option label="Brazil" value="string:BR">Brazil</option>
<option label="British Indian Ocean Territory" value="string:IO">British Indian Ocean Territory</option>
<option label="British Virgin Islands" value="string:VG">British Virgin Islands</option>
<option label="Brunei" value="string:BN">Brunei</option>
<option label="Bulgaria" value="string:BG">Bulgaria</option>
<option label="Burkina Faso" value="string:BF">Burkina Faso</option>
<option label="Burundi" value="string:BI">Burundi</option>
<option label="Cambodia" value="string:KH">Cambodia</option>
<option label="Cameroon" value="string:CM">Cameroon</option>
<option label="Canada" value="string:CA">Canada</option>
<option label="Cape Verde" value="string:CV">Cape Verde</option>
<option label="Cayman Islands" value="string:KY">Cayman Islands</option>
<option label="Central African Republic" value="string:CF">Central African Republic</option>
<option label="Chad" value="string:TD">Chad</option>
<option label="Chile" value="string:CL">Chile</option>
<option label="China" value="string:CN">China</option>
<option label="Christmas Island" value="string:CX">Christmas Island</option>
<option label="Cocos Islands" value="string:CC">Cocos Islands</option>
<option label="Colombia" value="string:CO">Colombia</option>
<option label="Comoros" value="string:KM">Comoros</option>
<option label="Cook Islands" value="string:CK">Cook Islands</option>
<option label="Costa Rica" value="string:CR">Costa Rica</option>
<option label="Croatia" value="string:HR">Croatia</option>
<option label="Cuba" value="string:CU">Cuba</option>
<option label="Curacao" value="string:CW">Curacao</option>
<option label="Cyprus" value="string:CY">Cyprus</option>
<option label="Czech Republic" value="string:CZ">Czech Republic</option>
<option label="Denmark" value="string:DK">Denmark</option>
<option label="Djibouti" value="string:DJ">Djibouti</option>
<option label="Dominica" value="string:DM">Dominica</option>
<option label="Dominican Republic" value="string:DO">Dominican Republic</option>
<option label="East Timor" value="string:TL">East Timor</option>
<option label="Ecuador" value="string:EC">Ecuador</option>
<option label="Egypt" value="string:EG">Egypt</option>
<option label="El Salvador" value="string:SV">El Salvador</option>
<option label="Equatorial Guinea" value="string:GQ">Equatorial Guinea</option>
<option label="Eritrea" value="string:ER">Eritrea</option>
<option label="Estonia" value="string:EE">Estonia</option>
<option label="Ethiopia" value="string:ET">Ethiopia</option>
<option label="Falkland Islands" value="string:FK">Falkland Islands</option>
<option label="Faroe Islands" value="string:FO">Faroe Islands</option>
<option label="Fiji" value="string:FJ">Fiji</option>
<option label="Finland" value="string:FI">Finland</option>
<option label="France" value="string:FR">France</option>
<option label="French Guiana" value="string:GF">French Guiana</option>
<option label="French Polynesia" value="string:PF">French Polynesia</option>
<option label="French Southern Territories" value="string:TF">French Southern Territories</option>
<option label="Gabon" value="string:GA">Gabon</option>
<option label="Gambia" value="string:GM">Gambia</option>
<option label="Georgia" value="string:GE">Georgia</option>
<option label="Germany" value="string:DE">Germany</option>
<option label="Ghana" value="string:GH">Ghana</option>
<option label="Gibraltar" value="string:GI">Gibraltar</option>
<option label="Greece" value="string:GR">Greece</option>
<option label="Greenland" value="string:GL">Greenland</option>
<option label="Grenada" value="string:GD">Grenada</option>
<option label="Guadeloupe" value="string:GP">Guadeloupe</option>
<option label="Guam" value="string:GU">Guam</option>
<option label="Guatemala" value="string:GT">Guatemala</option>
<option label="Guernsey" value="string:GG">Guernsey</option>
<option label="Guinea" value="string:GN">Guinea</option>
<option label="Guinea-Bissau" value="string:GW">Guinea-Bissau</option>
<option label="Guyana" value="string:GY">Guyana</option>
<option label="Haiti" value="string:HT">Haiti</option>
<option label="Heard Island and McDonald Islands" value="string:HM">Heard Island and McDonald Islands</option>
<option label="Honduras" value="string:HN">Honduras</option>
<option label="Hong Kong" value="string:HK">Hong Kong</option>
<option label="Hungary" value="string:HU">Hungary</option>
<option label="Iceland" value="string:IS">Iceland</option>
<option label="India" value="string:IN">India</option>
<option label="Indonesia" value="string:ID">Indonesia</option>
<option label="Ireland" value="string:IE">Ireland</option>
<option label="Isle of Man" value="string:IM">Isle of Man</option>
<option label="Israel" value="string:IL">Israel</option>
<option label="Italy" value="string:IT">Italy</option>
<option label="Ivory Coast" value="string:CI">Ivory Coast</option>
<option label="Jamaica" value="string:JM">Jamaica</option>
<option label="Japan" value="string:JP">Japan</option>
<option label="Jersey" value="string:JE">Jersey</option>
<option label="Jordan" value="string:JO">Jordan</option>
<option label="Kazakhstan" value="string:KZ">Kazakhstan</option>
<option label="Kenya" value="string:KE">Kenya</option>
<option label="Kiribati" value="string:KI">Kiribati</option>
<option label="Kosovo" value="string:XK">Kosovo</option>
<option label="Kuwait" value="string:KW">Kuwait</option>
<option label="Kyrgyzstan" value="string:KG">Kyrgyzstan</option>
<option label="Laos" value="string:LA">Laos</option>
<option label="Latvia" value="string:LV">Latvia</option>
<option label="Lebanon" value="string:LB">Lebanon</option>
<option label="Lesotho" value="string:LS">Lesotho</option>
<option label="Libya" value="string:LY">Libya</option>
<option label="Liechtenstein" value="string:LI">Liechtenstein</option>
<option label="Lithuania" value="string:LT">Lithuania</option>
<option label="Luxembourg" value="string:LU">Luxembourg</option>
<option label="Macao" value="string:MO">Macao</option>
<option label="Macedonia" value="string:MK">Macedonia</option>
<option label="Madagascar" value="string:MG">Madagascar</option>
<option label="Malawi" value="string:MW">Malawi</option>
<option label="Malaysia" value="string:MY">Malaysia</option>
<option label="Maldives" value="string:MV">Maldives</option>
<option label="Mali" value="string:ML">Mali</option>
<option label="Malta" value="string:MT">Malta</option>
<option label="Marshall Islands" value="string:MH">Marshall Islands</option>
<option label="Martinique" value="string:MQ">Martinique</option>
<option label="Mauritania" value="string:MR">Mauritania</option>
<option label="Mauritius" value="string:MU">Mauritius</option>
<option label="Mayotte" value="string:YT">Mayotte</option>
<option label="Mexico" value="string:MX">Mexico</option>
<option label="Micronesia" value="string:FM">Micronesia</option>
<option label="Moldova" value="string:MD">Moldova</option>
<option label="Monaco" value="string:MC">Monaco</option>
<option label="Mongolia" value="string:MN">Mongolia</option>
<option label="Montenegro" value="string:ME">Montenegro</option>
<option label="Montserrat" value="string:MS">Montserrat</option>
<option label="Morocco" value="string:MA">Morocco</option>
<option label="Mozambique" value="string:MZ">Mozambique</option>
<option label="Myanmar" value="string:MM">Myanmar</option>
<option label="Namibia" value="string:NA">Namibia</option>
<option label="Nauru" value="string:NR">Nauru</option>
<option label="Nepal" value="string:NP">Nepal</option>
<option label="Netherlands" value="string:NL">Netherlands</option>
<option label="New Caledonia" value="string:NC">New Caledonia</option>
<option label="New Zealand" value="string:NZ">New Zealand</option>
<option label="Nicaragua" value="string:NI">Nicaragua</option>
<option label="Niger" value="string:NE">Niger</option>
<option label="Nigeria" value="string:NG">Nigeria</option>
<option label="Niue" value="string:NU">Niue</option>
<option label="Norfolk Island" value="string:NF">Norfolk Island</option>
<option label="Northern Mariana Islands" value="string:MP">Northern Mariana Islands</option>
<option label="Norway" value="string:NO">Norway</option>
<option label="Oman" value="string:OM">Oman</option>
<option label="Pakistan" value="string:PK">Pakistan</option>
<option label="Palau" value="string:PW">Palau</option>
<option label="Palestinian Territory" value="string:PS">Palestinian Territory</option>
<option label="Panama" value="string:PA">Panama</option>
<option label="Papua New Guinea" value="string:PG">Papua New Guinea</option>
<option label="Paraguay" value="string:PY">Paraguay</option>
<option label="Peru" value="string:PE">Peru</option>
<option label="Philippines" value="string:PH">Philippines</option>
<option label="Pitcairn" value="string:PN">Pitcairn</option>
<option label="Poland" value="string:PL">Poland</option>
<option label="Portugal" value="string:PT">Portugal</option>
<option label="Puerto Rico" value="string:PR">Puerto Rico</option>
<option label="Qatar" value="string:QA">Qatar</option>
<option label="Republic of the Congo" value="string:CG">Republic of the Congo</option>
<option label="Reunion" value="string:RE">Reunion</option>
<option label="Romania" value="string:RO">Romania</option>
<option label="Russia" value="string:RU">Russia</option>
<option label="Rwanda" value="string:RW">Rwanda</option>
<option label="Saint Barthelemy" value="string:BL">Saint Barthelemy</option>
<option label="Saint Helena" value="string:SH">Saint Helena</option>
<option label="Saint Kitts and Nevis" value="string:KN">Saint Kitts and Nevis</option>
<option label="Saint Lucia" value="string:LC">Saint Lucia</option>
<option label="Saint Martin" value="string:MF">Saint Martin</option>
<option label="Saint Pierre and Miquelon" value="string:PM">Saint Pierre and Miquelon</option>
<option label="Saint Vincent and the Grenadines" value="string:VC">Saint Vincent and the Grenadines</option>
<option label="Samoa" value="string:WS">Samoa</option>
<option label="San Marino" value="string:SM">San Marino</option>
<option label="Sao Tome and Principe" value="string:ST">Sao Tome and Principe</option>
<option label="Saudi Arabia" value="string:SA">Saudi Arabia</option>
<option label="Senegal" value="string:SN">Senegal</option>
<option label="Serbia" value="string:RS">Serbia</option>
<option label="Seychelles" value="string:SC">Seychelles</option>
<option label="Singapore" value="string:SG">Singapore</option>
<option label="Sint Maarten" value="string:SX">Sint Maarten</option>
<option label="Slovakia" value="string:SK">Slovakia</option>
<option label="Slovenia" value="string:SI">Slovenia</option>
<option label="Solomon Islands" value="string:SB">Solomon Islands</option>
<option label="South Africa" value="string:ZA">South Africa</option>
<option label="South Georgia and the South Sandwich Islands" value="string:GS">South Georgia and the South Sandwich Islands</option>
<option label="South Korea" value="string:KR">South Korea</option>
<option label="South Sudan" value="string:SS">South Sudan</option>
<option label="Spain" value="string:ES">Spain</option>
<option label="Sri Lanka" value="string:LK">Sri Lanka</option>
<option label="Suriname" value="string:SR">Suriname</option>
<option label="Svalbard and Jan Mayen" value="string:SJ">Svalbard and Jan Mayen</option>
<option label="Swaziland" value="string:SZ">Swaziland</option>
<option label="Sweden" value="string:SE">Sweden</option>
<option label="Switzerland" value="string:CH">Switzerland</option>
<option label="Taiwan" value="string:TW">Taiwan</option>
<option label="Tajikistan" value="string:TJ">Tajikistan</option>
<option label="Tanzania" value="string:TZ">Tanzania</option>
<option label="Thailand" value="string:TH">Thailand</option>
<option label="Togo" value="string:TG">Togo</option>
<option label="Tokelau" value="string:TK">Tokelau</option>
<option label="Tonga" value="string:TO">Tonga</option>
<option label="Trinidad and Tobago" value="string:TT">Trinidad and Tobago</option>
<option label="Tunisia" value="string:TN">Tunisia</option>
<option label="Turkey" value="string:TR">Turkey</option>
<option label="Turkmenistan" value="string:TM">Turkmenistan</option>
<option label="Turks and Caicos Islands" value="string:TC">Turks and Caicos Islands</option>
<option label="Tuvalu" value="string:TV">Tuvalu</option>
<option label="U.S. Virgin Islands" value="string:VI">U.S. Virgin Islands</option>
<option label="Uganda" value="string:UG">Uganda</option>
<option label="Ukraine" value="string:UA">Ukraine</option>
<option label="United Arab Emirates" value="string:AE">United Arab Emirates</option>
<option label="United Kingdom" value="string:GB">United Kingdom</option>
<option label="United States" value="string:US" selected="selected">United States</option>
<option label="United States Minor Outlying Islands" value="string:UM">United States Minor Outlying Islands</option>
<option label="Uruguay" value="string:UY">Uruguay</option>
<option label="Uzbekistan" value="string:UZ">Uzbekistan</option>
<option label="Vanuatu" value="string:VU">Vanuatu</option>
<option label="Vatican" value="string:VA">Vatican</option>
<option label="Venezuela" value="string:VE">Venezuela</option>
<option label="Vietnam" value="string:VN">Vietnam</option>
<option label="Wallis and Futuna" value="string:WF">Wallis and Futuna</option>
<option label="Western Sahara" value="string:EH">Western Sahara</option>
<option label="Yemen" value="string:YE">Yemen</option>
<option label="Zambia" value="string:ZM">Zambia</option>
</select>
<!-- ngIf: countryResitrictedText -->
</div>
</div>
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if billing_country fails required" style="display: none;"> Please select your country. </span>
</div>
</div>
</div>
</div>
</div>
<!-- ngInclude: ::template('phone') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('phone')">
<div class="donation-table ng-scope">
<div class="donation-table_label">
<label class="donation-label" data-ng-class="{ required: get.homephone('is_required') }" data-sc-form-error="highlight if member_phone fails">Phone Number</label>
</div>
<div class="donation-table_row">
<div class="donation-table_columns">
<div class="donation-table_column half">
<div data-class="donation-text_input" data-ng-model="MODEL.member_phone" data-ng-required="get.homephone('is_required')" data-sc-phone-input="" data-name="member_phone" aria-label="phone number, numbers only"
class="ng-pristine ng-untouched ng-valid ng-isolate-scope ng-empty ng-valid-phone-number ng-valid-required ng-not-modified"><input inputmode="numeric" type="tel" aria-label="phone number, numbers only" class="donation-text_input"
name="member_phone" placeholder="" data-sc-form-error="highlight if member_phone fails" ng-required="" aria-invalid="false"></div>
</div>
</div>
<div aria-live="polite" role="alert">
<span class="donation-error ng-binding" data-sc-form-error="show if member_phone fails phoneNumber" style="display: none;"> Please enter a valid phone number. </span>
<span class="donation-error ng-binding" data-sc-form-error="show if member_phone fails required" style="display: none;"> Don't forget your phone number. </span>
</div>
</div>
</div>
</div>
<!-- ngIf: show.cellPhone() -->
<!-- ngIf: show.comment() --><!-- ngInclude: ::template('comment') -->
<div data-heap-ignore="true" class="mp-sensitive ng-scope" data-ng-include="::template('comment')" data-ng-if="show.comment()">
<div class="donation-table ng-scope">
<div class="donation-table_label">
<label for="text-area-comment" class="donation-label" data-sc-form-error="highlight if comment fails">Leave a comment</label>
</div>
<div class="donation-table_row">
<div class="donation-table_columns">
<div class="donation-table_column">
<froala-field id="text-area-comment" model="MODEL.comment" name="comment" froala-options="froalaCommentOptions" wrapper-class="'form__froala-wrapper--dark create-flow_textarea-wrap'" aria-label="Leave a comment"
aria-roledescription="textbox" class="ng-isolate-scope">
<div class="froala-field form_field full">
<form-label required="$ctrl.required" _spec="label" class="ng-isolate-scope">
<div class="form__label" ng-class="{ required: $ctrl.required }" ng-transclude="">
</div>
</form-label>
<!-- ngIf: $ctrl.sublabel -->
<div class="form__froala-wrapper--dark create-flow_textarea-wrap" sc-error-class="$ctrl.name" _spec="wrapper" data-ng-class="{ 'admin-body__lock-field form__text-input__outer': $ctrl.lockField }">
<!-- ngIf: $ctrl.lockField -->
<div class="fr-box textarea-theme fr-basic fr-bottom">
<div class="fr-wrapper show-placeholder" dir="auto">
<div class="fr-element fr-view" dir="auto" contenteditable="true" aria-disabled="false" aria-label="Leave a comment" spellcheck="true">
<p><br></p>
</div><span class="fr-placeholder" style="font-size: 16px; line-height: 24px; margin-top: 0px; padding-top: 10px; padding-left: 10px; margin-left: 0px; padding-right: 10px; margin-right: 0px; text-align: start;">Type
something</span>
</div>
<div class="fr-toolbar textarea-theme fr-desktop fr-bottom fr-basic" style="" aria-disabled="false"></div><span class="fr-counter" style="bottom: 0px; margin-bottom: 0px; margin-right: 0px;">0/1000</span>
</div><textarea data-ng-model="$ctrl.modelGetterSetter" ng-model-options="{ getterSetter: true }" data-parse-merge-tags="$ctrl.parseMergeTags" data-alt-ng-model="$ctrl.altModel" ng-required="$ctrl.required"
sc-validity-reporter="" sc-validity-classes="" data-froala="$ctrl.froalaOptions" name="" ng-change="$ctrl.onChange()" qa-id="text-area-field" _spec="input"
class="ng-pristine ng-untouched ng-valid ng-isolate-scope ng-empty sc-valid ng-valid-required ng-not-modified ng-valid-parse" id="froala-0" style="display: none;"></textarea>
<!-- Merge Tag Tooltip Template -->
<!-- ngIf: $ctrl.parseMergeTags -->
</div>
<div data-ng-class="{ 'admin-body__lock-field form__text-input__outer': $ctrl.lockCheckboxField }">
<!-- ngIf: $ctrl.lockCheckboxField -->
<!-- ngIf: $ctrl.checkboxModel !== undefined -->
</div>
<form-error name="$ctrl.name" messages="$ctrl.errorMessages" _spec="errors" class="ng-isolate-scope">
<p class="form__error" aria-live="polite" role="alert" sc-validity-message="::$ctrl.name" messages="::$ctrl.messages"></p>
</form-error>
</div>
</froala-field>
</div>
</div>
</div>
</div>
</div><!-- end ngIf: show.comment() -->
<!-- ngIf: show.company() -->
<!-- ngIf: show.blog() -->
<!-- ngIf: show.website() -->
<!-- ngIf: show.gender() -->
<!-- ngIf: show.pronoun() -->
<!-- ngIf: show.birthdate() -->
<!-- ngIf: show.customQuestions() -->
</div>
</div>
</section><!-- end ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
<section class="block-component ng-scope" data-ng-repeat="component in list.components | filter:{section:'main'} | orderBy:'order'">
<!-- ngInclude: component.templateUrl -->
<div data-ng-include="component.templateUrl" class="ng-scope">
<div data-ng-controller="frsDonationPaymentCtrl" id="df_checkout_donation-payment" class="donation-payment ng-scope" aria-label="Payment Details">
<div>
<cp-payment-widget id="classy-payment-widget" api="API" payment="MODEL.payment" submit-digital-wallets="submitDigitalWallets" fee-processing="globalState.feeProcessing" meta="META" parent-model="MODEL" hide-postal="true"
currency="MODEL.payment.raw_currency_code" validate-form="helpers.validateForm" class="ng-isolate-scope">
<div class="donation-payment-method-select row ng-hide" ng-hide="$ctrl.hideButtons">
<div class="eg-payment-button-mask ng-hide" data-ng-show="!$ctrl.arePaymentButtonEnabled"></div>
<div class="column-md-7">
<summary-amount amount="$ctrl.meta.summaryAmount" recur_until="$ctrl.parentModel.recur_until" feeprocessing="$ctrl.feeProcessing" frequency="$ctrl.parentModel.frequency" taxcompliance="$ctrl.meta.unsupportedTaxCompliance"
currency="$ctrl.parentModel.payment.raw_currency_code" estimatedcharge="$ctrl.meta.estimatedCharge" class="ng-isolate-scope">
<p class="donation-summary-amount">
<span class="sr-only">your currently selected donation amount is </span>
<!-- ngIf: !$ctrl.preventRecurringFrequency --><span class="donation-summary-amount-label ng-binding ng-scope" aria-hidden="true" ng-if="!$ctrl.preventRecurringFrequency">One-time
donation</span><!-- end ngIf: !$ctrl.preventRecurringFrequency -->
<!-- ngIf: $ctrl.preventRecurringFrequency -->
<span class="donation-summary-amount-amount ng-binding" data-ng-class="{ processing: $ctrl.feeprocessing }"> €150.00<!-- ngIf: $ctrl.preventRecurringFrequency -->
<span class="donation-summary-amount-currency ng-binding">EUR</span>
<span class="donation-summary-amount-processing">
<span class="donation-summary-amount-processing-spinner"></span>
</span>
</span>
<!-- ngIf: !$ctrl.preventRecurringFrequency && $ctrl.recurUntil -->
<!-- ngIf: !$ctrl.preventRecurringFrequency --><span class="donation-summary-amount-date ng-binding ng-scope" ng-if="!$ctrl.preventRecurringFrequency"></span><!-- end ngIf: !$ctrl.preventRecurringFrequency -->
<!-- ngIf: $ctrl.taxCompliance -->
</p>
</summary-amount>
<fee-on-top fot="$ctrl.parentModel.fee_on_top" class="ng-isolate-scope"><!-- ngIf: $ctrl.showFOT() -->
<div class="donation-table ng-scope" ng-if="$ctrl.showFOT()" style="margin-top:0">
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column">
<button type="button" class="fot-checkbox sc-checkbox " data-ng-click="toggle()" role="checkbox" aria-checked="false" data-sc-checkbox="" data-ng-model="$ctrl.fot" name="donation_fot" data-id="DCF-check"
aria-label="I’d like to cover the fees associated with my donation so more of my donation goes directly to Petaluma Valley Hospital Foundation."><span class="sc-checkbox_input"></span><span class="sc-checkbox_label"
data-ng-transclude="" aria-hidden="true">
<span data-sc-ctx-bind-html="$ctrl.classyModeAppeal() | scTrustedHtml" class="ng-scope">
<p>I’d like to cover the fees associated with my donation so more of my donation goes directly to Petaluma Valley Hospital Foundation.</p>
</span>
</span></button>
</div>
</div>
</div>
</div><!-- end ngIf: $ctrl.showFOT() -->
</fee-on-top>
</div>
<div class="column-md-5">
<small class="cp-payment-widget__terms ng-binding" ng-bind-html="$ctrl.terms()">By donating, you agree to <a href="https://www.classy.org/terms" target="_blank">Classy's Terms</a> and
<a href="https://www.classy.org/terms/privacy/" target="_blank">Privacy Policy</a>. Classy facilitates your donations.</small>
<!-- ngIf: !$ctrl.isTrial --><cp-digital-wallets data-ng-if="!$ctrl.isTrial" frequency="$ctrl.parentModel.frequency" amount="$ctrl.getAmount()" currency="$ctrl.parentModel.payment.raw_currency_code" submit="$ctrl.submitDigitalWallets"
pay-type="$ctrl.meta.digitalWalletType" fot="$ctrl.parentModel.fee_on_top" classymode="$ctrl.isClassyMode" validate-form="$ctrl.validateForm()"
class="ng-scope ng-isolate-scope"><!-- ngIf: $ctrl.showDigitalWallets --></cp-digital-wallets><!-- end ngIf: !$ctrl.isTrial -->
<!-- ngIf: $ctrl.show.paypal() && !$ctrl.isTrial -->
<!-- ngIf: $ctrl.show.paypalCommerce() || $ctrl.show.venmo() -->
<button data-tracked-element="donation-page_checkout_credit-card-btn" class="payment-method-select-btn__cc" type="button" style="background:rgb(0, 51, 142)" ng-click="$ctrl.showCardInputs()" aria-expanded="true"
aria-controls="donation-page_checkout_payment-form donation-page_checkout_payment-details" data-id="paymethod-card">Credit Card</button>
<!-- ngIf: $ctrl.show.achButton() && !$ctrl.isTrial -->
<!-- ngIf: $ctrl.show.accountRoutingButton() && !$ctrl.isTrial -->
<!-- ngIf: $ctrl.show.crypto() && !$ctrl.isTrial -->
<small class="cp-payment-widget__powered"> Powered by Classy from GoFundMe </small>
</div>
</div>
<!-- ngIf: $ctrl.meta.showPaymentDetails -->
<div class="donation-border-top ng-scope" ng-if="$ctrl.meta.showPaymentDetails"></div><!-- end ngIf: $ctrl.meta.showPaymentDetails -->
<!-- ngIf: $ctrl.meta.showPaymentDetails -->
<div ng-if="$ctrl.meta.showPaymentDetails" id="donation-page_checkout_payment-details" class="ng-scope">
<h2 class="donation-subtitle" id="donationPage_payment-details-heading">Payment Details</h2>
<cp-payment-details label="$ctrl.getPaymentLabel()" details="$ctrl.paymentDetails" payment-method="$ctrl.getPaymentMethod()" payment="$ctrl.payment" show="$ctrl.show" on-token="$ctrl.handleTokenexToken(token)"
on-card="$ctrl.handleTokenexCard(brand, lastFour)" primary-color="$ctrl.theme.styles.primaryColor" hide-postal="$ctrl.hidePostal" currency="$ctrl.currency" class="ng-isolate-scope">
<div class="donation-table payment-details">
<div class="donation-table_label ng-hide" data-ng-hide="$ctrl.show.cc()">
<!-- ngIf: $ctrl.paymentMethod === 'PayPal_Commerce' && $ctrl.payment.paypal_commerce.status === 'success' || $ctrl.paymentMethod === 'PayPal' -->
<!-- ngIf: $ctrl.paymentMethod === 'Venmo' && $ctrl.payment.venmo.status === 'success' -->
<!-- ngIf: $ctrl.show.stripe() -->
<!-- ngIf: $ctrl.show.accountRouting() -->
<!-- ngIf: $ctrl.paymentMethod === 'ACH' && !$ctrl.show.accountRouting() -->
</div>
<div class="donation-table_row">
<div class="donation-table_columns">
<div class="donation-table_column">
<div class="cp-payment-widget">
<!-- ngIf: $ctrl.show.cc() --><cp-credit-card-widget data-ng-if="$ctrl.show.cc()" payment="$ctrl.payment.cc" on-token="$ctrl.onToken({token})" on-card="$ctrl.onCard({brand, lastFour})" primary-color="$ctrl.primaryColor"
hide-postal="$ctrl.hidePostal" hide-label="true" class="ng-scope ng-isolate-scope">
<div class="cp-credit-card"
ng-class="{ 'details-mode': $ctrl.mode === 'details', 'details-mode-visited': $ctrl.modeChanged, 'loaded': $ctrl.loaded, 'has-postal': !$ctrl.hidePostal, 'is-amex': $ctrl.payment.brand === 'americanExpress' }">
<form-label ng-hide="$ctrl.hideLabel" required="true" _spec="label" class="ng-isolate-scope ng-hide">
<div class="form__label required" ng-class="{ required: $ctrl.required }" ng-transclude="">Card number</div>
</form-label>
<ng-form name="$ctrl.form" sc-validity-reporter="$ctrl.formName" class="cp-credit-card-form ng-invalid ng-invalid-required ng-invalid-sc-pattern ng-valid-cp-expiration-date ng-dirty">
<div class="cp-credit-card__frame" ng-class="{ error: $ctrl.numberInvalid }" _spec="frame">
<div class="cp-credit-card__carousel">
<div class="cp-credit-card__number">
<div class="donation-label required">Card Number</div>
<div id="cc-entry-el" class="sr-only" tabindex="-1" aria-hidden="true">tab to enter credit card field</div>
<cp-tokenizer-control ng-model="$ctrl.payment.token" cmd-event="'tokenizer'" on-valid="$ctrl.handleValidCard(brand, lastFour)" on-token="$ctrl.handleToken(token)" on-reset="$ctrl.handleReset()" name="token"
card-brand="$ctrl.payment.brand" sc-autofocus="1" sc-validity-reporter="" required="" class="ng-untouched ng-isolate-scope ng-empty ng-invalid ng-invalid-required ng-not-modified ng-pristine">
<span class="cp-tokenizer-control__status" ng-class="{ loading: $ctrl.isLoading }" aria-live="polite" title="payment card input is ready">
<span class="cp-tokenizer-control__status-loading" aria-hidden="true"></span>
<span class="cp-tokenizer-control__status-ready" aria-hidden="true">
<i class="ci ci-credit-card cp-tokenizer-control__status-icon" aria-hidden="true"></i>
</span>
</span>
<span id="cp-tokenizer-control__iframe" data-tracked-element="donation-page_checkout_tokenex-cc-input" class="cp-tokenizer-control__iframe" title="please enter your payment card information"><iframe
src="https://htp.tokenex.com/iframe/v3?AuthenticationKey=14VRFUm9SUOIiLD6kI%2FkZ6tBh3Xj8M%2FHkUQO1EiC6CU%3D&Origin=https%3A%2F%2Fgive.givetopvh.org&TokenExID=7896239581428323&Timestamp=20241217123926&Container=cp-tokenizer-control__iframe&Mode=Data&PCI=true&EnforceLuhnCompliance=true&TokenScheme=sixTOKENfour&ExpiresInSeconds=1200"
frameborder="0" width="100%" height="100%" id="tx_iframe_cp-tokenizer-control__iframe" name="tx_iframe_cp-tokenizer-control__iframe" data-airgap-id="37" title="Credit Card details"></iframe></span>
<!-- ngIf: $ctrl.cardBrand --></cp-tokenizer-control>
</div>
<div class="cp-credit-card__details">
<button class="cp-credit-card__go-to-number" ng-click="$ctrl.userChangeMode('number')" type="button" aria-label="go back to payment card number field for payment">
<!-- Brand icon -->
<span class="cp-credit-card__brand ng-binding" ng-bind-html="$ctrl.brandIcon()"><i class="cp-credit-card__brand-icon ci ci-credit-card"></i></span>
<!-- Last four -->
<span class="cp-credit-card__last-four ng-binding"> 1234 </span>
</button>
<span class="sr-only" aria-label="your current payment card brand is with the last four digits " aria-live="polite"></span>
</div>
</div>
</div>
<div class="cp-credit-card-field-box" ng-class="{ error: $ctrl.expirationDateInvalid }">
<span class="donation-label required">Expiration Date</span>
<div class="cp-credit-card-field" ng-class="{errorField: $ctrl.expirationDateInvalid}">
<!-- Expiration month -->
<input class="cp-credit-card__month ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-sc-pattern ng-invalid-required ng-not-modified ng-valid-cp-expiration-date" ng-model="$ctrl.payment.expirationMonth"
sc-validity-reporter="" sc-pattern="^(0[1-9]|1[0-2])$" sc-restrict-input="^(0[1-9]?|1[0-2]?)$" cp-validate-expiration="$ctrl.payment" placeholder="MM" name="expirationMonth" sc-autofocus="2"
aria-label="please enter your payment card expiration month" autocomplete="cc-exp-month" required="">
<!-- Expiration slash -->
<span class="cp-credit-card__slash">/</span>
<!-- Expiration year -->
<input class="cp-credit-card__year ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-sc-pattern ng-invalid-required ng-not-modified ng-valid-cp-expiration-date" ng-model="$ctrl.payment.expirationYear"
sc-validity-reporter="" sc-pattern="^[0-9]{2}$" sc-restrict-input="^[0-9]{0,2}$" cp-validate-expiration="$ctrl.payment" sc-autofocus="3" placeholder="YY" name="expirationYear"
aria-label="please enter the last 2 digits of your payment card expiration year" autocomplete="cc-exp-year" required="">
</div>
</div>
<div class="cp-credit-card-field-box" ng-class="{ error: $ctrl.securityCodeInvalid }">
<!-- Security code -->
<span class="donation-label required">Security code</span>
<div class="cp-credit-card-field" ng-class="{errorField: $ctrl.securityCodeInvalid}">
<input class="cp-credit-card__security-code ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-sc-pattern ng-invalid-required ng-not-modified" ng-model="$ctrl.payment.securityCode" sc-pattern="^[0-9]{3}$"
sc-restrict-input="^[0-9]{0,4}$" sc-validity-reporter="" placeholder="CVV" name="securityCode" aria-label="please enter your payment card security code" autocomplete="cc-csc" sc-autofocus="4" required="">
</div>
</div>
<!-- ngIf: !$ctrl.hidePostal -->
</ng-form>
<!-- ngIf: $ctrl.errorVisible -->
</div>
</cp-credit-card-widget><!-- end ngIf: $ctrl.show.cc() -->
<!-- ngIf: $ctrl.show.stripe() -->
</div>
<!-- ngIf: $ctrl.show.accountRouting() -->
<div ng-hide="$ctrl.show.accountRouting() || $ctrl.show.cc() || $ctrl.show.stripe()" class="ng-binding ng-hide"> <span class="payment-details-change ng-hide" ng-click="$ctrl.changeAccount($ctrl.paymentMethod)"
ng-show="!$ctrl.waitingChange && !$ctrl.paymentMethod === 'PayPal_Commerce'">change</span></div>
<div class="payment-details-openModal ng-hide" ng-show="$ctrl.waitingChange && $ctrl.changeAccountTo === 'PayPal'" ng-click="$ctrl.openModal()">Connect to PayPal</div>
<div class="payment-details-openModal ng-hide" ng-show="$ctrl.waitingChange && $ctrl.changeAccountTo === 'ACH'" ng-click="$ctrl.openModal()">Link to Bank Account</div>
</div>
</div>
</div>
</div>
</cp-payment-details>
<cp-donate-footer donation-frequency="$ctrl.parentModel.frequency" donation-currency="$ctrl.parentModel.payment.raw_currency_code" donation-amount="$ctrl.meta.summaryAmount" btn-color="$ctrl.theme.styles.primaryColor"
class="ng-isolate-scope"><!-- ngIf: $ctrl.is.accessible -->
</cp-donate-footer>
</div><!-- end ngIf: $ctrl.meta.showPaymentDetails -->
</cp-payment-widget>
</div>
<!-- ngIf: META.showPaymentDetails -->
<div ng-if="META.showPaymentDetails" id="donation-page_checkout_payment-form" class="ng-scope">
<!-- ngIf: show.companyName() -->
<!-- ngIf: show.companyName() && META.showCompanyName -->
</div><!-- end ngIf: META.showPaymentDetails -->
</div>
</div>
</section><!-- end ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
<section class="block-component ng-scope" data-ng-repeat="component in list.components | filter:{section:'main'} | orderBy:'order'">
<!-- ngInclude: component.templateUrl -->
<div data-ng-include="component.templateUrl" class="ng-scope">
<section id="df_checkout_donation-footer" class="donation-footer ng-scope" data-ng-controller="frsDonationFooterCtrl" data-ng-show="META.showPaymentDetails">
<div class="donation-footer_container">
<!-- ngIf: show.terms() --><small data-ng-if="show.terms()" class="donation-footer_terms ng-binding ng-scope" ng-bind-html="build.terms()">By donating, you agree to <a href="https://www.classy.org/terms" target="_blank">Classy's Terms</a>
and <a href="https://www.classy.org/terms/privacy/" target="_blank">Privacy Policy</a>. Classy facilitates your donations.</small><!-- end ngIf: show.terms() -->
<!-- ngIf: show.feeOnTop() --><fee-on-top ng-if="show.feeOnTop()" fot="MODEL.fee_on_top" class="ng-scope ng-isolate-scope"><!-- ngIf: $ctrl.showFOT() -->
<div class="donation-table ng-scope" ng-if="$ctrl.showFOT()" style="margin-top:0">
<div class="donation-table_row">
<div class="donation-table_columns donation-table_columns_without_margin">
<div class="donation-table_column">
<button type="button" class="fot-checkbox sc-checkbox " data-ng-click="toggle()" role="checkbox" aria-checked="false" data-sc-checkbox="" data-ng-model="$ctrl.fot" name="donation_fot" data-id="DCF-check"
aria-label="I’d like to cover the fees associated with my donation so more of my donation goes directly to Petaluma Valley Hospital Foundation."><span class="sc-checkbox_input"></span><span class="sc-checkbox_label"
data-ng-transclude="" aria-hidden="true">
<span data-sc-ctx-bind-html="$ctrl.classyModeAppeal() | scTrustedHtml" class="ng-scope">
<p>I’d like to cover the fees associated with my donation so more of my donation goes directly to Petaluma Valley Hospital Foundation.</p>
</span>
</span></button>
</div>
</div>
</div>
</div><!-- end ngIf: $ctrl.showFOT() -->
</fee-on-top><!-- end ngIf: show.feeOnTop() -->
<div class="donation-footer_controls">
<!-- ngIf: !editable --><button id="donate-cta-main" data-id="cp-donation-form-donate" class="donation-footer_submit ng-binding ng-scope" ng-if="!editable" data-ng-style="{'background-color': theme.current.styles.primaryColor}"
data-ng-disabled="globalState.processing || globalState.submitDisabled" data-ng-bind="block['submit-button-text'] || 'Donate' " aria-label="click give now to donate €150.00" type="submit" style="background-color: rgb(0, 51, 142);">Give
now!</button><!-- end ngIf: !editable -->
<!-- ngIf: editable -->
</div>
<div class="donation-footer_summary">
<!-- ngIf: show.creditee() -->
<summary-amount amount="META.summaryAmount" recur_until="MODEL.recur_until" feeprocessing="globalState.feeProcessing" frequency="MODEL.frequency" taxcompliance="META.unsupportedTaxCompliance" currency="MODEL.payment.raw_currency_code"
estimatedcharge="META.estimatedCharge" class="ng-isolate-scope">
<p class="donation-summary-amount">
<span class="sr-only">your currently selected donation amount is </span>
<!-- ngIf: !$ctrl.preventRecurringFrequency --><span class="donation-summary-amount-label ng-binding ng-scope" aria-hidden="true" ng-if="!$ctrl.preventRecurringFrequency">One-time
donation</span><!-- end ngIf: !$ctrl.preventRecurringFrequency -->
<!-- ngIf: $ctrl.preventRecurringFrequency -->
<span class="donation-summary-amount-amount ng-binding" data-ng-class="{ processing: $ctrl.feeprocessing }"> €150.00<!-- ngIf: $ctrl.preventRecurringFrequency -->
<span class="donation-summary-amount-currency ng-binding">EUR</span>
<span class="donation-summary-amount-processing">
<span class="donation-summary-amount-processing-spinner"></span>
</span>
</span>
<!-- ngIf: !$ctrl.preventRecurringFrequency && $ctrl.recurUntil -->
<!-- ngIf: !$ctrl.preventRecurringFrequency --><span class="donation-summary-amount-date ng-binding ng-scope" ng-if="!$ctrl.preventRecurringFrequency"></span><!-- end ngIf: !$ctrl.preventRecurringFrequency -->
<!-- ngIf: $ctrl.taxCompliance -->
</p>
</summary-amount>
</div>
<!-- ngIf: show.terms() --><small ng-if="show.terms()" class="donation-footer_powered ng-scope"> Powered by Classy from GoFundMe </small><!-- end ngIf: show.terms() -->
<!-- ngIf: META.unsupportedTaxCompliance -->
<div class="donation-footer__compliance--unsupported ng-scope" ng-if="META.unsupportedTaxCompliance">
<div class="donation-footer__compliance-img">
<i class="ci ci-world-hands"></i>
</div>
<div class="donation-footer__compliance-text">
<span class="donation-footer__compliance-title">International Gift</span>
<p class="ng-binding"> You are giving to an organization located in United States. This donation will be processed and receipted in USD and deposited to a US bank account. Contributions are tax deductible to the extent allowed by the
laws of your country. Consult your local tax professional. </p>
</div>
</div><!-- end ngIf: META.unsupportedTaxCompliance -->
</div>
</section>
<div class="donation-border-top donation-footer__compliance ng-scope ng-hide" ng-show="META.showTaxComplianceLanguage">
<p ng-bind-html="META.taxComplianceLanguage" class="ng-binding"></p>
</div>
</div>
</section><!-- end ngRepeat: component in list.components | filter:{section:'main'} | orderBy:'order' -->
</form>Text Content
Close UNTIL MIDNIGHT DECEMBER 31, YOUR GIFT WILL BE MATCHED Thanks to one generous donor, your donation will be MATCHED, DOLLAR FOR DOLLAR — up to $25,000. Your gift will go twice as far to advance patient care, invest in leading-edge technology, and train the next generation of health care professionals. Please note: All funds from our matching donor are designated to the area of greatest need. One-time monthly Choose a one-time amount * €48 * €150 * €480 * €1,000 * AED | United Arab Emirates DirhamAFN | Afghan AfghaniALL | Albanian LekAMD | Armenian DramANG | Netherlands Antillean GuilderAOA | Angolan KwanzaARS | Argentine PesoAUD | Australian DollarAWG | Aruban FlorinAZN | Azerbaijani ManatBAM | Bosnia And Herzegovina Convertible MarkBBD | Barbados DollarBDT | Bangladeshi TakaBGN | Bulgarian LevBHD | Bahraini DinarBIF | Burundian FrancBMD | Bermudian Dollar (customarily Known As Bermuda Dollar)BND | Brunei DollarBOB | BolivianoBRL | Brazilian RealBSD | Bahamian DollarBTN | Bhutanese NgultrumBWP | Botswana PulaBZD | Belize DollarCAD | Canadian DollarCDF | Congolese FrancCHF | Swiss FrancCLF | Unidad De Fomento (funds Code)CLP | Chilean PesoCNY | Chinese YuanCOP | Colombian PesoCRC | Costa Rican ColonCUC | Cuban Convertible PesoCUP | Cuban PesoCVE | Cape Verde EscudoCZK | Czech KorunaDJF | Djiboutian FrancDKK | Danish KroneDOP | Dominican PesoDZD | Algerian DinarEGP | Egyptian PoundERN | Eritrean NakfaETB | Ethiopian BirrEUR | EuroFJD | Fiji DollarFKP | Falkland Islands PoundGBP | Pound SterlingGEL | Georgian LariGHS | Ghanaian CediGIP | Gibraltar PoundGMD | Gambian DalasiGNF | Guinean FrancGTQ | Guatemalan QuetzalGYD | Guyanese DollarHKD | Hong Kong DollarHNL | Honduran LempiraHTG | Haitian GourdeHUF | Hungarian ForintIDR | Indonesian RupiahILS | Israeli New ShekelINR | Indian RupeeIQD | Iraqi DinarIRR | Iranian RialISK | Icelandic KrónaJMD | Jamaican DollarJOD | Jordanian DinarJPY | Japanese YenKES | Kenyan ShillingKGS | Kyrgyzstani SomKHR | Cambodian RielKMF | Comoro FrancKPW | North Korean WonKRW | South Korean WonKWD | Kuwaiti DinarKYD | Cayman Islands DollarKZT | Kazakhstani TengeLAK | Lao KipLBP | Lebanese PoundLKR | Sri Lankan RupeeLRD | Liberian DollarLSL | Lesotho LotiLYD | Libyan DinarMAD | Moroccan DirhamMDL | Moldovan LeuMGA | Malagasy AriaryMKD | Macedonian DenarMMK | Myanma KyatMNT | Mongolian TugrikMOP | Macanese PatacaMUR | Mauritian RupeeMVR | Maldivian RufiyaaMWK | Malawian KwachaMXN | Mexican PesoMYR | Malaysian RinggitMZN | Mozambican MeticalNAD | Namibian DollarNGN | Nigerian NairaNIO | Nicaraguan CórdobaNOK | Norwegian KroneNPR | Nepalese RupeeNZD | New Zealand DollarOMR | Omani RialPAB | Panamanian BalboaPEN | Peruvian Nuevo SolPGK | Papua New Guinean KinaPHP | Philippine PesoPKR | Pakistani RupeePLN | Polish ZłotyPYG | Paraguayan GuaraníQAR | Qatari RiyalRON | Romanian New LeuRSD | Serbian DinarRWF | Rwandan FrancSAR | Saudi RiyalSBD | Solomon Islands DollarSCR | Seychelles RupeeSDG | Sudanese PoundSEK | Swedish Krona/kronorSGD | Singapore DollarSHP | Saint Helena PoundSLL | Sierra Leonean LeoneSOS | Somali ShillingSRD | Surinamese DollarSSP | South Sudanese PoundSTD | São Tomé And Príncipe DobraSYP | Syrian PoundSZL | Swazi LilangeniTHB | Thai BahtTJS | Tajikistani SomoniTMT | Turkmenistani ManatTND | Tunisian DinarTOP | Tongan PaʻangaTRY | Turkish LiraTTD | Trinidad And Tobago DollarTWD | New Taiwan DollarTZS | Tanzanian ShillingUAH | Ukrainian HryvniaUGX | Ugandan ShillingUSD | United States DollarUYU | Uruguayan PesoUZS | Uzbekistan SomVND | Vietnamese DongVUV | Vanuatu VatuWST | Samoan TalaXAF | CFA Franc BEACXCD | East Caribbean DollarXDR | Special Drawing RightsXOF | CFA Franc BCEAOXPF | CFP FrancYER | Yemeni RialZAR | South African Rand EUR € Dedicate my donation in honor or in memory of someone Type In honor of … In memory of … Honoree’s First Name Honoree’s Last Name Don't forget to give us a name for the dedication. YOUR INFORMATION First Name Last Name Be sure to provide your name. Email Don't forget your email address. Please enter in the format: name@domain.com. Your receipt will be emailed here. Address Don't forget to provide an address. Add apt., suite, floor ZIP City Don't forget to provide a city. State Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (the) AmericasArmed Forces EuropeArmed Forces PacificAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoVirgin Islands Don't forget to provide a state. Province Please SelectAlberta (AB)British Columbia (BC)Manitoba (MB)New Brunswick (NB)Newfoundland and Labrador (NL)Northwest Territories (NT)Nova Scotia (NS)Nunavut (NU)Prince Edward Island (PE)Saskatchewan (SK)Ontario (ON)Quebec (QC)Yukon (YT) Don't forget to provide a province. Region Don't forget to provide a region. Country Please SelectAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and Saba Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the CongoReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambia Please select your country. Phone Number Please enter a valid phone number. Don't forget your phone number. Leave a comment Type something 0/1000 your currently selected donation amount is One-time donation €150.00 EUR I’d like to cover the fees associated with my donation so more of my donation goes directly to Petaluma Valley Hospital Foundation. By donating, you agree to Classy's Terms and Privacy Policy. Classy facilitates your donations. Credit Card Powered by Classy from GoFundMe PAYMENT DETAILS Card number Card Number tab to enter credit card field 1234 Expiration Date / Security code change Connect to PayPal Link to Bank Account By donating, you agree to Classy's Terms and Privacy Policy. Classy facilitates your donations. I’d like to cover the fees associated with my donation so more of my donation goes directly to Petaluma Valley Hospital Foundation. Give now! your currently selected donation amount is One-time donation €150.00 EUR Powered by Classy from GoFundMe International Gift You are giving to an organization located in United States. This donation will be processed and receipted in USD and deposited to a US bank account. Contributions are tax deductible to the extent allowed by the laws of your country. Consult your local tax professional. QUESTIONS Is this donation tax deductible? Petaluma Valley Hospital Foundation is a 501(c)3 tax-exempt organization and your donation is tax-deductible within the guidelines of U.S. law. To claim a donation as a deduction on your U.S. taxes, please keep your email donation receipt as your official record. We'll send it to you upon successful completion of your donation. Have an account? Sign in ❤️ Before you go Would you consider a donation? Your support will help create change and inspire hope throughout our community. Return to donate PETALUMA VALLEY HOSPITAL FOUNDATION 400 N. McDowell Blvd. Petaluma, CA 94954 US Back to top Donor Support pvhfoundation@providence.org 707-778-2796 Copyright ©2024 • All rights reserved • Classy Privacy Policy • Terms of Use • Cookie Statement • DMCA Policy Do Not Sell My Personal Information Have an account? Sign in • Powered by Classy from GoFundMe Hey there! * Sign in * Share this page