secure.everyaction.com
Open in
urlscan Pro
45.60.33.183
Public Scan
Submitted URL: https://donate.ppagwni.org/
Effective URL: https://secure.everyaction.com/iHQ6FraatEugpLoaRaKTAA2
Submission: On September 17 via api from US — Scanned from DE
Effective URL: https://secure.everyaction.com/iHQ6FraatEugpLoaRaKTAA2
Submission: On September 17 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST
<form class="clearfix" method="post" novalidate="" action="" accept-charset="utf-8" autocomplete="on">
<div class="at-markup FastAction" id="NVContributionForm95552-FastAction">
<div class="fastaction-block">
<div class="fastAction clearfix">
<p>
<span class="fa-cta">
<a href="#fastaction-login" class="profile-link" aria-label="FastAction">
<img class="profile-link-fa-image" src="//static.everyaction.com/ea-actiontag/assets/images/fast-action.svg">
</a>
<span><a href="https://fastaction.ngpvan.com##whats-this" class="circle" id="fastaction-whatsthis" data-popup="true" data-popup-width="515" data-popup-height="540" target="_blank">?</a></span>
</span>
<span class="fa-lead"> Take future action with a single click.<br>
<a href="#fastaction-login" class="call-modal" id="fastaction-widget-login">Log in</a> or <a href="#fastaction-signup" class="call-modal" id="fastaction-widget-signup">Sign up</a> for <i>Fast</i><b>Action</b>
</span>
</p>
</div>
</div>
</div>
<div data-name="undefined" data-subview="submit_view" data-subview-index="3"></div>
<fieldset class="at-fieldset ContributionInformation" id="NVContributionForm95552-ContributionInformation" style="border: none;">
<legend class="at-legend">Contribution Information</legend>
<div class="at-fields">
<div class="at-row at-row-full ">
<input id="ProcessingCurrency_Value" type="hidden" name="ProcessingCurrency.Value" value="USD">
</div>
<div class="at-row at-row-full ">
<div class="form-item form-type-radios form-item-selectamount" id="NVContributionForm95552-ContributionInformation-SelectAmount">
<div class="at-row SelectAmount OtherAmount NonRecurringButtons">
<div class="at-radio">
<div class="at-radios clearfix">
<label class="label-amount" title="$20">
<input name="SelectAmount" type="radio" value="20.00"> $20 <a></a> </label><label class="label-amount" title="$35">
<input name="SelectAmount" type="radio" value="35.00"> $35 <a></a> </label><label class="label-amount" title="$50">
<input name="SelectAmount" type="radio" value="50.00"> $50 <a></a> </label><label class="label-amount" title="$100">
<input name="SelectAmount" type="radio" value="100.00"> $100 <a></a> </label><label class="label-amount" title="$500">
<input name="SelectAmount" type="radio" value="500.00"> $500 <a></a> </label><label class="label-amount" title="$2,500">
<input name="SelectAmount" type="radio" value="2500.00"> $2,500 <a></a> </label><label class="label-amount label-otheramount" title="Other">
<input name="SelectAmount" type="radio" class="radio-other" value="other"> Other <input type="number" tabindex="-1" autocomplete="transaction-amount" class="edit-otheramount" name="OtherAmount" title="Other Amount"
placeholder="0.00">
<span class="label-otheramount-prefix">$</span>
</label>
</div>
</div>
</div>
</div>
</div>
<div class="at-recurring"><label class="at-check IsRecurring" id="NVContributionForm95552-ContributionInformation-IsRecurring"><input type="checkbox" name="IsRecurring" aria-label="Make this contribution: Monthly"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVContributionForm95552-ContributionInformation-IsRecurring-label">Make this contribution:</span></span>
</label><label class="at-select SelectedFrequency select-collapse" id="NVContributionForm95552-ContributionInformation-SelectedFrequency"><label for="edit-selectedfrequency"> Frequency <small>(Optional)</small></label>
<span class="at-select SelectedFrequency select-collapse" name="SelectedFrequency" id="NVContributionForm95552-ContributionInformation-SelectedFrequency-label"> Monthly </span>
</label></div>
</div>
</fieldset>
<fieldset class="at-fieldset TributeGift" id="NVContributionForm95552-TributeGift">
<div class="at-fields">
<div class="at-row at-row-full EnableTributeGift">
<label class="at-check EnableTributeGift" id="NVContributionForm95552-TributeGift-EnableTributeGift"><input type="checkbox" name="EnableTributeGift"> <span class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVContributionForm95552-TributeGift-EnableTributeGift-label">I'd like to make this contribution in honor or in memory of someone</span></span>
</label>
</div>
<div class="at-row">
<div class="at-tribute-gift" style="display:none">
<div class="form-unit form-unit-radio form-item-inhonororinmemoryof" id="NVContributionForm95552-TributeGift-InHonorOrInMemoryOf"><label id="NVContributionForm95552-TributeGift-InHonorOrInMemoryOf"> Is this an Honorary or Memorial
Gift?</label>
<div class="radios" role="radiogroup" aria-labelledby="NVContributionForm95552-TributeGift-InHonorOrInMemoryOf">
<label title="In honor of" class="at-radio-label-2" role="radio">
<input type="radio" name="InHonorOrInMemoryOf" checked="" value="2"> In honor of </label><label title="In memory of" class="at-radio-label-1" role="radio">
<input type="radio" name="InHonorOrInMemoryOf" value="1"> In memory of </label>
</div>
</div><label class="at-text HonoreeName" id="NVContributionForm95552-TributeGift-HonoreeName">Honoree Name <small>(Optional)</small><input type="text" autocomplete="on" false="" title="Honoree Name" name="HonoreeName" value=""
maxlength="100">
</label>
</div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset RecipientInformation" id="NVContributionForm95552-RecipientInformation" style="display: none;">
<div class="at-fields">
<div class="at-row">
<label class="at-check IncludeRecipient" id="NVContributionForm95552-RecipientInformation-IncludeRecipient"><input type="checkbox" name="IncludeRecipient"> <span class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVContributionForm95552-RecipientInformation-IncludeRecipient-label">I'd like to notify someone of this contribution</span></span>
</label>
</div>
<div class="at-recipient-info" style="display: none;">
<div class="at-title">Who would you like to notify?</div>
<div class="at-row at-row-solo at-row-full RecipientInfoHeaderHtml">
<div class="at-markup RecipientInfoHeaderHtml" id="NVContributionForm95552-RecipientInformation-RecipientInfoHeaderHtml">
<p>A message will be sent to the recipient to inform them of your contribution.</p>
</div>
</div>
<div class="at-row RecipientFirstName RecipientLastName"><label class="at-text RecipientFirstName" id="NVContributionForm95552-RecipientInformation-RecipientFirstName">First Name <small>(Optional)</small><input type="text" autocomplete="on"
false="" title="First Name" name="RecipientFirstName" value="" maxlength="50">
</label><label class="at-text RecipientLastName" id="NVContributionForm95552-RecipientInformation-RecipientLastName">Last Name <small>(Optional)</small><input type="text" autocomplete="on" false="" title="Last Name"
name="RecipientLastName" value="" maxlength="50">
</label></div>
<div class="at-row at-row-solo RecipientStreetAddress"><label class="at-text RecipientStreetAddress" id="NVContributionForm95552-RecipientInformation-RecipientStreetAddress">Street Address <small>(Optional)</small><input type="text"
autocomplete="on" false="" title="Street Address" name="RecipientStreetAddress" value="" maxlength="100">
</label></div>
<div class="at-row RecipientCountry RecipientPostalCode RecipientCity RecipientStateProvince"><label class="at-select RecipientCountry" id="NVContributionForm95552-RecipientInformation-RecipientCountry">Country
<small>(Optional)</small><select autocomplete="on" title="Country" name="RecipientCountry" class="select2-hidden-accessible" id="NVContributionForm95552-RecipientInformation-RecipientCountry-select" tabindex="-1" aria-hidden="true">
<option value="">- Select -</option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia (Plurinational State of)</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="CV">Cabo Verde</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo (Democratic Republic of the)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czechia</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="SZ">Eswatini</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran (Islamic Republic of)</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea (Democratic People's Republic of)</option>
<option value="KR">Korea (Republic of)</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia (Federated States of)</option>
<option value="MD">Moldova (Republic of)</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MK">North Macedonia</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine (State of)</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania (United Republic of)</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela (Bolivarian Republic of)</option>
<option value="VN">Viet Nam</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 100px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Country" tabindex="0" aria-labelledby="select2-NVContributionForm95552-RecipientInformation-RecipientCountry-select-container"><span class="select2-selection__rendered"
id="select2-NVContributionForm95552-RecipientInformation-RecipientCountry-select-container" title="United States">United States</span><span class="select2-selection__arrow"
role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-text RecipientPostalCode" id="NVContributionForm95552-RecipientInformation-RecipientPostalCode">Postal Code <small>(Optional)</small><input type="tel" autocomplete="on" pattern="^\d{5}([\-]\d{4})?$" false=""
title="Postal Code" name="RecipientPostalCode" value="" maxlength="10">
</label><label class="at-text RecipientCity" id="NVContributionForm95552-RecipientInformation-RecipientCity">City <small>(Optional)</small><input type="text" autocomplete="on" false="" title="City" name="RecipientCity" value=""
maxlength="25">
</label><label class="at-select RecipientStateProvince" id="NVContributionForm95552-RecipientInformation-RecipientStateProvince">State/Province <small>(Optional)</small><select autocomplete="on" title="State/Province"
name="RecipientStateProvince" class="" id="NVContributionForm95552-RecipientInformation-RecipientStateProvince-select">
<option value="">- State -</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="FM">FM</option>
<option value="GU">GU</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
</select>
</label></div>
</div>
<div class="at-row">
<div class="at-recipient-msg" style="display: none;"></div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset ContactInformation" id="NVContributionForm95552-ContactInformation">
<legend class="at-legend">Contact Information</legend>
<div class="at-fields">
<div class="at-row FirstName LastName"><label class="at-text FirstName" id="NVContributionForm95552-ContactInformation-FirstName">First Name<input type="text" autocomplete="given-name" x-autocompletetype="given-name" required=""
title="First Name (required)" name="FirstName" value="" maxlength="20">
</label><label class="at-text LastName" id="NVContributionForm95552-ContactInformation-LastName">Last Name<input type="text" autocomplete="family-name" x-autocompletetype="surname" required="" title="Last Name (required)" name="LastName"
value="" maxlength="25">
</label></div>
<div class="at-row at-row-solo AddressLine1"><label class="at-text AddressLine1" id="NVContributionForm95552-ContactInformation-AddressLine1">Street Address <small>(Optional)</small><input type="text" autocomplete="address-line1"
x-autocompletetype="address-line1" false="" title="Street Address" name="AddressLine1" value="" maxlength="99">
</label></div>
<div class="at-row PostalCode City StateProvince"><label class="at-text PostalCode" id="NVContributionForm95552-ContactInformation-PostalCode">Postal Code<input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code"
pattern="^\d{5}([\-]\d{4})?$" required="" title="Postal Code (required)" name="PostalCode" value="" maxlength="10">
</label><label class="at-text City" id="NVContributionForm95552-ContactInformation-City">City<input type="text" autocomplete="address-level2" x-autocompletetype="locality" required="" title="City (required)" name="City" value=""
maxlength="25">
</label><label class="at-select StateProvince" id="NVContributionForm95552-ContactInformation-StateProvince">State/Province<select required="" autocomplete="address-level1" x-autocompletetype="administrative-area" title="State/Province"
name="StateProvince" class=" required" id="NVContributionForm95552-ContactInformation-StateProvince-select">
<option value="" disabled="">- State -</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="FM">FM</option>
<option value="GU">GU</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
</select>
</label></div>
<div class="at-row EmailAddress MobilePhone"><label class="at-text EmailAddress" id="NVContributionForm95552-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
pattern="^([\w!#$%&'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
name="EmailAddress" value="" maxlength="100" placeholder="email@email.com">
</label><label class="at-text MobilePhone" id="NVContributionForm95552-ContactInformation-MobilePhone">Mobile Phone <small>(Optional)</small>
<div class="intl-tel-input iti iti--allow-dropdown">
<div class="iti__flag-container">
<div class="iti__selected-flag" role="combobox" aria-controls="iti-0__country-listbox" aria-owns="iti-0__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-0__item-us-preferred">
<div class="iti__flag iti__us"></div>
<div class="iti__arrow"></div>
</div>
</div><input type="tel" class="intl-phone-MobilePhone" name="MobilePhone" title="Mobile Phone" data-intl-tel-input-id="0">
</div>
</label></div>
<div class="at-row at-row-solo at-row-full SmsSubscribeMobilePhone"><label class="at-check SmsSubscribeMobilePhone" id="NVContributionForm95552-ContactInformation-SmsSubscribeMobilePhone"><input type="checkbox" checked=""
name="SmsSubscribeMobilePhone"> <span class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVContributionForm95552-ContactInformation-SmsSubscribeMobilePhone-label">Sign me up for SMS messages.</span></span>
</label></div>
<div class="at-row at-row-solo at-row-full SmsLegalDisclaimer at-indented">
<div class="at-markup SmsLegalDisclaimer at-legal" id="NVContributionForm95552-ContactInformation-SmsLegalDisclaimer">
<p>By checking this box, you agree to receive calls and texts to that number from Planned<br> Parenthood organizations that may be automatically dialed or prerecorded on Planned Parenthood issues and other ways to get involved. Msg freq
varies. STOP to quit. Msg & Data Rates May Apply.</p>
</div>
</div>
<div class="at-row at-row-solo at-row-full YesSignMeUpForUpdatesForBinder"><label class="at-check YesSignMeUpForUpdatesForBinder" id="NVContributionForm95552-ContactInformation-YesSignMeUpForUpdatesForBinder"><input type="checkbox" checked=""
name="YesSignMeUpForUpdatesForBinder"> <span class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVContributionForm95552-ContactInformation-YesSignMeUpForUpdatesForBinder-label">I agree to receive emails from Planned
Parenthood organizations. I may unsubscribe at any time.</span></span>
</label></div>
<div class="at-row "><label class="at-text PersonalUrl" id="NVContributionForm95552-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
</label></div>
<div class="at-row ">
<div class="at-markup TrackingPixel" id="NVContributionForm95552-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
src="https://secure.everyaction.com/v1/Track/iHQ6FraatEugpLoaRaKTAA2?formSessionId=f6e6a404-199b-462a-b0fa-6363d39e132c&bName=chrome&dType=desktop&formVersion=7/24/2024 8:38:53 PM|8/5/2024 6:27:25 PM&fUrl=aHR0cHM6Ly9zZWN1cmUuZXZlcnlhY3Rpb24uY29tL2lIUTZGcmFhdEV1Z3BMb2FSYUtUQUEy&fRef="
style="display:none"></div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset PaymentInformation" id="NVContributionForm95552-PaymentInformation">
<legend class="at-legend">Payment Information</legend>
<div class="at-row">
<div class="at-payment-method-buttons" id="NVContributionForm95552-PaymentInformation-PaymentMethod"></div>
</div>
<div class="at-fields">
<div class="at-row "><label class="at-text at-cc-number" id="NVContributionForm95552-PaymentInformation-Account">Card Number<div class="cc-type-wrapper vgs-loading-placeholder" style="display: none;">
<div class="cc-type unknown"></div>
<input type="tel" autocomplete="cc-number" title="Credit Card Number" placeholder="•••• •••• •••• ••••" readonly="true">
</div>
<div id="vgs-Account-95552" class="vgs-cc-iframe-wrapper vgs-input-container vgs-collect-container__empty vgs-collect-container__invalid isEmpty" tabindex="-1"><iframe title="Secure card number input frame"
src="https://js.verygoodvault.com/vgs-collect/2.18.4/lib/index.html#name=Account&placeholder=%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2&type=card-number&validations%5B0%5D=validCardNumber&validations%5B1%5D=required&autoComplete=cc-number&formId=randomId17004851858781849461&fieldId=randomId1701922865913383618&createdAt=1726580815610&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=5958a745-1ad5-4e3b-99ba-7c43a395354f&css%5BfontSize%5D=.875rem&css%5BfontFamily%5D=monospace&css%5BlineHeight%5D=1&css%5BbackgroundColor%5D=%23fff&css%5B%26%3A%3Aplaceholder%5D%5Bcolor%5D=%23ced4da&css%5B%26%3A%3Aplaceholder%5D%5BfontWeight%5D=bold"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId1701922865913383618" form-id="randomId17004851858781849461" data-gtm-yt-inspected-666187_821="true" data-gtm-yt-inspected-61934708_454="true"></iframe></div>
</label><label class="at-text at-cc-expiration" id="NVContributionForm95552-PaymentInformation-ExpirationDate">Expiration Date<div class="vgs-loading-placeholder" style="display: none;">
<input type="tel" autocomplete="cc-exp" title="Expiration Date (MM / YY)" placeholder="MM / YY" readonly="true">
</div>
<div id="vgs-ExpirationDate-95552" class="vgs-ccexpiration-iframe-wrapper vgs-input-container vgs-collect-container__empty vgs-collect-container__invalid isEmpty"><iframe title="Secure card expiration date input frame"
src="https://js.verygoodvault.com/vgs-collect/2.18.4/lib/index.html#name=ExpirationDate&placeholder=MM%20%2F%20YY&type=card-expiration-date&serializers=W3sibmFtZSI6InNlcGFyYXRlIiwib3B0aW9ucyI6eyJtb250aE5hbWUiOiJFeHBpcmF0aW9uTW9udGgiLCJ5ZWFyTmFtZSI6IkV4cGlyYXRpb25ZZWFyIn19XQ%3D%3D&validations%5B0%5D=validCardExpirationDate&validations%5B1%5D=required&autoComplete=cc-exp&formId=randomId17004851858781849461&fieldId=randomId1706505768064755275&createdAt=1726580815616&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=5958a745-1ad5-4e3b-99ba-7c43a395354f&css%5BfontSize%5D=.875rem&css%5BfontFamily%5D=monospace&css%5BlineHeight%5D=1&css%5BbackgroundColor%5D=%23fff&css%5B%26%3A%3Aplaceholder%5D%5Bcolor%5D=%23ced4da&css%5B%26%3A%3Aplaceholder%5D%5BfontWeight%5D=bold"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId1706505768064755275" form-id="randomId17004851858781849461" data-gtm-yt-inspected-666187_821="true" data-gtm-yt-inspected-61934708_454="true"></iframe></div>
</label></div>
<div class="at-row ">
<div class="at-markup UpdateMyProfile at-mode-person-only" id="NVContributionForm95552-PaymentInformation-UpdateMyProfile">
<div class="updateMyProfileSection" style=""><label style="display:inline;"><input type="checkbox" name="updateMyProfile" checked="checked"><span><span class="text">Remember me so that I can use <i>Fast</i><b>Action</b> next
time.</span></span></label></div>
</div>
</div>
</div>
</fieldset>
<div class="at-form-submit clearfix">
<input type="submit" value="Contribute" class="at-submit btn-at btn-at-primary">
<div class="at-markup secure-processing-single-step-div" style="display: block;">
<label class="secure-processing-label at-text"> Your donation will be securely processed.<div class="glyphicons glyphicons-lock" aria-hidden="true"></div>
</label>
</div>
</div>
</form>Text Content
Planned Parenthood Advocates of Greater Washington and North Idaho Donate to Planned Parenthood Advocates of Greater Washington and North Idaho Your support of Planned Parenthood Advocates of Greater Washington and North Idaho will protect reproductive rights and access to health care - in your community and across the country. ? Take future action with a single click. Log in or Sign up for FastAction Contribution Information $20 $35 $50 $100 $500 $2,500 Other $ Make this contribution: Frequency (Optional) Monthly I'd like to make this contribution in honor or in memory of someone Is this an Honorary or Memorial Gift? In honor of In memory of Honoree Name (Optional) I'd like to notify someone of this contribution Who would you like to notify? A message will be sent to the recipient to inform them of your contribution. First Name (Optional) Last Name (Optional) Street Address (Optional) Country (Optional)- Select -AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamWallis and FutunaWestern SaharaYemenZambiaZimbabweUnited States Postal Code (Optional) City (Optional) State/Province (Optional)- State -AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYASFMGUMHMPPRPWVIAAAEAP Contact Information First Name Last Name Street Address (Optional) Postal Code City State/Province- State -AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYASFMGUMHMPPRPWVIAAAEAP Email Mobile Phone (Optional) Sign me up for SMS messages. By checking this box, you agree to receive calls and texts to that number from Planned Parenthood organizations that may be automatically dialed or prerecorded on Planned Parenthood issues and other ways to get involved. Msg freq varies. STOP to quit. Msg & Data Rates May Apply. I agree to receive emails from Planned Parenthood organizations. I may unsubscribe at any time. (Optional) Payment Information Card Number Expiration Date Remember me so that I can use FastAction next time. Your donation will be securely processed. Contributions or gifts to Planned Parenthood Advocates of Greater Washington and North Idaho are not tax deductible as charitable contributions or as business expenses under IRC Section 162(e). SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Sign up with your email address Already have a FastAction account? Log in By clicking "Log in," I confirm that I agree with the FastAction terms of service and privacy policy. × SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Log in with your email address Don't have a FastAction account yet? Sign up By clicking "Sign up," I confirm that I agree with the FastAction terms of service and privacy policy. × SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Sign up with your email address Already have a FastAction account? Log in By clicking "Log in," I confirm that I agree with the FastAction terms of service and privacy policy. × SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Log in with your email address Don't have a FastAction account yet? Sign up By clicking "Sign up," I confirm that I agree with the FastAction terms of service and privacy policy. × Planned Parenthood Advocates of Greater Washington and North Idaho This page is controlled and operated by: Planned Parenthood Advocates of Greater Washington and North Idaho * Privacy Policy * Terms of Use © 2024 Planned Parenthood Advocates of Greater Washington and North Idaho