secure.info-komen.org
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Submitted URL: https://lnkd.in/ekwggeWb
Effective URL: https://secure.info-komen.org/site/Donation2?idb=529106759&df_id=25031&FR_ID=9196&mfc_pref=T&PROXY_ID=22839057&PROXY_TYPE=20&2...
Submission: On November 01 via manual from US — Scanned from DE
Effective URL: https://secure.info-komen.org/site/Donation2?idb=529106759&df_id=25031&FR_ID=9196&mfc_pref=T&PROXY_ID=22839057&PROXY_TYPE=20&2...
Submission: On November 01 via manual from US — Scanned from DE
Form analysis 4 forms found in the DOM
POST UserLogin
<form class="form-inline kd-header__cta-form ng-pristine ng-valid" action="UserLogin" method="POST">
<input type="hidden" name="RememberMe" value="RememberMe">
<input type="hidden" name="NEXTURL" value="RedirectHandler?key=RFCLoginSuccess&s_trID=9196&pw_id=13871">
<input type="hidden" name="pw_id" value=" 13871">
<input type="text" class="form-control" name="USERNAME" placeholder="username" maxlength="60" autocorrect="off" autocapitalize="off" spellcheck="false" onfocus="scrollBody()">
<input type="password" class="form-control" name="Password" placeholder="password" maxlength="99" autocorrect="off" autocapitalize="off" spellcheck="false" onfocus="scrollBody()">
<button type="submit" class="btn btn-primary">Login</button>
<div class="kd-header__cta-options-form-links">
<a href="UserLogin?CMD=ForgotLogin&fr_id=9196&pw_id=13871&s_AffiliateSecCatId=2982">Need Help?</a>
</div>
</form>Name: headerDonateSearchForm — POST STR?fr_id=9196&pg=pfind
<form class="form-inline kd-header__cta-form ng-pristine ng-valid" name="headerDonateSearchForm" action="STR?fr_id=9196&pg=pfind" method="POST">
<input type="hidden" name="s_tr_part_finder_search_mode" value="basic">
<input type="hidden" name="submit" value="true">
<div class="kd-header__cta-options-form-links"> Select Participant or Team: </div>
<select class="form-control ng-pristine ng-untouched ng-valid ng-not-empty" name="fr_search_type" ng-model="headerDonateSearch.search_type">
<option value="participant">Participant</option>
<option value="team">Team</option>
</select>
<!-- ngIf: headerDonateSearch.search_type == 'participant' --><input type="text" class="form-control ng-scope" name="searchFirstName" placeholder="First Name" ng-if="headerDonateSearch.search_type == 'participant'"
onfocus="scrollBody()"><!-- end ngIf: headerDonateSearch.search_type == 'participant' -->
<!-- ngIf: headerDonateSearch.search_type == 'participant' --><input type="text" class="form-control ng-scope" name="searchLastName" placeholder="Last Name" ng-if="headerDonateSearch.search_type == 'participant'"
onfocus="scrollBody()"><!-- end ngIf: headerDonateSearch.search_type == 'participant' -->
<!-- ngIf: headerDonateSearch.search_type == 'team' -->
<button type="submit" class="btn btn-primary-darker" name="fr_find_search">Go</button>
<div class="kd-header__cta-options-form-links"> or <a href="Donation2?df_id=25031&FR_ID=9196&PROXY_TYPE=21&PROXY_ID=9196">Make a General Donation</a>
</div>
</form>POST UserLogin
<form class="form-inline kd-header__cta-form ng-pristine ng-valid" action="UserLogin" method="POST">
<input type="hidden" name="RememberMe" value="RememberMe">
<input type="hidden" name="NEXTURL" value="RedirectHandler?key=RFCLoginSuccess&s_trID=9196&pw_id=13871">
<input type="hidden" name="pw_id" value=" 13871">
<input type="text" class="form-control" name="USERNAME" placeholder="username" maxlength="60" autocorrect="off" autocapitalize="off" spellcheck="false" onfocus="scrollBody()">
<input type="password" class="form-control" name="Password" placeholder="password" maxlength="99" autocorrect="off" autocapitalize="off" spellcheck="false" onfocus="scrollBody()">
<button type="submit" class="btn btn-primary">Login</button>
<div class="kd-header__cta-options-form-links">
<a href="UserLogin?CMD=ForgotLogin&fr_id=9196&pw_id=13871&s_AffiliateSecCatId=2982">Need Help?</a>
</div>
</form>Name: process — POST https://secure.info-komen.org/site/Donation2
<form name="process" id="ProcessForm" action="https://secure.info-komen.org/site/Donation2" method="post" onsubmit="return checkDoubleClick();" class="ng-pristine ng-valid">
<div class="donation-form-container responsive">
<script type="text/javascript">
<!--
function reloadPage() {
window.location.reload(true);
}
function testAjax() {
var xmlHttp = null;
// Opera 8.0+, Firefox, Chrome, Safari
try {
xmlHttp = new XMLHttpRequest();
} catch (e) {
// Internet Explorer Browsers
try {
xmlHttp = new ActiveXObject("Msxml2.XMLHTTP");
} catch (e) {
try {
xmlHttp = new ActiveXObject("Microsoft.XMLHTTP");
} catch (e) {
return false;
}
}
}
xmlHttp.open('POST', 'AjaxHelper;jsessionid=00000000.app30111b?NONCE_TOKEN=DAB4DDBAD6AD2BB85A05F590C83E4457', true);
xmlHttp.send();
}
addOnLoadHandler(testAjax);
//
-->
</script>
<div class="donation-form-content">
<input type="hidden" name="user_donation_amt" id="user_donation_amt" value="">
<input type="hidden" name="company_min_matching_amt" id="company_min_matching_amt" value="">
<input type="hidden" name="currency_locale" id="currency_locale" value="en_US">
<input type="hidden" name="facebook_donation_idhidden" id="facebook_donation_idhidden" value="">
<div class="form-row">
<div class="html-caption-container">
</div>
</div>
<div class="form-row">
<div class="html-caption-container">
<!-- /.donation-description -->
</div>
</div>
<div class="tributes-caption"> Your Donation to <strong>Flora Hacker</strong>
</div>
<h2 class="section-header-container"> Gift Amount </h2>
<div id="level_standard_row">
<div class="don-standard-levels form-row">
<div class="levels-label">
</div>
<div id="level_standard_row" class="form-row form-donation-level">
<div class="form-content">
<span class="field-required"></span> <span class="aural-only">Field Is Required</span>
<span class="FormLabelText">Select Gift Amount:</span>
<div class="donation-level-general-ask">
</div>
<div class="donation-levels">
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded84376" value="84376" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded84376" onclick="">
<div class="donation-level-label-container"> $500 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_84376expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded84382" value="84382" checked="checked" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded84382" onclick="" class="active">
<div class="donation-level-label-container"> $250 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_84382expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded84378" value="84378" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded84378" onclick="">
<div class="donation-level-label-container"> $100 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_84378expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded84381" value="84381" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded84381" onclick="">
<div class="donation-level-label-container"> $75 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_84381expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded84377" value="84377" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded84377" onclick="">
<div class="donation-level-label-container"> $30 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_84377expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded84380" value="84380" onclick="evalMatchingGift(document.getElementById('level_standardexpanded84380amount').value);
updateDonorCoverAmount(document.getElementById('level_standardexpanded84380amount').value);">
</div>
<div class="donation-level-user-entered"><span class="dollar">$</span>
<label for="level_standardexpanded84380amount"><span class="aural-only">Enter amount</span></label>
<input type="text" name="level_standardexpanded84380amount" id="level_standardexpanded84380amount" value="" size="12" maxlength="50"
onfocus="var el = document.getElementById ('level_standardexpanded84380');if (el) el.click(); fire_obs_comp_event('level_standardexpanded84380amount', this, event);evalMatchingGift(value); "
onchange="fire_obs_comp_event('level_standardexpanded84380amount', this, event);evalMatchingGift(value);" onkeyup="fire_obs_comp_event('level_standardexpanded84380amount', this, event);evalMatchingGift(value);"
onblur="fire_obs_comp_event('level_standardexpanded84380amount', this);updateDonorCoverAmount(value);" placeholder="Other">
</div>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_84380expandedsubmit" value="true">
</div>
<span class="minimum">$10.00 Minimum</span>
</div>
</div>
</div>
<script type="text/javascript">
Y.use("jquery-ui", function(Y) {
jQuery(function() {
// subscribe observables
jQuery('div.donation-level-element-container').find('input[type="radio"]').each(function() {
var syncAction = function(obj) {
if (obj.is(':checked')) {
obj.closest('div.donation-level-container').addClass('selected');
} else {
obj.closest('div.donation-level-container').removeClass('selected');
};
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('div.donation-level-container').removeClass('selected');
syncAction(jQuery(this));
});
});
});
});
</script><noscript> </noscript>
</div>
<div class="levels-gift-aid">
</div>
<input type="hidden" name="level_standardsubmit" id="level_standardsubmit" value="true">
<script type="text/javascript">
function updateDonorCoverAmount(gift) {
if (typeof updateAmount !== "undefined") {
updateAmount(gift);
}
};
function evalMatchingGift(gift) {}
</script><noscript> </noscript>
</div>
<div class="donation-ask-container"></div>
<div id="cc_fees_row">
<div class="custom-field-container form-row ">
<div class="form-content">
<div class="form-input-label-block">
<label for="cover_fees_dropdown">Cover Fees</label>
</div>
<fieldset>
<input type="checkbox" name="cover_fees_radio" id="cover_fees_radio" value="true">
<label class="custom-element-checkbox-label" for="cover_fees_radio">I choose to add <div id="cover_fees_activeamt" class="cover_fees_activeamt">$10.00</div> to cover the fees to process my donation.</label>
</fieldset>
<input type="hidden" name="cover_feessubmit" id="cover_feessubmit" value="true">
</div>
</div>
<div class="custom-field-container form-row " style="display: none; visibility: hidden;">
<div class="form-content">
<div class="form-input-label-block">
<label for="cover_fees_amount_input">Cover Fees Amount</label>
</div>
<input type="text" name="cover_fees_amount_input" id="cover_fees_amount_input" value="" maxlength="255">
<input type="hidden" name="cover_fees_amountsubmit" id="cover_fees_amountsubmit" value="true">
</div>
</div>
</div>
<script type="text/javascript">
// subscribe listeners to make an ajax call to the server to calculate the total amount
Y.use('jquery-noconflict', function() {
var fetchAmountFunc = function() {
// find all the select, textarea, input, etc... and format them into key=val pairs.
var params = jQuery('#level_standard_row :input').serialize();
// parse the path and append the key/value pairs above to the url
var url = 'https://secure.info-komen.org/site/Donation2?level_standardtotalcalculateBtn=true&25031.donation=form1&df_id=25031&PROXY_TYPE=20&PROXY_ID=22839057&mfc_pref=T&idb=117049083&FR_ID=9196&level_standardajaxfetch=true';
var index = url.indexOf("?");
var path = url.substring(0, index);
var args = url.substring(index + 1, url.length);
args += '&' + params;
jQuery.ajax(path, {
data: args,
success: function(data) {
jQuery('#recurring_gift_terms_acceptance_message_container').trigger("recurringTermsChange");
}
});
};
jQuery('#level_standard_row :input').blur(function() {
fetchAmountFunc();
});
jQuery('#level_standard_row input:checkbox, #level_standard_row input:radio').click(function() {
fetchAmountFunc();
});
jQuery('#level_standard_row select').change(function() {
fetchAmountFunc();
});
// call it on page load
fetchAmountFunc();
});
</script><noscript> </noscript>
</div>
<div class="form-row">
<div class="html-caption-container">
<!--<style>
.ohnohoney{
opacity: 0;
position: absolute;
top: 0;
left: 0;
height: 0;
width: 0;
z-index: -1;
}
</style>
<label for="first-name" class="ohnohoney">First Name</label>
<input type="text" class="ohnohoney" id="first-name" name="first-name" placeholder="First Name" />
<label for="last-name" class="ohnohoney">Last Name</label>
<input type="text" class="ohnohoney" id="last-name" name="last-name" placeholder="Last Name"/>
<label for="email" class="ohnohoney">Email Address</label>
<input type="text" class="ohnohoney" id="email" name="email" placeholder="email"/>
<label for="street-address" class="ohnohoney">Street Address</label>
<input type="text" class="ohnohoney" id="street-address" name="street-address" placeholder="street address"/>
<label for="street-address-2" class="ohnohoney">Street Address Line 2</label>
<input type="text" class="ohnohoney" id="street-address-2" name="street-address-2" placeholder="street address line 2"/>
<label for="zip" class="ohnohoney">Zip / postal code</label>
<input type="text" class="ohnohoney" id="zip" name="zip" placeholder="zip / postal code"/>
<label for="city" class="ohnohoney">city</label>
<input type="text" class="ohnohoney" id="city" name="city" placeholder="city"/>
<label for="state" class="ohnohoney">state</label>
<input type="text" class="ohnohoney" id="state" name="state" placeholder="state"/>
<label for="credit-card" class="ohnohoney">credit card number</label>
<input type="text" class="ohnohoney" id="credit-card" name="credit-card" placeholder="credit card number"/>
<script>
//prevent form submit if h o n e y p o t inputs have been filled by bots
$( document ).ready(function() {
jQuery('#ProcessForm').on('submit', function(e){
jQuery('input.ohnohoney').each(function(){
if(jQuery(this).val()){
e.preventDefault()
}
})
})
});
</script>-->
</div>
</div>
<div class="form-row">
<div class="html-caption-container">
<style>
#ProcessForm>div>div>div.custom-field-container.form-row>div {
margin-left: 20px;
}
#ProcessForm>div>div>div.custom-field-container.form-row>div>div>label {
font-size: 16px;
}
#mobile_phone_number_input {
height: 42px;
}
#billing_addr_city_row,
#billing_addr_state_row {
display: block !important;
}
</style>
</div>
</div>
<h2 class="section-header-container"> Your Information </h2>
<div id="billing_first_name_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_first_namename">First Name</label>
<input type="text" name="billing_first_namename" id="billing_first_namename" value="" maxlength="50">
<input type="hidden" name="billing_first_namesubmit" id="billing_first_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_first_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_first_name_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_last_name_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_last_namename">Last Name</label>
<input type="text" name="billing_last_namename" id="billing_last_namename" value="" maxlength="50">
<input type="hidden" name="billing_last_namesubmit" id="billing_last_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_last_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_last_name_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div class="custom-field-container form-row ">
<div class="form-content">
<div class="form-input-label-block">
<label for="mobile_phone_number_input">Mobile Phone Number</label>
</div>
<input type="text" name="mobile_phone_number_input" id="mobile_phone_number_input" value="" maxlength="255">
<input type="hidden" name="mobile_phone_numbersubmit" id="mobile_phone_numbersubmit" value="true">
</div>
</div>
<div id="donor_email_address_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="donor_email_addressname">Email Address</label>
<input type="text" name="donor_email_addressname" id="donor_email_addressname" value="" maxlength="255">
<input type="hidden" name="donor_email_addresssubmit" id="donor_email_addresssubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('donor_email_address', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor_email_address_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div class="form-row form-checkbox" id="donor_email_opt_in_Row">
<div class="form-content">
<span class="check-box-form-label-text"></span>
<input type="checkbox" name="donor_email_opt_inname" id="donor_email_opt_inname" checked="checked" onclick="fire_obs_comp_event('donor_email_opt_in', this);">
<label for="donor_email_opt_inname"> Yes, I would like to receive communications from Susan G. Komen®. </label>
<script type="text/javascript">
var comp = new ObservableComponent('donor_email_opt_in', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor_email_opt_in_Row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('donor_email_opt_inname')) {
document.getElementById('donor_email_opt_inname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('donor_email_opt_inname')) return document.getElementById('donor_email_opt_inname').checked;
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
<input type="hidden" name="donor_email_opt_insubmit" id="donor_email_opt_insubmit" value="true">
</div>
</div>
<div class="form-row">
<div class="html-caption-container">
<!--<div class="form-content">
<input type="checkbox" name="donor_mobile_opt_in" id="donor_mobile_opt_in" checked="checked">
<label for="donor_mobile_opt_in">
Yes, I would like to receive text messages from Susan G. Komen®.
</label>
</div>
<script type="text/javascript">
jQuery(document).ready(function(){
//hide the mobile opt-in dropdown in favor of the custom checkbox
jQuery('#mobile_opt_in_dropdown').closest('.custom-field-container').hide();
// set the state of the checkbox on page load from the state of the dropdown
if (jQuery('#mobile_opt_in_dropdown').val() === 'true'){
jQuery('#donor_mobile_opt_in').prop('checked',true);
}
else{
jQuery('#donor_mobile_opt_in').prop('checked',false);
}
// set the state of the hidden dropdown on the basis of the checkbox when clicked
jQuery('#donor_mobile_opt_in').click(function(){
if (jQuery('#donor_mobile_opt_in').is(':checked')){
jQuery('#mobile_opt_in_dropdown').val('true');
}
else{
jQuery('#mobile_opt_in_dropdown').val('false');
}
});
});
</script>
-->
</div>
</div>
<input type="hidden" name="mobile_opt_inhidden" id="mobile_opt_inhidden" value="">
<h2 class="section-header-container"> Billing Address </h2>
<div id="billing_addr_street1_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_street1name">Street Address</label>
<input type="text" name="billing_addr_street1name" id="billing_addr_street1name" value="" maxlength="50">
<input type="hidden" name="billing_addr_street1submit" id="billing_addr_street1submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_street1', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_street1_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_street2_row" class="form-row form-text">
<div class="form-content">
<label for="billing_addr_street2name">Street Address Line 2 <em>(optional)</em></label>
<input type="text" name="billing_addr_street2name" id="billing_addr_street2name" value="" maxlength="50">
<input type="hidden" name="billing_addr_street2submit" id="billing_addr_street2submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_street2', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_street2_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_country_row" class="form-row form-selectlist">
<div class="form-content">
<label class="FormLabel" for="billing_addr_country">Country</label>
<select name="billing_addr_country" id="billing_addr_country" size="1" onchange="fire_obs_comp_event('billing_addr_country', this)" disabled="disabled">
<option value=""></option>
<option selected="selected" value="United States">United States</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia, Plurinational State of">Bolivia, Plurinational State of</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, The Democratic Republic of the">Congo, The Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'Ivoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</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, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former Yugoslav Republic of</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French Part)">Saint Martin (French Part)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch Part)">Sint Maarten (Dutch Part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela, Bolivarian Republic of">Venezuela, Bolivarian Republic of</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><a class="change-country" id="billing-change-country">change country</a>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_addr_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_country_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="billing_addr_countrysubmit" id="billing_addr_countrysubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_country_row', _display);
this.disable_submit_flag(_hidden);
}
function billing_addr_country_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_addr_country', src);
}
}
var el = document.getElementById('billing_addr_country');
if (el) {
Utils.addEvent(el, 'change', billing_addr_country_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_zip_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_zipname">ZIP/Postal Code</label>
<input type="text" name="billing_addr_zipname" id="billing_addr_zipname" value="" maxlength="50">
<input type="hidden" name="billing_addr_zipsubmit" id="billing_addr_zipsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_zip', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_zip_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_city_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_cityname">City</label>
<input type="text" name="billing_addr_cityname" id="billing_addr_cityname" value="" maxlength="50">
<input type="hidden" name="billing_addr_citysubmit" id="billing_addr_citysubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_city', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_city_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_state_row" class="form-row form-selectlist">
<div class="form-content">
<span class="field-required"></span>
<label class="FormLabel" for="billing_addr_state">State/Province</label>
<select name="billing_addr_state" id="billing_addr_state" size="1" onchange="fire_obs_comp_event('billing_addr_state', this)">
<option value=""></option>
<option value="AK">AK - Alaska</option>
<option value="AL">AL - Alabama</option>
<option value="AR">AR - Arkansas</option>
<option value="AZ">AZ - Arizona</option>
<option value="CA">CA - California</option>
<option value="CO">CO - Colorado</option>
<option value="CT">CT - Connecticut</option>
<option value="DC">DC - District of Columbia</option>
<option value="DE">DE - Delaware</option>
<option value="FL">FL - Florida</option>
<option value="GA">GA - Georgia</option>
<option value="HI">HI - Hawaii</option>
<option value="IA">IA - Iowa</option>
<option value="ID">ID - Idaho</option>
<option value="IL">IL - Illinois</option>
<option value="IN">IN - Indiana</option>
<option value="KS">KS - Kansas</option>
<option value="KY">KY - Kentucky</option>
<option value="LA">LA - Louisiana</option>
<option value="MA">MA - Massachusetts</option>
<option value="MD">MD - Maryland</option>
<option value="ME">ME - Maine</option>
<option value="MI">MI - Michigan</option>
<option value="MN">MN - Minnesota</option>
<option value="MO">MO - Missouri</option>
<option value="MS">MS - Mississippi</option>
<option value="MT">MT - Montana</option>
<option value="NC">NC - North Carolina</option>
<option value="ND">ND - North Dakota</option>
<option value="NE">NE - Nebraska</option>
<option value="NH">NH - New Hampshire</option>
<option value="NJ">NJ - New Jersey</option>
<option value="NM">NM - New Mexico</option>
<option value="NV">NV - Nevada</option>
<option value="NY">NY - New York</option>
<option value="OH">OH - Ohio</option>
<option value="OK">OK - Oklahoma</option>
<option value="OR">OR - Oregon</option>
<option value="PA">PA - Pennsylvania</option>
<option value="RI">RI - Rhode Island</option>
<option value="SC">SC - South Carolina</option>
<option value="SD">SD - South Dakota</option>
<option value="TN">TN - Tennessee</option>
<option value="TX">TX - Texas</option>
<option value="UT">UT - Utah</option>
<option value="VA">VA - Virginia</option>
<option value="VT">VT - Vermont</option>
<option value="WA">WA - Washington</option>
<option value="WI">WI - Wisconsin</option>
<option value="WV">WV - West Virginia</option>
<option value="WY">WY - Wyoming</option>
<option value="AS">AS - American Samoa</option>
<option value="FM">FM - Federated States of Micronesia</option>
<option value="GU">GU - Guam</option>
<option value="MH">MH - Marshall Islands</option>
<option value="MP">MP - Northern Mariana Islands</option>
<option value="PR">PR - Puerto Rico</option>
<option value="PW">PW - Palau</option>
<option value="VI">VI - Virgin Islands</option>
<option value="AA">AA - Armed Forces Americas</option>
<option value="AE">AE - Armed Forces</option>
<option value="AP">AP - Armed Forces Pacific</option>
<option value="AB">AB - Alberta</option>
<option value="BC">BC - British Columbia</option>
<option value="MB">MB - Manitoba</option>
<option value="NB">NB - New Brunswick</option>
<option value="NL">NL - Newfoundland and Labrador</option>
<option value="NS">NS - Nova Scotia</option>
<option value="NT">NT - Northwest Territories</option>
<option value="NU">NU - Nunavut</option>
<option value="ON">ON - Ontario</option>
<option value="QC">QC - Quebec</option>
<option value="SK">SK - Saskatchewan</option>
<option value="YT">YT - Yukon</option>
<option value="None">None</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_addr_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="billing_addr_statesubmit" id="billing_addr_statesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_state_row', _display);
this.disable_submit_flag(_hidden);
}
function billing_addr_state_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_addr_state', src);
}
}
var el = document.getElementById('billing_addr_state');
if (el) {
Utils.addEvent(el, 'change', billing_addr_state_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div class="form-row">
<div class="html-caption-container">
<div id="dtd-form-elements">
<h2 style="border: none;font-size: 22px;font-family: 'Montserrat', sans-serif;font-weight: 400;margin-bottom: 12px;"> Would you like your employer to match your gift? If so, please search below. </h2>
<style>
.dd-company-selected .wrongcompany {
display: block;
}
.dd-company-selected .wrongcompany a {
color: #c5006e !important;
font-family: 'Montserrat', sans-serif;
font-size: 16px;
font-weight: 400;
}
</style>
<script src="https://doublethedonation.com/api/js/ddplugin.js"></script>
<link href="https://doublethedonation.com/api/css/ddplugin.css" rel="stylesheet">
<div id="dd-company-name-input" data-doublethedonation-widget-id="G__2">
<div class="dtd-streamlined-plugin"><input type="hidden" name="doubledonation_status" value="no_interaction"><input type="hidden" name="doublethedonation_status" value="no_interaction"><input type="hidden"
name="doublethedonation_entered_text"><input type="hidden" name="doubledonation_company_id"><input type="hidden" name="doublethedonation_company_id"><input type="hidden" name="doubledonation_company_name"><input type="hidden"
name="doublethedonation_company_name">
<div class="dtd-search-box" style="width: 100%; margin-bottom: 0px;">
<div aria-live="assertive" style="display: block; font-size: 0px; color: rgb(255, 255, 255); opacity: 0; position: absolute; height: 0px; margin: 0px; z-index: -99999;"></div>
<div aria-live="polite" style="display: block; font-size: 0px; color: rgb(255, 255, 255); opacity: 0; position: absolute; height: 0px; margin: 0px; z-index: -99999;"></div><input role="listbox" aria-expanded="false"
name="doublethedonation_company_name_input" autocomplete="new-password" type="text" id="dd-input" class="dtd-search-input form-control" aria-label="Search company" style="width: 100%;" placeholder="Search company name...">
</div>
</div>
</div>
<script type="text/javascript">
// <![CDATA[
if (window.doublethedonation) {
console.log('DOUBLE THE DONATION LOADED');
var targetNodeTimer = setInterval(function() {
var targetNode = document.querySelector('#dd-company-name-input > div > input[name="doublethedonation_company_id"]');
if (targetNode != null) {
// Options for the observer (which mutations to observe)
var config = {
attributes: true
};
// Callback function to execute when mutations are observed
var callback = function(mutationsList, observer) {
var mutation = mutationsList[mutationsList.length - 1];
if (mutation.type === 'attributes' && mutation.attributeName === 'value') {
console.log('Company changed');
var dtd_company_id = document.querySelector('input[name="doublethedonation_company_id"]').value;
console.log('Selected company ID: ' + dtd_company_id);
document.getElementById('double_the_donation_company_idhidden').value = dtd_company_id;
}
};
// Create an observer instance linked to the callback function
var observer = new MutationObserver(callback);
// Start observing the target node for configured mutations
observer.observe(targetNode, config);
// Clear the timer
clearInterval(targetNodeTimer);
}
}, 100);
}
// ]]>
</script>
</div>
<style>
#dtd-form-elements {
padding: 5px 20px 15px 20px;
}
#dtd-form-elements h2 {
display: inline-block;
margin-top: 35px;
}
</style>
</div>
</div>
<input type="hidden" name="double_the_donation_company_idhidden" id="double_the_donation_company_idhidden" value="">
<h2 class="section-header-container"> Payment Information </h2>
<div class="payment-type-element-container">
<div class="payment-type-selection-container payment-field-container">
<h3>Payment Method:</h3>
<div id="responsive_payment_typepay_typeradio_row" class="form-row">
<div class="form-content">
<div class="payment-type-selections" id="responsive_payment_typepay_typeradio_payment_types">
<span class="internal-payment"><span class="payment-type-option selected"><input type="radio" name="responsive_payment_typepay_typeradio" id="responsive_payment_typepay_typeradiocredit" value="credit" checked="checked"
onclick="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" onkeypress="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);"><label
for="responsive_payment_typepay_typeradiocredit"><a href="javascript:void(0);" class="payment-type-label">Credit Card</a></label>
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
</script><noscript> </noscript>
</span><span class="payment-type-option"><input type="radio" name="responsive_payment_typepay_typeradio" id="responsive_payment_typepay_typeradioach" value="ach"
onclick="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" onkeypress="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);"><label
for="responsive_payment_typepay_typeradioach"><a href="javascript:void(0);" class="payment-type-label">Checking Account</a></label>
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
</script><noscript> </noscript>
</span></span>
<span class="external-payment"><span class="payment-type-option"><input type="radio" name="responsive_payment_typepay_typeradio" id="responsive_payment_typepay_typeradiopaypal" value="paypal"
onclick="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" onkeypress="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);"><label
for="responsive_payment_typepay_typeradiopaypal"><a href="javascript:void(0);" class="payment-type-label"><img src="../images/payment/paypal-logo.png" alt="Pay with Paypal"></a></label>
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
</script><noscript> </noscript>
</span></span>
</div>
<input type="hidden" name="responsive_payment_typepay_typeradiosubmit" id="responsive_payment_typepay_typeradiosubmit" value="true">
<script type="text/javascript">
Y.use("jquery-ui", function(Y) {
jQuery(function() {
// subscribe observable for payment type options
jQuery('.payment-type-option').each(function() {
var syncAction = function(obj) {
if (obj.hasClass('selected')) {
var radioGroupName = obj.find('input').attr('name');
obj.find('input').prop('checked', true);
fire_obs_comp_event(radioGroupName, obj.find('input').get());
}
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('.payment-type-option').removeClass('selected');
jQuery(this).addClass('selected');
syncAction(jQuery(this));
var selectedValue = jQuery(this).find('input').val();
if (selectedValue == 'paypal' || selectedValue == 'amazon') {
// open up a boxinator dialog
jQuery(document).trigger('redirect-external');
jQuery('#btn_next').click();
}
});
});
});
});
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typepay_typeradio_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
</div>
<div id="payment_cc_container" class="payment-field-container">
<h3>Credit Card Information:</h3>
<div id="responsive_payment_typecc_type_row" class="form-row form-radio-array">
<div class="form-content">
<fieldset>
<legend>Credit Card Type:</legend>
<ul class="radio-array-list">
<li class="tender-row ">
<img src="../images/discovercard_sm.gif" alt="Discover" name="responsive_payment_typecc_type_Discover" id="responsive_payment_typecc_type_Discover">
</li>
<li class="tender-row ">
<img src="../images/amex_small.gif" alt="American Express" name="responsive_payment_typecc_type_American_Express" id="responsive_payment_typecc_type_American_Express">
</li>
<li class="tender-row ">
</li>
<li class="tender-row ">
<img src="../images/mastercd_small.gif" alt="MasterCard" name="payment_typecc_type_MasterCard" id="payment_typecc_type_MasterCard">
</li>
<li class="tender-row ">
<img src="../images/visa_small.gif" alt="Visa" name="payment_typecc_type_Visa" id="payment_typecc_type_Visa">
</li>
</ul>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_typesubmit" id="responsive_payment_typecc_typesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typecc_type', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_type_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_number_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_numbername">Credit Card Number:</label>
<input type="text" name="responsive_payment_typecc_numbername" id="responsive_payment_typecc_numbername" value="" maxlength="22" autocomplete="off">
<input type="hidden" name="responsive_payment_typecc_numbersubmit" id="responsive_payment_typecc_numbersubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typecc_number', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_number_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('null', new ComponentDisplayer('responsive_payment_typecc_number'));
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_exp_date_row" class="form-row form-date">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_exp_date_MONTH">
<span class="label-text">Expiration Date:</span><span class="aural-only">Select month of credit card</span>
</label>
<label for="responsive_payment_typecc_exp_date_YEAR"><span class="aural-only">Select Expiration Year</span></label>
<div class="date-input-container">
<fieldset class="cardExpGroup">
<select name="responsive_payment_typecc_exp_date_MONTH" id="responsive_payment_typecc_exp_date_MONTH" onchange="fire_obs_comp_event('responsive_payment_typecc_exp_date_MONTH', this)">
<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" selected="selected">11</option>
<option value="12">12</option>
</select>
<select name="responsive_payment_typecc_exp_date_YEAR" id="responsive_payment_typecc_exp_date_YEAR" onchange="fire_obs_comp_event('responsive_payment_typecc_exp_date_YEAR', this)">
<option value="2022" selected="selected">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>
</select>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_exp_date_DAY" id="responsive_payment_typecc_exp_date_DAY" value="1">
<script type="text/javascript">
<!--
var comp1 = new ObservableComponent('responsive_payment_typecc_exp_date_MONTH', '');
comp1.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag(_hidden);
}
var comp2 = new ObservableComponent('responsive_payment_typecc_exp_date_YEAR', '');
comp2.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script><noscript> </noscript>
</div>
<input type="hidden" name="responsive_payment_typecc_exp_datesubmit" id="responsive_payment_typecc_exp_datesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typecc_exp_date', 'input');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_row', _display);
disable_submit_flag('responsive_payment_typecc_exp_datesubmit', _hidden);
}
comp.disable = function(_disabled) {
disable_element('responsive_payment_typecc_exp_date_MONTH', _disabled);
disable_element('responsive_payment_typecc_exp_date_DAY', _disabled);
disable_element('responsive_payment_typecc_exp_date_YEAR', _disabled);
disable_element('responsive_payment_typecc_exp_date_HOUR12', _disabled);
disable_element('responsive_payment_typecc_exp_date_HOUR24', _disabled); //For UK, 24 hour clock used
disable_element('responsive_payment_typecc_exp_date_MINUTE', _disabled);
disable_element('responsive_payment_typecc_exp_date_AMPM', _disabled);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_cvv_row" class="form-row form-text cvv-input">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_cvvname">
<span class="FormLabelText">CVV Number:</span>
</label>
<a href="http://help.convio.net/site/PageServer?s_site=kd&pagename=user_donation_cvv" class="HelpLink" title="What is this? Opens new window.">What is this?</a>
<input type="text" name="responsive_payment_typecc_cvvname" id="responsive_payment_typecc_cvvname" value="" maxlength="4" autocomplete="cc-csc">
<input type="hidden" name="responsive_payment_typecc_cvvsubmit" id="responsive_payment_typecc_cvvsubmit" value="true">
<script type="text/javascript">
//chrome is mapping cvv as card name
if (/Chrome/.test(navigator.userAgent) && /Google Inc/.test(navigator.vendor)) {
document.getElementById('responsive_payment_typecc_cvvname').autocomplete = 'cc-csc';
}
var comp = new ObservableComponent('responsive_payment_typecc_cvv', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_cvv_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
</div>
<div id="payment_bank_container" class="payment-field-container" style="display: none;">
<h3>Checking Account Information:</h3>
<div id="responsive_payment_typerouting_number_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typerouting_numbername">Bank Routing Number:</label>
<a href="http://help.convio.net/site/PageServer?s_site=kd&pagename=User_Donation_ACH" class="HelpLink" title="What is this? Opens new window.">What is this?</a>
<input type="text" name="responsive_payment_typerouting_numbername" id="responsive_payment_typerouting_numbername" value="" size="20" maxlength="20" onchange="fire_obs_comp_event('responsive_payment_typerouting_number', this);"
autocomplete="off">
<input type="hidden" name="responsive_payment_typerouting_numbersubmit" id="responsive_payment_typerouting_numbersubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typerouting_number', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typerouting_number_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typebank_account_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typebank_accountname">Bank Account Number:</label>
<input type="text" name="responsive_payment_typebank_accountname" id="responsive_payment_typebank_accountname" value="" maxlength="20" autocomplete="off">
<input type="hidden" name="responsive_payment_typebank_accountsubmit" id="responsive_payment_typebank_accountsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typebank_account', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typebank_account_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('null', new ComponentDisplayer('responsive_payment_typebank_account'));
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typeverify_bank_account_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typeverify_bank_accountname">Verify Bank Account Number:</label>
<input type="text" name="responsive_payment_typeverify_bank_accountname" id="responsive_payment_typeverify_bank_accountname" value="" maxlength="20" autocomplete="off">
<input type="hidden" name="responsive_payment_typeverify_bank_accountsubmit" id="responsive_payment_typeverify_bank_accountsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typeverify_bank_account', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typeverify_bank_account_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('null', new ComponentDisplayer('responsive_payment_typeverify_bank_account'));
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_type.account_type_row" class="form-row form-radio-array">
<div class="form-content">
<fieldset>
<legend><span class="field-required"></span> Account Type:</legend>
<ul class="radio-array-list">
<li>
<input type="radio" name="responsive_payment_type.account_type" id="responsive_payment_type.account_type_responsive_payment_typeaccount_type_checking" value="CHECKING"
onclick="fire_obs_comp_event('responsive_payment_type.account_type', this);">
<span class="radio-label">
<label for="responsive_payment_type.account_type_responsive_payment_typeaccount_type_checking">Checking</label>
</span>
</li>
<li>
<input type="radio" name="responsive_payment_type.account_type" id="responsive_payment_type.account_type_responsive_payment_typeaccount_type_savings" value="SAVINGS"
onclick="fire_obs_comp_event('responsive_payment_type.account_type', this);">
<span class="radio-label">
<label for="responsive_payment_type.account_type_responsive_payment_typeaccount_type_savings">Savings</label>
</span>
</li>
</ul>
</fieldset>
<input type="hidden" name="responsive_payment_type.account_typesubmit" id="responsive_payment_type.account_typesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_type.account_type', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_type.account_type_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typeach_confirm_row" class="form-row form-checkbox">
<div class="form-content">
<span class="field-required"></span>
<input type="checkbox" name="responsive_payment_typeach_confirmname" id="responsive_payment_typeach_confirmname" onclick="fire_obs_comp_event('responsive_payment_typeach_confirm', this);">
<label for="responsive_payment_typeach_confirmname">By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.</label>
<input type="hidden" name="responsive_payment_typeach_confirmsubmit" id="responsive_payment_typeach_confirmsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typeach_confirm', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typeach_confirm_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('responsive_payment_typeach_confirmname')) {
document.getElementById('responsive_payment_typeach_confirmname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('responsive_payment_typeach_confirmname')) {
return document.getElementById('responsive_payment_typeach_confirmname').checked;
}
}
comp.clear = function() {
this.set(false);
}
observe_component('null', new ComponentEnabler('responsive_payment_typeach_confirm'));
</script><noscript> </noscript>
</div>
</div>
</div>
<div id="payment_check_container" class="payment-field-container" style="display: none;">
<h3>Check Information</h3>
</div>
<input type="hidden" name="responsive_payment_typesubmit" id="responsive_payment_typesubmit" value="true">
<script type="text/javascript">
function PaymentObserver() {
this.observe = function(_event) {
var sVal = _event.component.get();
switch (sVal) {
case 'check':
hide_element('payment_cc_container');
hide_element('payment_bank_container');
show_element('payment_check_container');
break;
case 'credit':
hide_element('payment_bank_container');
hide_element('payment_check_container');
show_element('payment_cc_container');
break;
case 'ach':
hide_element('payment_cc_container');
hide_element('payment_check_container');
show_element('payment_bank_container');
break;
case 'paypal':
case 'amazon':
case 'mobilepay':
default:
// hide all
hide_element('payment_bank_container');
hide_element('payment_cc_container');
hide_element('payment_check_container');
break;
}
}
}
// Set the observer to show/hide the relevant fields
observe_component('responsive_payment_typepay_typeradio', new PaymentObserver());
</script><noscript> </noscript>
</div>
<h2 class="section-header-container"> Additional Gift Information </h2>
<div id="tribute_show_honor_fields_row" class="form-row form-checkbox">
<div class="form-content">
<span class="check-box-form-label-text">Honor or Memorial Gift <em>(optional)</em></span>
<input type="checkbox" name="tribute_show_honor_fieldsname" id="tribute_show_honor_fieldsname" onclick="fire_obs_comp_event('tribute_show_honor_fields', this);">
<label for="tribute_show_honor_fieldsname">Yes, this gift is in honor or memory of someone special, and I would like a tribute card delivered by postal mail.</label>
<input type="hidden" name="tribute_show_honor_fieldssubmit" id="tribute_show_honor_fieldssubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_show_honor_fields', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_show_honor_fields_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('tribute_show_honor_fieldsname')) {
document.getElementById('tribute_show_honor_fieldsname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('tribute_show_honor_fieldsname')) {
return document.getElementById('tribute_show_honor_fieldsname').checked;
}
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_type_row" class="form-row form-selectlist" style="display: none;">
<div class="form-content">
<label class="FormLabel" for="tribute_type">Your Tribute Type</label>
<select name="tribute_type" id="tribute_type" size="1">
<option value=""></option>
<option value="tribute_type_value1">In Memory of</option>
<option value="tribute_type_value2">In Honor of</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_type', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_type_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_typesubmit_skip" id="tribute_typesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_type', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_type_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_type'));
function tribute_type_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_type', src);
}
}
var el = document.getElementById('tribute_type');
if (el) {
Utils.addEvent(el, 'change', tribute_type_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_honoree_name_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_honoree_namename">Honoree Name / Occasion</label>
<input type="text" name="tribute_honoree_namename" id="tribute_honoree_namename" value="" maxlength="50">
<input type="hidden" name="tribute_honoree_namesubmit_skip" id="tribute_honoree_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_honoree_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_honoree_name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_honoree_name'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_signature_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_signaturename">Tribute Card Signature <em>(optional)</em></label>
<input type="text" name="tribute_signaturename" id="tribute_signaturename" value="" maxlength="70">
<input type="hidden" name="tribute_signaturesubmit_skip" id="tribute_signaturesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_signature', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_signature_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_signature'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_name_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_notify_recip_namename">Recipient Name</label>
<input type="text" name="tribute_notify_recip_namename" id="tribute_notify_recip_namename" value="" maxlength="70">
<input type="hidden" name="tribute_notify_recip_namesubmit_skip" id="tribute_notify_recip_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_name'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_street1_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_notify_recip_street1name">Recipient Street Address</label>
<input type="text" name="tribute_notify_recip_street1name" id="tribute_notify_recip_street1name" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_street1submit_skip" id="tribute_notify_recip_street1submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_street1', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_street1_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_street1'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_street2_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_notify_recip_street2name">Recipient Street Address 2 <em>(optional)</em></label>
<input type="text" name="tribute_notify_recip_street2name" id="tribute_notify_recip_street2name" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_street2submit_skip" id="tribute_notify_recip_street2submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_street2', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_street2_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_street2'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_country_row" class="form-row form-selectlist" style="display: none;">
<div class="form-content">
<label class="FormLabel" for="tribute_notify_recip_country">Recipient Country</label>
<select name="tribute_notify_recip_country" id="tribute_notify_recip_country" size="1" onchange="fire_obs_comp_event('tribute_notify_recip_country', this)" disabled="disabled">
<option value=""></option>
<option selected="selected" value="United States">United States</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia, Plurinational State of">Bolivia, Plurinational State of</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, The Democratic Republic of the">Congo, The Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'Ivoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</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, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former Yugoslav Republic of</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French Part)">Saint Martin (French Part)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch Part)">Sint Maarten (Dutch Part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela, Bolivarian Republic of">Venezuela, Bolivarian Republic of</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><a class="change-country" id="tribute-change-country">change country</a>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_notify_recip_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_country_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_notify_recip_countrysubmit_skip" id="tribute_notify_recip_countrysubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_country_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_country'));
function tribute_notify_recip_country_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_notify_recip_country', src);
}
}
var el = document.getElementById('tribute_notify_recip_country');
if (el) {
Utils.addEvent(el, 'change', tribute_notify_recip_country_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_zip_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_notify_recip_zipname">Recipient ZIP / Postal Code</label>
<input type="text" name="tribute_notify_recip_zipname" id="tribute_notify_recip_zipname" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_zipsubmit_skip" id="tribute_notify_recip_zipsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_zip', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_zip_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_zip'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_city_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_notify_recip_cityname">Recipient City</label>
<input type="text" name="tribute_notify_recip_cityname" id="tribute_notify_recip_cityname" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_citysubmit_skip" id="tribute_notify_recip_citysubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_city', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_city_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_city'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_state_row" class="form-row form-selectlist" style="display: none;">
<div class="form-content">
<label class="FormLabel" for="tribute_notify_recip_state">Recipient State</label>
<select name="tribute_notify_recip_state" id="tribute_notify_recip_state" size="1" onchange="fire_obs_comp_event('tribute_notify_recip_state', this)">
<option value=""></option>
<option value="AK">AK - Alaska</option>
<option value="AL">AL - Alabama</option>
<option value="AR">AR - Arkansas</option>
<option value="AZ">AZ - Arizona</option>
<option value="CA">CA - California</option>
<option value="CO">CO - Colorado</option>
<option value="CT">CT - Connecticut</option>
<option value="DC">DC - District of Columbia</option>
<option value="DE">DE - Delaware</option>
<option value="FL">FL - Florida</option>
<option value="GA">GA - Georgia</option>
<option value="HI">HI - Hawaii</option>
<option value="IA">IA - Iowa</option>
<option value="ID">ID - Idaho</option>
<option value="IL">IL - Illinois</option>
<option value="IN">IN - Indiana</option>
<option value="KS">KS - Kansas</option>
<option value="KY">KY - Kentucky</option>
<option value="LA">LA - Louisiana</option>
<option value="MA">MA - Massachusetts</option>
<option value="MD">MD - Maryland</option>
<option value="ME">ME - Maine</option>
<option value="MI">MI - Michigan</option>
<option value="MN">MN - Minnesota</option>
<option value="MO">MO - Missouri</option>
<option value="MS">MS - Mississippi</option>
<option value="MT">MT - Montana</option>
<option value="NC">NC - North Carolina</option>
<option value="ND">ND - North Dakota</option>
<option value="NE">NE - Nebraska</option>
<option value="NH">NH - New Hampshire</option>
<option value="NJ">NJ - New Jersey</option>
<option value="NM">NM - New Mexico</option>
<option value="NV">NV - Nevada</option>
<option value="NY">NY - New York</option>
<option value="OH">OH - Ohio</option>
<option value="OK">OK - Oklahoma</option>
<option value="OR">OR - Oregon</option>
<option value="PA">PA - Pennsylvania</option>
<option value="RI">RI - Rhode Island</option>
<option value="SC">SC - South Carolina</option>
<option value="SD">SD - South Dakota</option>
<option value="TN">TN - Tennessee</option>
<option value="TX">TX - Texas</option>
<option value="UT">UT - Utah</option>
<option value="VA">VA - Virginia</option>
<option value="VT">VT - Vermont</option>
<option value="WA">WA - Washington</option>
<option value="WI">WI - Wisconsin</option>
<option value="WV">WV - West Virginia</option>
<option value="WY">WY - Wyoming</option>
<option value="AS">AS - American Samoa</option>
<option value="FM">FM - Federated States of Micronesia</option>
<option value="GU">GU - Guam</option>
<option value="MH">MH - Marshall Islands</option>
<option value="MP">MP - Northern Mariana Islands</option>
<option value="PR">PR - Puerto Rico</option>
<option value="PW">PW - Palau</option>
<option value="VI">VI - Virgin Islands</option>
<option value="AA">AA - Armed Forces Americas</option>
<option value="AE">AE - Armed Forces</option>
<option value="AP">AP - Armed Forces Pacific</option>
<option value="AB">AB - Alberta</option>
<option value="BC">BC - British Columbia</option>
<option value="MB">MB - Manitoba</option>
<option value="NB">NB - New Brunswick</option>
<option value="NL">NL - Newfoundland and Labrador</option>
<option value="NS">NS - Nova Scotia</option>
<option value="NT">NT - Northwest Territories</option>
<option value="NU">NU - Nunavut</option>
<option value="ON">ON - Ontario</option>
<option value="QC">QC - Quebec</option>
<option value="SK">SK - Saskatchewan</option>
<option value="YT">YT - Yukon</option>
<option value="None">None</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_notify_recip_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_notify_recip_statesubmit_skip" id="tribute_notify_recip_statesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_state_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_state'));
function tribute_notify_recip_state_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_notify_recip_state', src);
}
}
var el = document.getElementById('tribute_notify_recip_state');
if (el) {
Utils.addEvent(el, 'change', tribute_notify_recip_state_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tr_message_to_participant_row" class="form-row form-text" style="display: block;">
<div class="form-content">
<label for="tr_message_to_participantname">Personal Note <em>(optional)</em></label>
<textarea cols="35" rows="4" name="tr_message_to_participantname" id="tr_message_to_participantname" placeholder="Write Flora Hacker a note of encouragement"></textarea>
<input type="hidden" name="tr_message_to_participantsubmit" id="tr_message_to_participantsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tr_message_to_participant', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tr_message_to_participant_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div class="tr-recognition-name-view">
<div id="tr_recognition_namerec_name_row" class="form-row form-text">
<div class="form-content">
<label for="tr_recognition_namerec_namename">Recognition Name <em>(optional)</em></label>
<input type="text" name="tr_recognition_namerec_namename" id="tr_recognition_namerec_namename" value="" maxlength="50" placeholder="If different from your name">
<input type="hidden" name="tr_recognition_namerec_namesubmit" id="tr_recognition_namerec_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tr_recognition_namerec_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tr_recognition_namerec_name_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<script type="text/javascript">
<!--
observe_component('tr_recognition_nameanonymous.true', new ComponentDisabler('tr_recognition_namerec_name', true));
//
-->
</script><noscript> </noscript>
<input type="hidden" name="tr_recognition_namesubmit" id="tr_recognition_namesubmit" value="true">
</div>
<div id="tr_show_gift_to_public_row" class="form-row form-checkbox">
<div class="form-content">
<span class="check-box-form-label-text">Public Recognition <em>(optional)</em></span>
<div id="tr_recognition_nameanonymous_row" class="form-row form-checkbox">
<div class="form-content">
<input type="checkbox" name="tr_recognition_nameanonymousname" id="tr_recognition_nameanonymousname" onclick="fire_obs_comp_event('tr_recognition_nameanonymous', this);">
<label for="tr_recognition_nameanonymousname">Please don't display my name on the website.</label>
<input type="hidden" name="tr_recognition_nameanonymoussubmit" id="tr_recognition_nameanonymoussubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tr_recognition_nameanonymous', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tr_recognition_nameanonymous_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('tr_recognition_nameanonymousname')) {
document.getElementById('tr_recognition_nameanonymousname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('tr_recognition_nameanonymousname')) {
return document.getElementById('tr_recognition_nameanonymousname').checked;
}
}
comp.clear = function() {
this.set(false);
}
observe_component('null', new ComponentEnabler('tr_recognition_nameanonymous'));
</script><noscript> </noscript>
</div>
</div>
<input type="checkbox" name="tr_show_gift_to_publicname" id="tr_show_gift_to_publicname" checked="checked" onclick="fire_obs_comp_event('tr_show_gift_to_public', this);">
<label for="tr_show_gift_to_publicname">Yes, you can display the amount of my donation publicly</label>
<input type="hidden" name="tr_show_gift_to_publicsubmit" id="tr_show_gift_to_publicsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tr_show_gift_to_public', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tr_show_gift_to_public_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('tr_show_gift_to_publicname')) {
document.getElementById('tr_show_gift_to_publicname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('tr_show_gift_to_publicname')) {
return document.getElementById('tr_show_gift_to_publicname').checked;
}
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
</div>
<div class="button-container clearfix">
<div class="button-sub-container">
<button class="step-button action-button finish-step" type="submit" id="pstep_finish_btn" name="pstep_finish" value="DONATE">DONATE $260</button>
</div>
</div>
<input type="hidden" name="idb" id="idb" value="117049083">
<input type="hidden" name="df_id" id="df_id" value="25031">
<input type="hidden" name="FR_ID" id="FR_ID" value="9196">
<input type="hidden" name="mfc_pref" id="mfc_pref" value="T">
<input type="hidden" name="PROXY_ID" id="PROXY_ID" value="22839057">
<input type="hidden" name="PROXY_TYPE" id="PROXY_TYPE" value="20">
<div class="form-row">
<div class="html-caption-container">
<!-- CC Fees Code DO NOT REMOVE -->
<script>
var default_checked = true;
</script>
<script>
var default_checked = true;
</script>
<style>
#cc_fees_row {
padding-left: 20px;
/* margin-top: -40px;*/
}
#cover_fees_amount_input {
display: none;
visibility: hidden;
}
label[for=cover_fees_amount_input],
label[for=cover_fees_dropdown] {
display: none;
visibility: hidden;
}
#cover_fees_activeamt {
display: inline;
}
</style>
<script>
jq112 = jQuery.noConflict();
var activeamt = 0;
var activeamt_toadd = 0;;
var totes_amt = 0;
var disp_amt = 0;
if (document.getElementById("pstep_finish") != null) {
document.getElementById("pstep_finish").id = "pstep_finish_btn"; // Change Submit ID To Override
}
jq112(document).ready(function() {
CC_Fees_Load();
Check_Reload();
});
function Check_Reload() {
if (default_checked) {
if (jq112("#cover_fees_radio").is(":checked")) {
//Form errored out on submit and cc fees checkbox is set to default checked
CheckInvalidCustom();
GetOtherBoxAmount();
CheckOtherExistingButtonReload();
updateactiveamt(); //Update fields to Current Active Amt
} else {
//Form loaded and default cc fees checkbox is set to checked
jQuery("#cover_fees_radio").prop("checked", true);
CheckInvalidCustom();
GetOtherBoxAmount();
getactiveamt(); // Get the Current Active Amt
updateactiveamt(); //Update fields to Current Active Amt
flexible_load_prechecked_value();
}
} else {
if (jq112("#cover_fees_radio").is(":checked")) {
//CC Fees Button checked and form submmission errored
CheckInvalidCustom();
GetOtherBoxAmount();
CheckOtherExistingButtonReload();
updateactiveamt(); //Update fields to Current Active Amt
} else {
//CC Fees Button unchecked and form default is unchecked
CheckInvalidCustom();
GetOtherBoxAmount();
getactiveamt(); // Get the Current Active Amt
updateactiveamt(); //Update fields to Current Active Amt
}
}
}
function update_giving_total() {
var isforever = false;
var total_giving_combined;
if (jq112(".donation-level-total-amount").length > 0) {
if (jq112("#level_flexiblegift_type2").is(":checked")) {
var num_times = jq112("#level_flexibleduration").val().substr(2);
if (Number(num_times) == 0) {
jq112(".donation-level-total-amount").text("");
return true;
} else {
jq112(".donation-level-total-amount").text("$" + String(Number(Number(num_times) * Number(disp_amt)).formatMoney(2, '.', ',')));
}
} else {
if (Number(num_times) == 0) {
jq112(".donation-level-total-amount").text("");
return true;
} else {
jq112(".donation-level-total-amount").text("$" + Number(disp_amt).formatMoney(2, '.', ','));
}
}
//Forever
//M:X
//Q:X
//Y:X
}
}
function flexible_load_prechecked_value() {
var regamtfnd = false;
var cstamtfnd = false;
if (jq112("[id^=level_flexibleexpanded]").length > 0) {
if (jq112(".donation-level-user-entered").children("input").val()) {
jq112(".donation-level-user-entered").addClass("active");
} else {
jq112("[id^=level_flexibleexpanded]").each(function() {
if (jq112(this).is(":checked")) {
jq112(this).closest(".donation-level-input-container").find("label").addClass("active");
}
});
}
}
}
function GetOtherBoxAmount() {
if (jq112(".donation-level-user-entered").children("input").val()) {
activeamt_toadd = Number(jq112("#cover_fees_amount_input").val());
activeamt = Number(jq112(".donation-level-user-entered").children("input").val());
activeamt = activeamt - activeamt_toadd;
jq112(".donation-level-user-entered").children("input").val(StrRound(activeamt, 2));
}
}
function CC_Fees_Load() {
if (document.getElementById("pstep_finish") != null) {
document.getElementById("pstep_finish").id = "pstep_finish_btn"; //Change Submit ID To Override
}
var moveDonElements = function() {
if (jq112('.donation-ask-container').length > 0) {
jq112('.donation-ask-container').insertAfter(".don-standard-levels"); // reposition ask container
jq112("#cc_fees_row").insertAfter(".donation-ask-container"); //Reposition CC Fees elements
} else {
window.setTimeout(moveDonElements, 50);
}
}
moveDonElements();
// jq112("#cc_fees_row").insertAfter(".don-standard-levels"); //Reposition CC Fees elements
// jq112("#cc_fees_row").insertAfter(".donation-ask-container"); //Reposition CC Fees elements
jq112("#cc_fees_row").append(jq112("#cover_fees_radio").closest(".custom-field-container")); //Reposition CC Fees elements
jq112("#cc_fees_row").append(jq112("#cover_fees_amount_input").closest(".custom-field-container")); //Reposition CC Fees elements
jq112("#cover_fees_amount_input").closest(".custom-field-container").css('display', 'none'); //Post Load Hide
jq112("#cover_fees_amount_input").closest(".custom-field-container").css('visibility', 'hidden'); //Post Load Hide
jq112("label[for=cover_fees_radio]").html("I choose to add <div id='cover_fees_activeamt' class='cover_fees_activeamt'>$0.00</div> to cover the fees to process my donation."); // Set Fees Label
jq112("#cover_fees_radio").change(function() { //Update Fees Fields anytime Custom Entered Amount Changes
getactiveamt(); // Get the Current Active Amt
updateactiveamt(); //Update Fields to Current Active Amt
update_giving_total();
});
jq112('#billing_addr_zipname').change(function() { //Show City and State Fields anytime Zip Changes ( Default Code Is Only For KeyUp )
if (jq112('#billing_addr_country').val() == 'United States' && jq112(this).val().length > 4) {
getCityStateByZip(jq112(this).val(), showCityStateForBilling);
}
});
}
function showCityStateForBilling(city, state) {
jq112('#billing_addr_cityname').val(city);
jq112('#billing_addr_city_row').css('display', 'inline');
jq112('#billing_addr_state').val(state);
jq112('#billing_addr_state_row').css('display', 'inline');
}
function getCityStateByZip(zipcode, callback) {
if (zipcode) {
jq112.getJSON('//maps.googleapis.com/maps/api/geocode/json?address=' + zipcode).success(function(response) {
var city = '',
state = '',
address_components = response.results[0].address_components;
jq112.each(address_components, function(index, component) {
var types = component.types;
jq112.each(types, function(index, type) {
if (type == 'locality') {
city = component.long_name;
}
if (type == 'administrative_area_level_1') {
state = component.short_name;
}
});
});
callback(city, state);
});
}
}
Number.prototype.formatMoney = function(c, d, t) {
var n = this,
c = isNaN(c = Math.abs(c)) ? 2 : c,
d = d == undefined ? "." : d,
t = t == undefined ? "," : t,
s = n < 0 ? "-" : "",
i = String(parseInt(n = Math.abs(Number(n) || 0).toFixed(c))),
j = (j = i.length) > 3 ? j % 3 : 0;
return s + (j ? i.substr(0, j) + t : "") + i.substr(j).replace(/(\d{3})(?=\d)/g, "$1" + t) + (c ? d + Math.abs(n - i).toFixed(c).slice(2) : "");
};
function delimitNumbers2(strg) {
return (strg + "").replace(/[^\d.-]/g, '');
}
function removeNonNumbers(strg) {
return (strg + "").replace(/[^0-9\.]+/g, "");
}
function updateactiveamt() {
totes_amt = (Number(activeamt) + Number(activeamt_toadd));
if (jq112("#cover_fees_radio").is(":checked")) {
jq112("#cover_fees_activeamt").text("$" + activeamt_toadd.formatMoney(2, '.', ','));
jq112("#cover_fees_amount_input").val(activeamt_toadd);
if (Math.round(totes_amt) == totes_amt) {
jq112('#pstep_finish_btn').html('DONATE $' + Math.round(totes_amt));
disp_amt = Math.round(totes_amt);
} else {
jq112('#pstep_finish_btn').html('DONATE $' + totes_amt.formatMoney(2, '.', ','));
disp_amt = totes_amt.formatMoney(2, '.', ',');
}
} else {
//jq112("#cover_fees_activeamt").text("$0.00");
jq112("#cover_fees_activeamt").text("$" + activeamt_toadd.formatMoney(2, '.', ','));
jq112("#cover_fees_amount_input").val("");
if (Math.round(activeamt) == activeamt) {
jq112('#pstep_finish_btn').html('DONATE $' + Math.round(Number(activeamt)));
disp_amt = Math.round(Number(activeamt));
} else {
jq112('#pstep_finish_btn').html('DONATE $' + Number(activeamt).formatMoney(2, '.', ','));
disp_amt = Number(activeamt).formatMoney(2, '.', ',');
}
}
update_giving_total();
}
function CheckOtherExistingButtonReload() {
var custom_amt = 0;
var preset_amt = 0;
if (jq112(".donation-level-user-entered").children("input").val()) {
custom_amt = jq112(".donation-level-user-entered").children("input").val();
}
//Standard DF
if (jq112("[id^=level_standardexpanded]").length > 0) {
jq112("[id^=level_standardexpanded]").each(function() {
preset_amt = removeNonNumbers(jq112(this).parent().next().children(".donation-level-label-container").text());
if (Number(custom_amt).formatMoney(2, '.', ',') == Number(preset_amt).formatMoney(2, '.', ',')) {
jq112(this).prop("checked", true);
jq112(this).children("label").addClass("active");
jq112(".donation-level-user-entered").removeClass("active");
jq112(".donation-level-user-entered").children("input").val("");
}
});
}
//Flexible Form
if (jq112("[id^=level_flexibleexpanded]").length > 0) {
jq112(".donation-level-user-entered").addClass("active");
jq112("[id^=level_flexibleexpanded]").each(function() {
preset_amt = removeNonNumbers(jq112(this).parent().next().children(".donation-level-amount-container").text());
if (Number(custom_amt).formatMoney(2, '.', ',') == Number(preset_amt).formatMoney(2, '.', ',')) {
jq112(this).prop("checked", true);
jq112(this).closest(".donation-level-input-container").children("label").addClass("active");
jq112(".donation-level-user-entered").removeClass("active");
jq112(".donation-level-user-entered").children("input").val("");
}
});
}
}
function getactiveamt() {
if (jq112(".donation-level-user-entered").children("input").val()) {
activeamt_toadd = Number(StrRound(jq112(".donation-level-user-entered").children("input").val() * .04), 2);
activeamt = jq112(".donation-level-user-entered").children("input").val();
return activeamt_toadd;
}
//Standard Buttons
if (jq112("[id^=level_standardexpanded]").length > 0) {
jq112("[id^=level_standardexpanded]").each(function() {
if (jq112(this).is(":checked")) {
activeamt = jq112(this).parent().next().children(".donation-level-label-container").text();
activeamt_toadd = Number(StrRound(delimitNumbers2(activeamt) * .04), 2);
activeamt = delimitNumbers2(activeamt);
}
});
}
//Flexible Buttons
if (jq112("[id^=level_flexibleexpanded]").length > 0) {
jq112("[id^=level_flexibleexpanded]").each(function() {
if (jq112(this).is(":checked")) {
activeamt = jq112(this).parent().next().children(".donation-level-amount-container").text();
activeamt_toadd = Number(StrRound(delimitNumbers2(activeamt) * .04), 2);
activeamt = delimitNumbers2(activeamt);
}
});
}
return activeamt_toadd;
}
function CheckOtherSetOtherAmountForFee() {
CheckInvalidCustom();
jq112(".donation-level-input-container").each(function() {
jq112(this).children("label").removeClass("active");
if (jq112(this).children(".donation-level-user-entered").length) {
jq112(this).find("input").prop("checked", true);
jq112(".donation-level-user-entered").children("input").val(totes_amt);
}
});
jq112(".donation-level-user-entered").addClass("active");
}
//Validation when form is submitted
jq112("#ProcessForm").submit(function(e) {
if (jq112("#cover_fees_radio").prop("checked")) {
CheckOtherSetOtherAmountForFee();
}
});
function CheckInvalidCustom() {
var inputted_amt = "";
inputted_amt = removeNonNumbers(jq112(".donation-level-user-entered").children("input").val());
inputted_amt = StrRound(inputted_amt, 2);
jq112(".donation-level-user-entered").children("input").val(inputted_amt);
}
function StrRound(the_str, places) {
var orig_str = the_str;
the_str = removeNonNumbers(the_str).split(".", 2);
if (the_str[1]) {
the_str[1] = the_str[1].substring(0, 2);
}
the_str = the_str.join(".");
return the_str;
}
jq112(".donation-levels").change(function() {
CheckInvalidCustom();
getactiveamt();
updateactiveamt();
});
jq112(".donation-level-user-entered").keyup(function() {
CheckInvalidCustom();
activeamt_toadd = Number(StrRound(jq112(this).children("input").val() * .04), 2);
activeamt = jq112(this).children("input").val();
updateactiveamt();
});
jq112("#level_flexiblegift_type2").change(function() {
update_giving_total();
});
jq112("#level_flexiblegift_type1").change(function() {
update_giving_total();
});
jq112("#level_flexibleduration").change(function() {
update_giving_total();
});
jq112("#level_flexibleduration").on("click", function() {
update_giving_total();
});
</script>
<!-- END CC Fees Code -->
</div>
</div>
</div>
<input type="hidden" name="25031.donation" id="25031.donation" value="form1">
</div>
<script type="text/javascript">
var submitted = false;
function checkDoubleClick() {
var elCheck = '';
if (elCheck == 'el') {
alert('Form submission is not enabled when previewing an individual data element.');
return false;
} else if (submitted) {
alert('You have already submitted this payment. Please wait....');
return false;
} else {
submitted = true;
return true;
}
}
</script><noscript> </noscript>
</form>Text Content
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DONATE
Thank you for donating to Susan G. Komen.
With your help, we're moving toward a world without breast cancer.
Your Donation to Flora Hacker
GIFT AMOUNT
Field Is Required Select Gift Amount:
$500
$250
$100
$75
$30
$ Enter amount
$10.00 Minimum
Cover Fees
I choose to add
$10.00
to cover the fees to process my donation.
Cover Fees Amount
YOUR INFORMATION
First Name
Last Name
Mobile Phone Number
Email Address
Yes, I would like to receive communications from Susan G. Komen®.
BILLING ADDRESS
Street Address
Street Address Line 2 (optional)
Country United States Afghanistan Aland Islands Albania Algeria American Samoa
Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba
Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium
Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint
Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British
Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia
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China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The
Democratic Republic of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba
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Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea
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City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic
Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan
Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic
of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former
Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall
Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated
States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco
Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand
Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman
Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru
Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian
Federation Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint Pierre and
Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe
Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten
(Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South
Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan
Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab
Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of
Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
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Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe change
country
Required
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City
State/Province AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona CA -
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Marshall Islands MP - Northern Mariana Islands PR - Puerto Rico PW - Palau VI -
Virgin Islands AA - Armed Forces Americas AE - Armed Forces AP - Armed Forces
Pacific AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL -
Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU -
Nunavut ON - Ontario QC - Quebec SK - Saskatchewan YT - Yukon None
Required
WOULD YOU LIKE YOUR EMPLOYER TO MATCH YOUR GIFT? IF SO, PLEASE SEARCH BELOW.
PAYMENT INFORMATION
PAYMENT METHOD:
Credit Card Checking Account
CREDIT CARD INFORMATION:
Credit Card Type:
*
*
*
*
*
Credit Card Number:
Expiration Date:Select month of credit card Select Expiration Year
01 02 03 04 05 06 07 08 09 10 11 12 2022 2023 2024 2025 2026 2027 2028 2029 2030
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Verify Bank Account Number:
Account Type:
* Checking
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By checking this option, I agree to use my bank account as a payment method and
authorize this organization to debit my bank account to fulfill my donation
commitment.
CHECK INFORMATION
ADDITIONAL GIFT INFORMATION
Honor or Memorial Gift (optional) Yes, this gift is in honor or memory of
someone special, and I would like a tribute card delivered by postal mail.
Your Tribute Type In Memory of In Honor of
Required
Honoree Name / Occasion
Tribute Card Signature (optional)
Recipient Name
Recipient Street Address
Recipient Street Address 2 (optional)
Recipient Country United States Afghanistan Aland Islands Albania Algeria
American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina
Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados
Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island
Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso
Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African
Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia
Comoros Congo Congo, The Democratic Republic of the Cook Islands Costa Rica Cote
D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica
Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia
Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French
Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany
Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey
Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See
(Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran,
Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey
Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea,
Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon
Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, The
Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta
Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia,
Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat
Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New
Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands
Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay
Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania
Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan
da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint
Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome
and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint
Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa
South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan
Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab
Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of
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