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Submitted URL: https://dhmcalumdev.hitchcock.org/page.redir?target=https%3a%2f%2fdhmcalumdev.hitchcock.org%2fgiving%2fchildrens-hospital%3fsource...
Effective URL: https://dhmcalumdev.hitchcock.org/giving/childrens-hospital?source=22.CH.E.05.Spr2&erid=4653369
Submission: On May 12 via manual from US — Scanned from DE
Effective URL: https://dhmcalumdev.hitchcock.org/giving/childrens-hospital?source=22.CH.E.05.Spr2&erid=4653369
Submission: On May 12 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /giving/childrens-hospital?source=22.CH.E.05.Spr2&erid=4653369
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<h1> Children’s Health </h1>
<p> Every child deserves to live a happy, healthy life. Your generosity strengthens the services and programs that enable us to provide the very best, comprehensive care to children and families. Thank you for your gift. </p>
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<td id="PC22929_DonationCapture1_AddressCtl_lblreq_country" class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> * </td>
<td id="PC22929_DonationCapture1_AddressCtl_ctl_Country" class="taLeft BBFieldControlCell DonationCaptureFieldControlCell">
<select name="PC22929$DonationCapture1$AddressCtl$dd_Country" onchange="javascript:setTimeout('__doPostBack(\'PC22929$DonationCapture1$AddressCtl$dd_Country\',\'\')', 0)" id="PC22929_DonationCapture1_AddressCtl_dd_Country"
class="BBFormSelectList DonationCaptureSelectList">
<option selected="selected" value="UNITED STATES">UNITED STATES</option>
<option value="ALBANIA">ALBANIA</option>
<option value="ANGUILLA">ANGUILLA</option>
<option value="ARGENTINA">ARGENTINA</option>
<option value="ARUBA">ARUBA</option>
<option value="AUSTRALIA">AUSTRALIA</option>
<option value="AUSTRIA">AUSTRIA</option>
<option value="BAHAMAS">BAHAMAS</option>
<option value="BANGLADESH">BANGLADESH</option>
<option value="BARBADOS">BARBADOS</option>
<option value="BELGIUM">BELGIUM</option>
<option value="BEQUIA">BEQUIA</option>
<option value="BERMUDA">BERMUDA</option>
<option value="BOLIVIA">BOLIVIA</option>
<option value="BOTSWANA">BOTSWANA</option>
<option value="BRAZIL">BRAZIL</option>
<option value="BRITISH VIRGIN ISLANDS">BRITISH VIRGIN ISLANDS</option>
<option value="CANADA">CANADA</option>
<option value="CHILE">CHILE</option>
<option value="COLOMBIA">COLOMBIA</option>
<option value="COSTA RICA">COSTA RICA</option>
<option value="CROATIA">CROATIA</option>
<option value="CZECH REPUBLIC">CZECH REPUBLIC</option>
<option value="DENMARK">DENMARK</option>
<option value="EGYPT">EGYPT</option>
<option value="ENGLAND">ENGLAND</option>
<option value="FINLAND">FINLAND</option>
<option value="FRANCE">FRANCE</option>
<option value="GERMANY">GERMANY</option>
<option value="GHANA">GHANA</option>
<option value="GREECE">GREECE</option>
<option value="GRENADA">GRENADA</option>
<option value="GRENADINES">GRENADINES</option>
<option value="HOLLAND">HOLLAND</option>
<option value="HONDURAS">HONDURAS</option>
<option value="HONG KONG">HONG KONG</option>
<option value="HUNGARY">HUNGARY</option>
<option value="ICELAND">ICELAND</option>
<option value="INDIA">INDIA</option>
<option value="INDONESIA">INDONESIA</option>
<option value="IRAN">IRAN</option>
<option value="IRELAND">IRELAND</option>
<option value="ISRAEL">ISRAEL</option>
<option value="ITALY">ITALY</option>
<option value="JAMAICA">JAMAICA</option>
<option value="JAPAN">JAPAN</option>
<option value="KENYA">KENYA</option>
<option value="LUXEMBOURG">LUXEMBOURG</option>
<option value="MALAYSIA">MALAYSIA</option>
<option value="MEXICO">MEXICO</option>
<option value="MICRONESIA, Federated States of">MICRONESIA, Federated States of</option>
<option value="NEPAL">NEPAL</option>
<option value="NETHERLANDS">NETHERLANDS</option>
<option value="NEW ZEALAND">NEW ZEALAND</option>
<option value="NIGERIA">NIGERIA</option>
<option value="NORWAY">NORWAY</option>
<option value="PANAMA">PANAMA</option>
<option value="PEOPLES REPUBLIC OF CHINA">PEOPLES REPUBLIC OF CHINA</option>
<option value="PHILIPPINES">PHILIPPINES</option>
<option value="PORTUGAL">PORTUGAL</option>
<option value="PUERTO RICO">PUERTO RICO</option>
<option value="ROMANIA">ROMANIA</option>
<option value="SAUDI ARABIA">SAUDI ARABIA</option>
<option value="SCOTLAND">SCOTLAND</option>
<option value="SINGAPORE">SINGAPORE</option>
<option value="SLOVENIA">SLOVENIA</option>
<option value="SOUTH AFRICA">SOUTH AFRICA</option>
<option value="SOUTH KOREA">SOUTH KOREA</option>
<option value="SPAIN">SPAIN</option>
<option value="SRI LANKA">SRI LANKA</option>
<option value="SWEDEN">SWEDEN</option>
<option value="SWITZERLAND">SWITZERLAND</option>
<option value="TAIWAN REP. of CHINA">TAIWAN REP. of CHINA</option>
<option value="TANZANIA">TANZANIA</option>
<option value="THAILAND">THAILAND</option>
<option value="TURKEY">TURKEY</option>
<option value="UAE">UAE</option>
<option value="UNITED KINGDOM">UNITED KINGDOM</option>
<option value="VENEZUELA">VENEZUELA</option>
<option value="via GENEVA, SWITZERLAND">via GENEVA, SWITZERLAND</option>
<option value="WEST INDIES">WEST INDIES</option>
<option value="ZIMBABWE">ZIMBABWE</option>
</select>
<span id="PC22929_DonationCapture1_AddressCtl_ctl18" style="display:none;"></span>
</td>
</tr>
<tr>
<td id="PC22929_DonationCapture1_AddressCtl_lbl_addrline" class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_AddressCtl_tb_AddressLine" id="PC22929_DonationCapture1_AddressCtl_lblAddressLine">Street address or P.O. box:</label>
</td>
<td id="PC22929_DonationCapture1_AddressCtl_lblreq_addrline" valign="top" class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> * </td>
<td id="PC22929_DonationCapture1_AddressCtl_ctl_addrline" class="taLeft BBFieldControlCell DonationCaptureFieldControlCell">
<textarea name="PC22929$DonationCapture1$AddressCtl$tb_AddressLine" rows="2" cols="20" id="PC22929_DonationCapture1_AddressCtl_tb_AddressLine" class="BBFormTextArea DonationCaptureTextArea"></textarea>
<span id="PC22929_DonationCapture1_AddressCtl_ctl03" style="display:none;"></span><span id="PC22929_DonationCapture1_AddressCtl_ctl04" style="display:none;"></span>
</td>
</tr>
<tr>
<td id="PC22929_DonationCapture1_AddressCtl_lbl_cityUS" class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_AddressCtl_tb_CityUS" id="PC22929_DonationCapture1_AddressCtl_lblCityUS">City:</label>
</td>
<td id="PC22929_DonationCapture1_AddressCtl_lblreq_cityUS" class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> * </td>
<td id="PC22929_DonationCapture1_AddressCtl_ctl_cityUS" class="taLeft BBFieldControlCell DonationCaptureFieldControlCell">
<input name="PC22929$DonationCapture1$AddressCtl$tb_CityUS" type="text" maxlength="50" id="PC22929_DonationCapture1_AddressCtl_tb_CityUS" class="BBFormTextbox DonationCaptureTextbox">
<span id="PC22929_DonationCapture1_AddressCtl_ctl05" style="display:none;"></span>
</td>
</tr>
<tr>
<td id="PC22929_DonationCapture1_AddressCtl_lbl_stateUS" class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_AddressCtl_dd_StateUS" id="PC22929_DonationCapture1_AddressCtl_lblStateUS">State:</label><span id="PC22929_DonationCapture1_AddressCtl_lblreq_stateUS"
class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker">*</span>
</td>
<td id="PC22929_DonationCapture1_AddressCtl_ctl_stateUS" class="taLeft BBFieldControlCell DonationCaptureFieldControlCell">
<select name="PC22929$DonationCapture1$AddressCtl$dd_StateUS" id="PC22929_DonationCapture1_AddressCtl_dd_StateUS" class="BBFormSelectList DonationCaptureSelectList">
<option value="-1"><Please select></option>
<option value="Not">Not</option>
<option value="*">*</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NC">NC</option>
<option value="ND">ND</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="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="**">**</option>
<option value="AB">AB</option>
<option value="BC">BC</option>
<option value="MB">MB</option>
<option value="NB">NB</option>
<option value="NL">NL</option>
<option value="NT">NT</option>
<option value="NS">NS</option>
<option value="NU">NU</option>
<option value="ON">ON</option>
<option value="Ont">Ont</option>
<option value="PE">PE</option>
<option value="QC">QC</option>
<option value="SK">SK</option>
<option value="YT">YT</option>
<option value="***">***</option>
<option value="AS">AS</option>
<option value="CZ">CZ</option>
<option value="FM">FM</option>
<option value="Gau">Gau</option>
<option value="GU">GU</option>
<option value="Mah">Mah</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PW">PW</option>
<option value="PR">PR</option>
<option value="SG">SG</option>
<option value="TAI">TAI</option>
<option value="VD">VD</option>
<option value="VI">VI</option>
<option value="---">---</option>
<option value="ACT">ACT</option>
<option value="NSW">NSW</option>
<option value="N.T">N.T</option>
<option value="QLD">QLD</option>
<option value="SA">SA</option>
<option value="TAS">TAS</option>
<option value="VIC">VIC</option>
<option value="W.A">W.A</option>
</select>
<span id="PC22929_DonationCapture1_AddressCtl_ctl06" style="display:none;"></span>
</td>
<td id="PC22929_DonationCapture1_AddressCtl_tdreq_stateUS">
</td>
</tr>
<tr>
</tr>
<tr>
<td id="PC22929_DonationCapture1_AddressCtl_lbl_zipUS" class="BBFieldCaption DonationCaptureFieldCaption"><label for="PC22929_DonationCapture1_AddressCtl_tb_ZipUS" id="PC22929_DonationCapture1_AddressCtl_lblZipUS">ZIP:</label></td>
<td id="PC22929_DonationCapture1_AddressCtl_lblreq_zipUS" class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> * </td>
<td id="PC22929_DonationCapture1_AddressCtl_ctl_zipUS" class="taLeft BBFieldControlCell DonationCaptureFieldControlCell"><span id="PC22929_DonationCapture1_AddressCtl_ctl23" style="display:none;"></span><input
name="PC22929$DonationCapture1$AddressCtl$tb_ZipUS" type="text" maxlength="10" id="PC22929_DonationCapture1_AddressCtl_tb_ZipUS" class="BBFormTextbox DonationCaptureTextbox"></td>
</tr>
<tr>
<td class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_txtPhone" id="PC22929_DonationCapture1_lblPhone">Phone:</label>
</td>
<td id="PC22929_DonationCapture1_tdReqPhone" class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> *</td>
<td class="BBFieldControlCell DonationCaptureFieldControlCell">
<input name="PC22929$DonationCapture1$txtPhone" type="text" maxlength="20" id="PC22929_DonationCapture1_txtPhone" class="BBFormTextbox DonationCaptureTextbox">
</td>
</tr>
<tr id="PC22929_DonationCapture1_trSingleEmailContainer">
<td class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_txtEmail" id="PC22929_DonationCapture1_lblEmail">Email:</label>
</td>
<td id="PC22929_DonationCapture1_tdEmailReq" class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker">*</td>
<td class="BBFieldControlCell DonationCaptureFieldControlCell">
<input name="PC22929$DonationCapture1$txtEmail" type="text" maxlength="100" id="PC22929_DonationCapture1_txtEmail" class="BBFormTextbox DonationCaptureTextboxWide"><span id="PC22929_DonationCapture1_ctl54"
style="display:none;"></span><span id="PC22929_DonationCapture1_ctl68" style="display:none;"></span>
</td>
</tr>
</tbody>
<tbody id="PC22929_DonationCapture1_tbdyPaymentInfo" class="BBFormTable DonationCaptureFormTable" style="border: solid 1 black">
<tr>
<td class="BBListingHeading DonationCaptureListingHeading" colspan="3">
<span id="PC22929_DonationCapture1_lblPayment">Payment information</span>
</td>
</tr>
<tr id="PC22929_DonationCapture1_trHelpletPaymentInformation">
<td class="BBMessage DonationMessage" colspan="3">
<span id="PC22929_DonationCapture1_lblHelpletPaymentInformation" class="DonationFieldHelpletCell">All donations are tax deductible to the fullest extent allowable by law. Fundraising is conducted by Dartmouth-Hitchcock Health
(EIN#26-4812335), a 501(c)3 charity recognized by the IRS. Your gift will appear on your credit card statement as a payment to “DHealth Giving.”</span>
</td>
</tr>
<tr>
<td class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_txtCardholder" id="PC22929_DonationCapture1_lblCardHoldersName">Cardholder’s name:</label>
</td>
<td class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> *</td>
<td class="BBFieldControlCell DonationCaptureFieldControlCell">
<input name="PC22929$DonationCapture1$txtCardholder" type="text" maxlength="60" id="PC22929_DonationCapture1_txtCardholder" class="BBFormTextbox DonationCaptureTextboxWide">
</td>
</tr>
<tr>
<td class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_txtCardNumber" id="PC22929_DonationCapture1_lblCCNumber">Credit card number:</label>
</td>
<td class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> *</td>
<td class="BBFieldControlCell DonationCaptureFieldControlCell">
<input name="PC22929$DonationCapture1$txtCardNumber" type="text" maxlength="20" id="PC22929_DonationCapture1_txtCardNumber" class="BBFormTextbox DonationCaptureTextboxWide" autocomplete="off">
</td>
</tr>
<tr>
<td class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_cboCardType" id="PC22929_DonationCapture1_lblCCType">Card type:</label>
</td>
<td class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> *</td>
<td class="BBFieldControlCell DonationCaptureFieldControlCell">
<select name="PC22929$DonationCapture1$cboCardType" id="PC22929_DonationCapture1_cboCardType" class="BBFormSelectList DonationCaptureSelectList">
<option value=""></option>
<option value="5963a708-fc7f-48af-952f-16d574c4b833">Visa</option>
<option value="c4a56513-9fdb-44c5-9b19-e617f2596107">American Express</option>
<option value="bf0ed898-ab0c-4374-9cef-1e66b09e816d">Discover</option>
<option value="b34832f7-8a95-47fa-9c43-bc8682562ea5">MasterCard</option>
</select>
</td>
</tr>
<tr>
<td class="BBFieldCaption DonationCaptureFieldCaption" id="td_ExpiryLbl">
<label for="PC22929_DonationCapture1_cboMonth" id="PC22929_DonationCapture1_lblExpiryLbl">Card expiration:</label>
</td>
<td class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> *</td>
<td class="wsNowrap BBFieldControlCell sDonationCaptureFieldControlCell">
<table style="margin-left: -3px">
<tbody>
<tr>
<td>
<select name="PC22929$DonationCapture1$cboMonth" id="PC22929_DonationCapture1_cboMonth" class="BBFormSelectList DonationCaptureSelectListNarrow">
<option value=""></option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select><label for="PC22929_DonationCapture1_cboYear" id="PC22929_DonationCapture1_lblTxtYear"> /</label>
</td>
<td class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> *</td>
<td>
<select name="PC22929$DonationCapture1$cboYear" id="PC22929_DonationCapture1_cboYear" class="BBFormSelectList DonationCaptureSelectListNarrow">
<option value=""></option>
<option value="2022">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
<option value="2034">2034</option>
<option value="2035">2035</option>
<option value="2036">2036</option>
<option value="2037">2037</option>
<option value="2038">2038</option>
<option value="2039">2039</option>
<option value="2040">2040</option>
<option value="2041">2041</option>
</select>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td class="BBFieldCaption DonationCaptureFieldCaption">
<label for="PC22929_DonationCapture1_txtCSC" id="PC22929_DonationCapture1_lblSecCode">Card security code:</label>
</td>
<td class="BBFormRequiredFieldMarker DonationCaptureRequiredFieldMarker"> *</td>
<td class="BBFieldControlCell DonationCaptureFieldControlCell">
<input name="PC22929$DonationCapture1$txtCSC" type="password" maxlength="4" id="PC22929_DonationCapture1_txtCSC" class="BBFormTextbox DonationCaptureTextboxNarrow"
autocomplete="off"><a id="PC22929_DonationCapture1_lnkcsc_help" title="Display help for Card Security Codes in another window" class="BBLinkHelpIcon" href="javascript:DonationCSCHelp()"><img src="../images/help-32_1.gif" cssclass="BBLinkHelpIconImg" height="23" style="vertical-align:bottom; border-style:none" alt="help" title="Help"></a>
</td>
</tr>
</tbody>
<tbody>
<tr>
<td class="BBListingHeading DonationListingHeading" colspan="3">
<span id="PC22929_lblTributeHeading">Memorial and honorary gifts</span>
</td>
</tr>
<tr>
<td class="BBMessage DonationMessage" colspan="3">
<span id="PC22929_lblTributeSectionDescription">Is your gift in memory of or in honor of someone? If so, please complete this section.</span>
</td>
</tr>
<tr id="PC22929_trTributeDesc">
<td id="PC22929_tdTribDescCaption" class="BBFieldCaption DonationFieldCaption">
<label for="PC22929_ddlTribute" id="PC22929_lblType">Type:</label>
</td>
<td id="PC22929_tdTributeTypeRequiredMarker" class="BBFormRequiredFieldMarker DonationRequiredFieldMarker" style="visibility: hidden"> * </td>
<td id="PC22929_tdTribDescControls" class="BBFieldControlCell DonationFieldControlCell" style="text-align: left;">
<select name="PC22929$ddlTribute" id="PC22929_ddlTribute" class="BBFormSelectList DonationSelectList" onchange="ddlTribute_OnChange(this)">
<option selected="selected" value="0"></option>
<option value="100">in memory of</option>
<option value="101">in honor of</option>
</select>
</td>
</tr>
<tr id="PC22929_trTributeName" style="display:;">
<td id="PC22929_tdTribNameCaption" class="BBFieldCaption DonationFieldCaption">
<label for="PC22929_txtTribute" id="PC22929_lblName">Full name of honoree:</label>
</td>
<td id="PC22929_tdTributeRequiredMarker" class="BBFormRequiredFieldMarker DonationRequiredFieldMarker" style="visibility:hidden;"> * </td>
<td id="PC22929_tdTribNameControls" class="BBFieldControlCell DonationFieldControlCell">
<input name="PC22929$txtTribute" type="text" maxlength="50" id="PC22929_txtTribute" class="BBFormTextbox DonationTextboxWide" onkeyup="txtTributeName_KeyUp(this, 'PC22929_tdTributeTypeRequiredMarker');">
<span id="PC22929_ReqFldValidatorTribName" style="display:none;"></span>
</td>
</tr>
<tr id="PC22929_trTributeFirstName" style="display:none;">
<td id="PC22929_tdTributeFirstName" class="BBFieldCaption DonationFieldCaption">
<label for="PC22929_txtTributeFirstName" id="PC22929_lblTributeFirstName">First name:</label>
</td>
<td id="PC22929_tdTributeFirstNameControls" class="BBFieldControlCell DonationFieldControlCell">
<input name="PC22929$txtTributeFirstName" type="text" maxlength="50" id="PC22929_txtTributeFirstName" class="BBFormTextbox DonationTextboxWide">
</td>
</tr>
<tr id="PC22929_trTributeLastName" style="display:none;">
<td id="PC22929_tdTributeLastName" class="BBFieldCaption DonationFieldCaption">
<label for="PC22929_txtTributeLastName" id="PC22929_lblTributeLastName">Last name:</label>
</td>
<td id="PC22929_tdTributeLastNameRequiredMarker" class="BBFormRequiredFieldMarker DonationRequiredFieldMarker" style="visibility:hidden;"> * </td>
<td id="PC22929_tdTributeLastNameControls" class="BBFieldControlCell DonationFieldControlCell">
<input name="PC22929$txtTributeLastName" type="text" maxlength="50" id="PC22929_txtTributeLastName" class="BBFormTextbox DonationTextboxWide">
</td>
</tr>
<tr id="PC22929_trTributeDesc2">
</tr>
<tr>
<td class="BBFieldCaption DonationFieldCaption">
</td>
<td class="w100p BBFieldControlCell DonationCaptureFieldControlCell">
<span class="BBFieldCheckboxCaption DonationFieldCheckboxCaption"><input id="PC22929_chkAcknowledge" type="checkbox" name="PC22929$chkAcknowledge"
onclick="javascript:setTimeout('__doPostBack(\'PC22929$chkAcknowledge\',\'\')', 0)"><label for="PC22929_chkAcknowledge">Mail a notification letter on my behalf</label></span>
</td>
<td id="PC22929_tdTributeChkAcknowledgeRequiredMarker" class="BBFormRequiredFieldMarker DonationRequiredFieldMarker" style="visibility: hidden"> * </td>
</tr>
<tr>
<td class="BBFieldControlCell DonationFieldControlCell DonationVerificationCell" colspan="3">
</td>
</tr>
<tr class="DonorOptInTR">
<td class="DonorOptInTD" colspan="3"><input type="checkbox" name="BBdonorOptIn" id="BBdonorOptIn" class="BBdonorOptIn"><label for="BBdonorOptIn">YES!</label>
<p class="BBDonorOptInDisclaimer">I would like my entire gift to benefit Dartmouth Health Children's, so I will increase my donation to cover the credit card processing fees.</p>
</td>
</tr>
<tr class="TotalTR">
<td class="TotalTD" colspan="3" style="text-align:right;" align="right"><span class="BBDonorOptInTotals"><span>Donation Total: </span><span>$0.00</span></span></td>
</tr>
<tr class="donationFormRow">
<td class="BBFormButtonCell DonationButtonCell" colspan="3">
<input type="submit" name="PC22929$btnNext" value="Give now" onclick="return showLoadingOverlay();(function(btn){var bDisableMe=true;__doPostBack('PC22929$btnNext','');btn.disabled=bDisableMe;})(this);return false;"
id="PC22929_btnNext" class="BBFormSubmitButton DonationSubmitButton">
</td>
</tr>
</tbody>
</table>
<div id="mpeDonationConsentPopup_backgroundElement" class="BBModalBackground" style="display: none; position: fixed; left: 0px; top: 0px;"></div>
</div>
<div id="donationLoadingOverlay" class="donationLoadingOverlay">
<img src="/images/FormEngine/Loading.gif" alt="" class="donationLoadingImage">
</div>
</div>
</div>
<div class="outro-content">
<p>Matching Gifts: If your employer will match your gift, please submit the matching gift form to Medical & Healthcare Advancement, One Medical Center Drive, HB 7070, Lebanon, NH 03756</p>
<p>Recurring Monthly Gifts: If you would like to pledge a recurring monthly gift, please call Medical & Healthcare Advancement at (603) 653-0700 or email
<a href="mailto:DH-Geisel.Gift.Recording@hitchcock.org">DH-Geisel.Gift.Recording@hitchcock.org</a></p>
</div>
</div>
<div class="rightsidebar">
<h5>Prefer to send a check?</h5>
<p><a href="https://dhgeiselgiving.org/ways-to-give
">Visit our website</a> for our mailing address and instructions for how to make out your check.</p>
<h5>Need help?</h5>
<p>Do you have a question or need help making your gift? Please call us at 603-653-0700. We’re happy to help!</p>
</div>
</div>
<footer>
<div class="footcontainer layout--full-width-grid">
<div class="footercolumn">
<div class="footerlogo">
<p><img alt="Dartmouth Health Geisel School of Medicine" height="90" src="https://dhmcalumdev.hitchcock.org/giving/image/new-logos-/DH-GeiselSoM_Logo-NoLine_OneColor_Reverse_RGB.svg" width="428"></p>
</div>
<div class="footeraddress">
<p>Medical & Healthcare Advancement<br>One Medical Center Drive, HB 7070<br>Lebanon, NH 03756 <br><a href="tel:603-653-0700">603-653-0700</a> | <a href="mailto:DH-GeiselDevelopment@hitchcock.org">DH-GeiselDevelopment@hitchcock.org</a>
</p>
</div>
<div class="footercopy">
<p> Copyright ©2022 Dartmouth-Hitchcock Health. All rights reserved. </p>
</div>
</div>
</div>
</footer>
<p>
<script type="text/javascript">
$(window).on('load', function() {
moveAsterisks();
});
function moveAsterisks() {
// this is for asterisks in a typical tr
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<input type="hidden" name="hidBrowserDateTime" id="hidBrowserDateTime">
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function donationFormButtons() {
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var newFormTableRowHTML = '<tr class="DonorOptInTR"><td class="DonorOptInTD" colspan="3"></td></tr><tr class="TotalTR"><td class="TotalTD" colspan="3" style="text-align:right;" align="right"></td></tr>';
var DonorOptInCheckbox = '<input type="checkbox" name="BBdonorOptIn" id="BBdonorOptIn" class="BBdonorOptIn">';
var DonorOptInLabelHTML = '<label for="BBdonorOptIn">YES!</label>';
var DonorOptInDisclaimer = '<p class="BBDonorOptInDisclaimer">I would like my entire gift to benefit Dartmouth Health Children\'s, so I will increase my donation to cover the credit card processing fees.</p>';
var DonorOptInTotals = '<span class="BBDonorOptInTotals"><span>Donation Total: </span><span>$0.00</span></span>';
$(newFormTableRowHTML).insertBefore('.donationFormRow');
$(DonorOptInCheckbox).appendTo('.DonationFormTable .DonorOptInTR > .DonorOptInTD');
$(DonorOptInLabelHTML).appendTo('.DonationFormTable .DonorOptInTR > .DonorOptInTD');
$(DonorOptInDisclaimer).appendTo('.DonationFormTable .DonorOptInTR > .DonorOptInTD');
$(DonorOptInTotals).appendTo('.DonationFormTable .TotalTR > .TotalTD');
$('input[id*="txtAmount"]').not('[data-attr]').on('blur change keyup', function() {
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$('.DonationFormTable .TotalTR > .TotalTD .BBDonorOptInTotals > span:last-child').text("\$" + DonationAmount);
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$('.BBdonorOptIn[name="BBdonorOptIn"]').click(function() {
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$('.DonationFormTable .TotalTR > .TotalTD .BBDonorOptInTotals > span:last-child').text("\$" + DonationAmount);
$('input[id*="txtAmount"]').val(DonationAmount);
}
});
}
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bbpage.add_pageLoaded(function() {
// functions
if ($('.donationAmounts').length > 0) {
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}
if ($('.DonationFormTable').length > 0) {
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}
});
// Raised after an asynchronous postback is finished and control has been returned to the browser.
bbpage.add_endRequest(function() {
//console.log('partial');
function supports_html5_storage() {
try {
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} catch (e) {
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}
}
if (supports_html5_storage() && localStorage.getItem('amtLevel') > 0) {
$('input[id*="txtAmount"]').focus();
$('input[id*="txtAmount"]').val(localStorage.getItem('amtLevel'));
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$('.donationAmountsTable').hide();
$('.DonationFormTable .presetAmount a').each(function() {
if ($(this).text() == localStorage.getItem('amtLevel')) {
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PC22929_DonationCapture1_ctl51.display = "None";
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PC22929_DonationCapture1_ctl51.evaluationfunction = "RequiredFieldValidatorEvaluateIsValid";
PC22929_DonationCapture1_ctl51.initialvalue = "";
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PC22929_DonationCapture1_ctl52.display = "None";
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PC22929_ReqFldValidatorTribName.evaluationfunction = "RequiredFieldValidatorEvaluateIsValid";
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</form>Text Content
Back to Dartmouth Health & Geisel Giving CHILDREN’S HEALTH Every child deserves to live a happy, healthy life. Your generosity strengthens the services and programs that enable us to provide the very best, comprehensive care to children and families. Thank you for your gift. * 85 * 50 * 35 * Other Donation information Amount: * 85 * 50 * 35 * Other $ * Designation: The Fund for Children’s Health Other Other* Additional information Frequency: Weekly Monthly Quarterly Annually On: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting: Ending: Ending: Corporate: This donation is on behalf of a company Anonymous: I prefer to make this donation anonymously Mailing address if different than billing address: Billing information Title: * <Please select> Dr. Miss Mr. Mrs. Ms. Mx. First name: * Last name: * Country: * UNITED STATES ALBANIA ANGUILLA ARGENTINA ARUBA AUSTRALIA AUSTRIA BAHAMAS BANGLADESH BARBADOS BELGIUM BEQUIA BERMUDA BOLIVIA BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS CANADA CHILE COLOMBIA COSTA RICA CROATIA CZECH REPUBLIC DENMARK EGYPT ENGLAND FINLAND FRANCE GERMANY GHANA GREECE GRENADA GRENADINES HOLLAND HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRELAND ISRAEL ITALY JAMAICA JAPAN KENYA LUXEMBOURG MALAYSIA MEXICO MICRONESIA, Federated States of NEPAL NETHERLANDS NEW ZEALAND NIGERIA NORWAY PANAMA PEOPLES REPUBLIC OF CHINA PHILIPPINES PORTUGAL PUERTO RICO ROMANIA SAUDI ARABIA SCOTLAND SINGAPORE SLOVENIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA SWEDEN SWITZERLAND TAIWAN REP. of CHINA TANZANIA THAILAND TURKEY UAE UNITED KINGDOM VENEZUELA via GENEVA, SWITZERLAND WEST INDIES ZIMBABWE Street address or P.O. box: * City: * State:* <Please select> Not * AA AE AP AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ** AB BC MB NB NL NT NS NU ON Ont PE QC SK YT *** AS CZ FM Gau GU Mah MH MP PW PR SG TAI VD VI --- ACT NSW N.T QLD SA TAS VIC W.A ZIP: * Phone: * Email:* Payment information All donations are tax deductible to the fullest extent allowable by law. Fundraising is conducted by Dartmouth-Hitchcock Health (EIN#26-4812335), a 501(c)3 charity recognized by the IRS. Your gift will appear on your credit card statement as a payment to “DHealth Giving.” Cardholder’s name: * Credit card number: * Card type: * Visa American Express Discover MasterCard Card expiration: * 01 02 03 04 05 06 07 08 09 10 11 12 / * 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 Card security code: * Memorial and honorary gifts Is your gift in memory of or in honor of someone? If so, please complete this section. Type: * in memory of in honor of Full name of honoree: * First name: Last name: * Mail a notification letter on my behalf * YES! I would like my entire gift to benefit Dartmouth Health Children's, so I will increase my donation to cover the credit card processing fees. Donation Total: $0.00 Matching Gifts: If your employer will match your gift, please submit the matching gift form to Medical & Healthcare Advancement, One Medical Center Drive, HB 7070, Lebanon, NH 03756 Recurring Monthly Gifts: If you would like to pledge a recurring monthly gift, please call Medical & Healthcare Advancement at (603) 653-0700 or email DH-Geisel.Gift.Recording@hitchcock.org PREFER TO SEND A CHECK? Visit our website for our mailing address and instructions for how to make out your check. NEED HELP? Do you have a question or need help making your gift? Please call us at 603-653-0700. We’re happy to help! Medical & Healthcare Advancement One Medical Center Drive, HB 7070 Lebanon, NH 03756 603-653-0700 | DH-GeiselDevelopment@hitchcock.org Copyright ©2022 Dartmouth-Hitchcock Health. All rights reserved.