secure.lutheranmedia.org.au
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Submitted URL: https://secure.messagesofhope.org.nz/
Effective URL: https://secure.lutheranmedia.org.au/
Submission: On August 17 via automatic, source certstream-suspicious — Scanned from NZ
Effective URL: https://secure.lutheranmedia.org.au/
Submission: On August 17 via automatic, source certstream-suspicious — Scanned from NZ
Form analysis 1 forms found in the DOM
POST /#gf_1
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_1" id="gform_1" action="/#gf_1" novalidate="">
<div class="gform_body gform-body">
<div id="gform_fields_1" class="gform_fields top_label form_sublabel_below description_below">
<div id="field_1_1" class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_1">
<h3 class="gsection_title">My Donation</h3>
</div>
<fieldset id="field_1_3" class="gfield gfield--width-full field_sublabel_below field_description_below hidden_label gfield_visibility_visible" data-js-reload="field_1_3">
<legend class="gfield_label">Untitled</legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_1_3">
<div class="gchoice gchoice_1_3_0">
<input class="gfield-choice-input" name="input_3" type="radio" value="Single Gift" id="choice_1_3_0" onchange="gformToggleRadioOther( this )">
<label for="choice_1_3_0" id="label_1_3_0">Single Gift</label>
</div>
<div class="gchoice gchoice_1_3_1">
<input class="gfield-choice-input" name="input_3" type="radio" value="Monthly Gift" id="choice_1_3_1" onchange="gformToggleRadioOther( this )">
<label for="choice_1_3_1" id="label_1_3_1">Monthly Gift</label>
</div>
</div>
</div>
</fieldset>
<fieldset id="field_1_23" class="gfield gfield--width-full amounts gfield_price gfield_price_1_23 gfield_product_1_23 gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible"
data-js-reload="field_1_23">
<legend class="gfield_label">Product Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_1_23">
<div class="gchoice gchoice_1_23_0">
<input class="gfield-choice-input" name="input_23" type="radio" value="$1000|1000" id="choice_1_23_0" onchange="gformToggleRadioOther( this )">
<label for="choice_1_23_0" id="label_1_23_0">$1000</label>
</div>
<div class="gchoice gchoice_1_23_1">
<input class="gfield-choice-input" name="input_23" type="radio" value="$500|500" id="choice_1_23_1" onchange="gformToggleRadioOther( this )">
<label for="choice_1_23_1" id="label_1_23_1">$500</label>
</div>
<div class="gchoice gchoice_1_23_2">
<input class="gfield-choice-input" name="input_23" type="radio" value="$100|100" id="choice_1_23_2" onchange="gformToggleRadioOther( this )">
<label for="choice_1_23_2" id="label_1_23_2">$100</label>
</div>
<div class="gchoice gchoice_1_23_3">
<input class="gfield-choice-input" name="input_23" type="radio" value="$50|50" id="choice_1_23_3" onchange="gformToggleRadioOther( this )">
<label for="choice_1_23_3" id="label_1_23_3">$50</label>
</div>
<div class="gchoice gchoice_1_23_4">
<input class="gfield-choice-input" name="input_23" type="radio" value="Other Amount|0" id="choice_1_23_4" onchange="gformToggleRadioOther( this )">
<label for="choice_1_23_4" id="label_1_23_4">Other Amount</label>
</div>
</div>
</div>
</fieldset>
<div id="field_1_25" class="gfield gfield--width-full gfield_price gfield_price_1_25 gfield_product_1_25 field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_25" style="display: none;"><label
class="gfield_label" for="input_1_25">Other Amount</label>
<div class="ginput_container ginput_container_product_price">
<input name="input_25" id="input_1_25" type="text" value="" class="large ginput_amount" aria-invalid="false" disabled="disabled">
</div>
</div>
<div id="field_1_5" class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_5">
<h3 class="gsection_title">My Details</h3>
</div>
<div id="field_1_6" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_6"><label class="gfield_label" for="input_1_6">Title</label>
<div class="ginput_container ginput_container_text"><input name="input_6" id="input_1_6" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_1_7" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_7"><label class="gfield_label" for="input_1_7">First Name</label>
<div class="ginput_container ginput_container_text"><input name="input_7" id="input_1_7" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_1_8" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_8"><label class="gfield_label" for="input_1_8">Last Name</label>
<div class="ginput_container ginput_container_text"><input name="input_8" id="input_1_8" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_1_9" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_9"><label class="gfield_label" for="input_1_9">Organisation</label>
<div class="ginput_container ginput_container_text"><input name="input_9" id="input_1_9" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_1_10" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_10"><label class="gfield_label" for="input_1_10">Email</label>
<div class="ginput_container ginput_container_text"><input name="input_10" id="input_1_10" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_1_11" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_11"><label class="gfield_label" for="input_1_11">Phone</label>
<div class="ginput_container ginput_container_text"><input name="input_11" id="input_1_11" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_1_12" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_12"><label class="gfield_label" for="input_1_12">Mobile</label>
<div class="ginput_container ginput_container_text"><input name="input_12" id="input_1_12" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_1_13" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_13"><label class="gfield_label" for="input_1_13">Birthdate (Optional)</label>
<div class="ginput_container ginput_container_date">
<input name="input_13" id="input_1_13" type="text" value="" class="datepicker ymd_dash datepicker_no_icon gdatepicker-no-icon hasDatepicker initialized" placeholder="yyyy-mm-dd" aria-describedby="input_1_13_date_format"
aria-invalid="false">
<span id="input_1_13_date_format" class="screen-reader-text">YYYY dash MM dash DD</span>
</div>
<input type="hidden" id="gforms_calendar_icon_input_1_13" class="gform_hidden" value="https://lutheranmedia.org.au/secure/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
</div>
<div id="field_1_14" class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_14">
<h3 class="gsection_title">My Address</h3>
</div>
<fieldset id="field_1_15" class="gfield gfield--width-full field_sublabel_hidden_label field_description_below gfield_visibility_visible" data-js-reload="field_1_15">
<legend class="gfield_label gfield_label_before_complex">Address</legend>
<div class="ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address" id="input_1_15">
<span class="ginput_full address_line_1 ginput_address_line_1" id="input_1_15_1_container">
<input type="text" name="input_15.1" id="input_1_15_1" value="" placeholder="Street Address" aria-required="false">
<label for="input_1_15_1" id="input_1_15_1_label" class="hidden_sub_label screen-reader-text">Street Address</label>
</span><span class="ginput_full address_line_2 ginput_address_line_2" id="input_1_15_2_container">
<input type="text" name="input_15.2" id="input_1_15_2" value="" placeholder="Address Line 2" aria-required="false">
<label for="input_1_15_2" id="input_1_15_2_label" class="hidden_sub_label screen-reader-text">Address Line 2</label>
</span><span class="ginput_left address_city ginput_address_city" id="input_1_15_3_container">
<input type="text" name="input_15.3" id="input_1_15_3" value="" placeholder="Suburb" aria-required="false">
<label for="input_1_15_3" id="input_1_15_3_label" class="hidden_sub_label screen-reader-text">City</label>
</span><span class="ginput_right address_state ginput_address_state" id="input_1_15_4_container">
<input type="text" name="input_15.4" id="input_1_15_4" value="" placeholder="State" aria-required="false">
<label for="input_1_15_4" id="input_1_15_4_label" class="hidden_sub_label screen-reader-text">State</label>
</span><span class="ginput_left address_zip ginput_address_zip" id="input_1_15_5_container">
<input type="text" name="input_15.5" id="input_1_15_5" value="" placeholder="Postal Code" aria-required="false">
<label for="input_1_15_5" id="input_1_15_5_label" class="hidden_sub_label screen-reader-text">Postcode</label>
</span><span class="ginput_right address_country ginput_address_country" id="input_1_15_6_container">
<select name="input_15.6" id="input_1_15_6" aria-required="false">
<option value=""></option>
<option value="Afghanistan">Afghanistan</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" selected="selected">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">Bolivia</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 Islands">Cocos Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czechia">Czechia</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</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="Eswatini">Eswatini</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</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">Holy See</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="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="Macau">Macau</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">Micronesia</option>
<option value="Moldova">Moldova</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="North Macedonia">North Macedonia</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="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Réunion">Réunion</option>
<option value="Saint Barthélemy">Saint Barthélemy</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">Saint Martin</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">Sint Maarten</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="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria Arab Republic">Syria Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, the United Republic of">Tanzania, the 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="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Türkiye">Türkiye</option>
<option value="US Minor Outlying Islands">US Minor Outlying Islands</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">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</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>
<option value="Åland Islands">Åland Islands</option>
</select>
<label for="input_1_15_6" id="input_1_15_6_label" class="hidden_sub_label screen-reader-text">Country</label>
</span>
<div class="gf_clear gf_clear_complex"></div>
</div>
</fieldset>
<fieldset id="field_1_19" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_19">
<legend class="gfield_label">Please send a tax deductible receipt via</legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_1_19">
<div class="gchoice gchoice_1_19_0">
<input class="gfield-choice-input" name="input_19" type="radio" value="Email" id="choice_1_19_0" onchange="gformToggleRadioOther( this )">
<label for="choice_1_19_0" id="label_1_19_0">Email</label>
</div>
<div class="gchoice gchoice_1_19_1">
<input class="gfield-choice-input" name="input_19" type="radio" value="Post" id="choice_1_19_1" onchange="gformToggleRadioOther( this )">
<label for="choice_1_19_1" id="label_1_19_1">Post</label>
</div>
</div>
</div>
</fieldset>
<div id="field_1_17" class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_17">
<h3 class="gsection_title">Payment Details</h3>
</div>
<div id="field_1_22" class="gfield gfield--width-full gfield_price gfield_price_1_ gfield_total gfield_total_1_ field_sublabel_below field_description_below gfield_visibility_visible" aria-atomic="true" aria-live="polite"
data-js-reload="field_1_22"><label class="gfield_label" for="input_1_22">Donation Amount</label>
<div class="ginput_container ginput_container_total">
<input readonly="" name="input_22" id="input_1_22" value="$ 0.00" class="gform-text-input-reset ginput_total ginput_total_1">
</div>
</div>
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<legend class="gfield_label gfield_label_before_complex">Credit Card</legend>
<div class="ginput_complex ginput_container ginput_container_creditcard" id="input_1_16"><span class="ginput_full" id="input_1_16_1_container">
<div class="gform_card_icon_container">
<div class="gform_card_icon gform_card_icon_amex">American Express</div>
<div class="gform_card_icon gform_card_icon_discover">Discover</div>
<div class="gform_card_icon gform_card_icon_mastercard">MasterCard</div>
<div class="gform_card_icon gform_card_icon_visa">Visa</div><span class="screen-reader-text" id="field_1_16_supported_creditcards">Supported Credit Cards: American Express, Discover, MasterCard, Visa</span>
</div>
<input type="text" name="input_16.1" class="gf_processcardnumber" id="input_1_16_1" value="" onchange="gformMatchCard("input_1_16_1");" onkeyup="gformMatchCard("input_1_16_1");" autocomplete="off" pattern="[0-9]*"
title="Only digits are allowed" aria-required="false">
<label for="input_1_16_1" id="input_1_16_1_label">Card Number</label>
</span><span class="ginput_full ginput_cardextras" id="input_1_16_2_container">
<fieldset class="ginput_cardinfo_left" id="input_1_16_2_cardinfo_left">
<legend>Expiration Date</legend>
<span class="ginput_card_expiration_container ginput_card_field">
<span class="ginput_card_expiration_month_container">
<label for="input_1_16_2_month" class="screen-reader-text">Month</label>
<select name="input_16.2[]" id="input_1_16_2_month" class="ginput_card_expiration ginput_card_expiration_month" aria-required="false">
<option value="">Month</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
</span>
<span class="ginput_card_expiration_year_container">
<label for="input_1_16_2_year" class="screen-reader-text">Year</label>
<select name="input_16.2[]" id="input_1_16_2_year" class="ginput_card_expiration ginput_card_expiration_year" aria-required="false">
<option value="">Year</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
<option value="2034">2034</option>
<option value="2035">2035</option>
<option value="2036">2036</option>
<option value="2037">2037</option>
<option value="2038">2038</option>
<option value="2039">2039</option>
<option value="2040">2040</option>
<option value="2041">2041</option>
<option value="2042">2042</option>
<option value="2043">2043</option>
</select>
</span>
</span>
</fieldset><span class="ginput_cardinfo_right" id="input_1_16_2_cardinfo_right">
<input type="text" name="input_16.3" id="input_1_16_3" class="ginput_card_security_code" value="" autocomplete="off" pattern="[0-9]*" title="Only digits are allowed" aria-required="false">
<span class="ginput_card_security_code_icon"> </span>
<label for="input_1_16_3">Security Code</label>
</span>
</span><span class="ginput_full" id="input_1_16_5_container">
<input type="text" name="input_16.5" id="input_1_16_5" value="" aria-required="false">
<label for="input_1_16_5" id="input_1_16_5_label">Cardholder Name</label>
</span> </div>
</fieldset>
<div id="field_1_20" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_1_20"><label class="gfield_label" for="input_1_20">Leave A Comment</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_20" id="input_1_20" class="textarea large" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_1_21" class="gfield gfield--width-full field_sublabel_below field_description_below hidden_label gfield_visibility_visible" data-js-reload="field_1_21">
<legend class="gfield_label gfield_label_before_complex">Please send me information about leaving a gift to Lutheran Media in my will</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_1_21">
<div class="gchoice gchoice_1_21_1">
<input class="gfield-choice-input" name="input_21.1" type="checkbox" value="Please send me information about leaving a gift to Lutheran Media in my will" id="choice_1_21_1">
<label for="choice_1_21_1" id="label_1_21_1">Please send me information about leaving a gift to Lutheran Media in my will</label>
</div>
</div>
</div>
</fieldset>
<div id="field_1_18" class="gfield gfield--width-full field_sublabel_below field_description_below hidden_label gfield_visibility_visible" data-js-reload="field_1_18"><label class="gfield_label" for="input_1_18">CAPTCHA</label>
<div id="input_1_18" class="ginput_container ginput_recaptcha gform-initialized" data-sitekey="6LdAwWAUAAAAAAzsQlAV_ARAaQFeG3O778wg8U-f" data-theme="light" data-tabindex="0" data-badge="">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-yz5h83ybb3gz" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LdAwWAUAAAAAAzsQlAV_ARAaQFeG3O778wg8U-f&co=aHR0cHM6Ly9zZWN1cmUubHV0aGVyYW5tZWRpYS5vcmcuYXU6NDQz&hl=en&v=hfUfsXWZFeg83qqxrK27GB8P&theme=light&size=normal&cb=6cpoylf13qod"></iframe>
</div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</div>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_1" class="gform_button button" value="Donate Now"
onclick="if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} "
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<input type="hidden" name="gform_ajax" value="form_id=1&title=&description=&tabindex=0">
<input type="hidden" class="gform_hidden" name="is_submit_1" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="1">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_1"
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<input type="hidden" class="gform_hidden" name="gform_source_page_number_1" id="gform_source_page_number_1" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</form>Text Content
* Home Select Page * Home MY DONATION Untitled Single Gift Monthly Gift Product Name(Required) $1000 $500 $100 $50 Other Amount Other Amount MY DETAILS Title First Name Last Name Organisation Email Phone Mobile Birthdate (Optional) YYYY dash MM dash DD MY ADDRESS Address Street Address Address Line 2 City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please send a tax deductible receipt via Email Post PAYMENT DETAILS Donation Amount Credit Card American Express Discover MasterCard Visa Supported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Leave A Comment Please send me information about leaving a gift to Lutheran Media in my will Please send me information about leaving a gift to Lutheran Media in my will CAPTCHA * Facebook * X * RSS Designed by Elegant Themes | Powered by WordPress Notifications