www.weareplannedparenthood.org
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Submitted URL: https://donate.ppncsnj.org/
Effective URL: https://www.weareplannedparenthood.org/cOJVhOyrzkq4uBcxVekXFA2?sourceid=1000065&affiliateID=090900
Submission: On November 01 via api from US — Scanned from DE
Effective URL: https://www.weareplannedparenthood.org/cOJVhOyrzkq4uBcxVekXFA2?sourceid=1000065&affiliateID=090900
Submission: On November 01 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST
<form class="clearfix" method="post" novalidate="" action="" accept-charset="utf-8" autocomplete="on">
<div class="at-markup FastAction" id="NVContributionForm266675-FastAction">
<div class="fastaction-block">
<div class="fastAction clearfix">
<p>
<span class="fa-cta">
<a href="#fastaction-login" class="profile-link" aria-label="FastAction">
<img class="profile-link-fa-image" src="//static.everyaction.com/ea-actiontag/assets/images/fast-action.svg" alt="Fast Action Logo">
</a>
<span><a href="https://fastaction.ngpvan.com##whats-this" class="circle" id="fastaction-whatsthis" data-popup="true" data-popup-width="515" data-popup-height="540" target="_blank">?</a></span>
</span>
<span class="fa-lead"> Take future action with a single click.<br>
<a href="#fastaction-login" class="call-modal" id="fastaction-widget-login">Log in</a> or <a href="#fastaction-signup" class="call-modal" id="fastaction-widget-signup">Sign up</a> for <i>Fast</i><b>Action</b>
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</p>
</div>
</div>
</div>
<div data-name="undefined" data-subview="submit_view" data-subview-index="2"></div>
<fieldset class="at-fieldset ContributionInformation" id="NVContributionForm266675-ContributionInformation" style="border: none;">
<div class="at-row at-row-full CustomFormFieldQuestion_3099446479006973 organizationSelection">
<label class="at-select CustomFormFieldQuestion_3099446479006973" id="NVContributionForm266675-AdditionalInformation-CustomFormFieldQuestion_3099446479006973">Organization<select required="" autocomplete="on" title="Organization"
name="CustomFormFieldQuestion_3099446479006973" class=" required" id="NVContributionForm266675-AdditionalInformation-CustomFormFieldQuestion_3099446479006973-select">
<option value="" disabled="">- Select -</option>
<option value="7077793159385449">Planned Parenthood Federation of America</option>
<option value="2219699997896815">Planned Parenthood Federation of America Global Programs</option>
<option value="8872732597946319">AL - Planned Parenthood Southeast</option>
<option value="4333883677234111">AK - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky</option>
<option value="8579676985485891">AR - Planned Parenthood Great Plains</option>
<option value="5241096305087933">AZ - Planned Parenthood Arizona</option>
<option value="3075788892113569">CA - Planned Parenthood Los Angeles</option>
<option value="2710812666953265">CA - Planned Parenthood Pasadena and San Gabriel Valley</option>
<option value="7866352512382433">CA - Planned Parenthood of the Pacific Southwest</option>
<option value="5314457785220661">CA - Planned Parenthood Mar Monte</option>
<option value="2901671801027117">CA - Planned Parenthood of Orange & San Bernardino Counties</option>
<option value="5184162050073665">CA - Planned Parenthood California Central Coast</option>
<option value="1313699947239083">CA - Planned Parenthood Northern California</option>
<option value="3520236367076511">CO - Planned Parenthood of the Rocky Mountains</option>
<option value="7283724903345955">CT - Planned Parenthood of Southern New England</option>
<option value="53967691880409">DC - Planned Parenthood of Metropolitan Washington, DC</option>
<option value="4186418145097585">DE - Planned Parenthood of Delaware</option>
<option value="2171032847735291">FL - Planned Parenthood of Southwest and Central Florida</option>
<option value="279617801401171">FL - Planned Parenthood of South, East and North Florida</option>
<option value="6428607118325769">GA - Planned Parenthood Southeast</option>
<option value="5315247544764799">HI - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky</option>
<option value="3073830187817823">IA - Planned Parenthood North Central States</option>
<option value="3760895556601873">ID - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky</option>
<option value="881557858091595">ID - Planned Parenthood of Greater Washington and North Idaho</option>
<option value="2405368091570733">IL - Planned Parenthood of Illinois</option>
<option value="8615429715507855">IL - Planned Parenthood Great Rivers</option>
<option value="1105928648502081">IN - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky</option>
<option value="5796563907645359">KS - Planned Parenthood Great Plains</option>
<option value="4320039153271393">KY - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky</option>
<option value="4217949673829179">KY - Planned Parenthood Southwest Ohio Region</option>
<option value="8615666742045531">LA - Planned Parenthood Gulf Coast</option>
<option value="7998556572181599">MA - Planned Parenthood League of Massachusetts</option>
<option value="6111962916041849">MD - Planned Parenthood of Maryland</option>
<option value="8847927222150645">MD - Planned Parenthood of Metropolitan Washington, DC</option>
<option value="5377699045172335">ME - Planned Parenthood of Northern New England</option>
<option value="6309035423385613">MI - Planned Parenthood of Michigan</option>
<option value="1056100257995731">MN - Planned Parenthood North Central States</option>
<option value="2504828012885881">MO - Planned Parenthood Great Plains</option>
<option value="3062908593394891">MO - Planned Parenthood Great Rivers</option>
<option value="337393539452481">MS - Planned Parenthood of Tennessee and North Mississippi</option>
<option value="6710996917008761">MS - Planned Parenthood Southeast</option>
<option value="6631891190073885">MT - Planned Parenthood of Montana</option>
<option value="7517341309663015">NC - Planned Parenthood South Atlantic</option>
<option value="2745675799657179">ND - Planned Parenthood North Central States</option>
<option value="3165845714162913">NE - Planned Parenthood North Central States</option>
<option value="1450848668198837">NH - Planned Parenthood of Northern New England</option>
<option value="173098353951025">NJ - Planned Parenthood of Northern, Central, and Southern New Jersey</option>
<option value="8649430485376981">NJ - Planned Parenthood of Metropolitan New Jersey</option>
<option value="6110757089269207">NM - Planned Parenthood of the Rocky Mountains</option>
<option value="1267074676312683">NV - Planned Parenthood Mar Monte</option>
<option value="7785634139347217">NV - Planned Parenthood of the Rocky Mountains</option>
<option value="8954377836341051">NY - Upper Hudson Planned Parenthood</option>
<option value="4562015550695211">NY - Planned Parenthood of Central and Western New York</option>
<option value="8626693859725307">NY - Planned Parenthood of Greater New York</option>
<option value="8149678753217985">NY - Planned Parenthood of the North Country New York</option>
<option value="6205641754840799">NY - Planned Parenthood Hudson Peconic</option>
<option value="1539625123090009">OH - Planned Parenthood of Greater Ohio</option>
<option value="4076272771180453">OH - Planned Parenthood Southwest Ohio Region</option>
<option value="6820664610986341">OK - Planned Parenthood Great Plains</option>
<option value="122364448193177">OR - Planned Parenthood of Southwestern Oregon</option>
<option value="1903528503091909">OR - Planned Parenthood Columbia Willamette</option>
<option value="4033586577254615">PA - Planned Parenthood Southeastern Pennsylvania</option>
<option value="4530612345439597">PA - Planned Parenthood of Western Pennsylvania</option>
<option value="5990091016149107">PA - Planned Parenthood Keystone</option>
<option value="527351775356259">RI - Planned Parenthood of Southern New England</option>
<option value="4891713969028967">SC - Planned Parenthood South Atlantic</option>
<option value="6304805501064177">SD - Planned Parenthood North Central States</option>
<option value="5291447056640219">TN - Planned Parenthood of Tennessee and North Mississippi</option>
<option value="7089794006172071">TX - Planned Parenthood of Greater Texas</option>
<option value="5714201046486659">TX - Planned Parenthood Gulf Coast</option>
<option value="3275122508939479">TX - Planned Parenthood South Texas</option>
<option value="441887204300363">UT - Planned Parenthood Association of Utah</option>
<option value="4280565114057527">VA - Planned Parenthood South Atlantic</option>
<option value="2865718582241259">VA - Planned Parenthood of Metropolitan Washington, DC</option>
<option value="7312478350319571">VA - Virginia League for Planned Parenthood</option>
<option value="3788541374591629">VT - Planned Parenthood of Northern New England</option>
<option value="3391141470399651">WA - Mt. Baker Planned Parenthood</option>
<option value="4283150818879209">WA - Planned Parenthood Columbia Willamette</option>
<option value="8396478752499669">WA - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky</option>
<option value="1339130471356251">WA - Planned Parenthood of Greater Washington and North Idaho</option>
<option value="5663341245969209">WI - Planned Parenthood of Wisconsin</option>
<option value="7073960733474601">WV - Planned Parenthood South Atlantic</option>
<option value="653174491922731">WY - Planned Parenthood of the Rocky Mountains</option>
</select>
</label>
</div>
<legend class="at-legend">Gift Information</legend>
<div class="at-fields">
<div class="at-row at-row-full ">
<div class="form-unit form-unit-radio form-item-selectedfrequency" id="NVContributionForm266675-ContributionInformation-SelectedFrequency">
<div class="radios" role="radiogroup" aria-labelledby="NVContributionForm266675-ContributionInformation-SelectedFrequency">
<label title="One-Time" class="at-radio-label-0" role="radio" aria-checked="true">
<input type="radio" name="SelectedFrequency" value="0"> One-Time </label><label title="Monthly" class="at-radio-label-4" role="radio" aria-checked="false">
<input type="radio" name="SelectedFrequency" checked="" value="4"> Monthly </label>
<div class="radio-description radio-description-value-4">A monthly gift does even more to protect reproductive rights</div>
</div>
</div>
</div>
<div class="at-row at-row-full ">
<input id="ProcessingCurrency_Value" type="hidden" name="ProcessingCurrency.Value" value="USD">
</div>
<div class="at-row at-row-full ">
<div class="form-item form-type-radios form-item-selectamount" id="NVContributionForm266675-ContributionInformation-SelectAmount">
<div class="at-row SelectAmount OtherAmount NonRecurringButtons">
<div class="at-radio">
<div class="at-radios clearfix">
<label class="label-amount" title="$50">
<input name="SelectAmount" type="radio" value="50.00"> $50 <a></a> </label><label class="label-amount" title="$35">
<input name="SelectAmount" type="radio" value="35.00"> $35 <a></a> </label><label class="label-amount" title="$25">
<input name="SelectAmount" type="radio" value="25.00"> $25 <a></a> </label><label class="label-amount" title="$15">
<input name="SelectAmount" type="radio" value="15.00"> $15 <a></a> </label><label class="label-amount label-otheramount" title="Other">
<input name="SelectAmount" type="radio" class="radio-other" value="other"> Other <input type="number" tabindex="-1" autocomplete="transaction-amount" class="edit-otheramount" name="OtherAmount" title="Other Amount"
placeholder="0.00">
<span class="label-otheramount-prefix">$</span>
</label>
</div>
</div>
</div>
</div>
</div><label class="at-check CoverCostsAmount" id="NVContributionForm266675-ContributionInformation-CoverCostsAmount"><input type="checkbox" name="CoverCostsAmount" class="ccDef"> <span class="at-checkbox-title-container"><span
class="at-checkbox-title" id="NVContributionForm266675-ContributionInformation-CoverCostsAmount-label">I'd like to help cover the transaction fees for my contribution</span><span>I'd like to cover the processing fees, making my total gift
<span class="contr">$36.14</span>, so <span class="amCon">$35.00</span> goes to protect reproductive health.</span></span>
</label>
</div>
<div id="monthlyWarn" style="display: none; padding-bottom: 24px; padding-left: 12px; color: #c9084c;">You are making a monthly gift of $<span id="monthlyWarnAmount"></span>. If you do not want to make a monthly gift, please select another option
above.</div>
</fieldset>
<fieldset class="at-fieldset TributeGift" id="NVContributionForm266675-TributeGift" style="display: block;">
<div class="at-fields">
<div class="at-row at-row-full EnableTributeGift">
<label class="at-check EnableTributeGift" id="NVContributionForm266675-TributeGift-EnableTributeGift"><input type="checkbox" name="EnableTributeGift"> <span class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVContributionForm266675-TributeGift-EnableTributeGift-label">I'd like to make this gift in honor or in memory of someone special</span></span>
</label>
</div>
<div class="at-row">
<div class="at-tribute-gift" style="display:none">
<div class="form-unit form-unit-radio form-item-inhonororinmemoryof" id="NVContributionForm266675-TributeGift-InHonorOrInMemoryOf"><label> Is this an Honorary or Memorial Gift?</label>
<div class="radios" role="radiogroup" aria-labelledby="NVContributionForm266675-TributeGift-InHonorOrInMemoryOf">
<label title="In honor of" class="at-radio-label-2" role="radio">
<input type="radio" name="InHonorOrInMemoryOf" checked="" value="2"> In honor of </label><label title="In memory of" class="at-radio-label-1" role="radio">
<input type="radio" name="InHonorOrInMemoryOf" value="1"> In memory of </label>
</div>
</div><label class="at-text HonoreeName" id="NVContributionForm266675-TributeGift-HonoreeName">Honoree Name<input type="text" autocomplete="on" required="" title="Honoree Name (required)" name="HonoreeName" value="" maxlength="100">
</label>
</div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset RecipientInformation" id="NVContributionForm266675-RecipientInformation" style="display: none;">
<div class="at-fields">
<div class="at-row">
<label class="at-check IncludeRecipient" id="NVContributionForm266675-RecipientInformation-IncludeRecipient"><input type="checkbox" name="IncludeRecipient"> <span class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVContributionForm266675-RecipientInformation-IncludeRecipient-label">I'd like to notify someone of this contribution</span></span>
</label>
</div>
<div class="at-recipient-info" style="display: none;">
<div class="mail-checks radios at-row">
<div class="email-container">
<label class="email-tile clicked" for="email">
<input type="checkbox" name="email" id="email" value="email">
<i class="fas fa-2x fa-paper-plane" aria-hidden="true"> </i><br>
<span class="mail-text">I'd like an e-card to be sent via email</span>
</label>
<div class="deliv"> (delivered instantly or on a specific date of your choosing) </div>
</div>
<div class="mail-container">
<label class="mail-tile" for="mail">
<input type="checkbox" name="mail" id="mail" value="mail">
<i class="far fa-2x fa-envelope" aria-hidden="true"> </i><br>
<span class="mail-text">I'd like a physical card to be sent via the mail</span>
</label>
<div class="deliv">(delivered within 2 - 3 weeks)</div>
</div>
</div>
<div class="at-title basic-info">Who would you like to notify?</div>
<div class="at-row at-row-solo at-row-full RecipientInfoHeaderHtml basic-info">
<div class="at-markup RecipientInfoHeaderHtml basic-info" id="NVContributionForm266675-RecipientInformation-RecipientInfoHeaderHtml">
<p>We will send an email notification to the email address you provide below. We are unable to send anonymous notifications — the recipient will see your name and email address.</p>
</div>
</div>
<div class="at-row RecipientFirstName RecipientLastName basic-info"><label class="at-text RecipientFirstName" id="NVContributionForm266675-RecipientInformation-RecipientFirstName">First Name*<input type="text" autocomplete="on" required=""
title="First Name* (required)" name="RecipientFirstName" value="" maxlength="50">
</label><label class="at-text RecipientLastName" id="NVContributionForm266675-RecipientInformation-RecipientLastName">Last Name*<input type="text" autocomplete="on" required="" title="Last Name* (required)" name="RecipientLastName"
value="" maxlength="50">
</label></div>
<div class="at-row at-row-solo RecipientStreetAddress mail" style="display: none;"><label class="at-text RecipientStreetAddress mail" id="NVContributionForm266675-RecipientInformation-RecipientStreetAddress" style="display: none;">Street
Address* <small>(Optional)</small><input type="text" autocomplete="on" false="" title="Street Address*" name="RecipientStreetAddress" value="" maxlength="100">
</label></div>
<div class="at-row RecipientCountry RecipientPostalCode RecipientCity RecipientStateProvince mail" style="display: none;"><label class="at-select RecipientCountry mail" id="NVContributionForm266675-RecipientInformation-RecipientCountry"
style="">Country* <small>(Optional)</small><select autocomplete="on" title="Country*" name="RecipientCountry" class="select2-hidden-accessible" id="NVContributionForm266675-RecipientInformation-RecipientCountry-select" tabindex="-1"
aria-hidden="true">
<option value="">- Select -</option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia (Plurinational State of)</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="CV">Cabo Verde</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo (Democratic Republic of the)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czechia</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="SZ">Eswatini</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran (Islamic Republic of)</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea (Democratic People's Republic of)</option>
<option value="KR">Korea (Republic of)</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia (Federated States of)</option>
<option value="MD">Moldova (Republic of)</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MK">North Macedonia</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine (State of)</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania (United Republic of)</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela (Bolivarian Republic of)</option>
<option value="VN">Viet Nam</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 100px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Country*" tabindex="0" aria-labelledby="select2-NVContributionForm266675-RecipientInformation-RecipientCountry-select-container"><span class="select2-selection__rendered"
id="select2-NVContributionForm266675-RecipientInformation-RecipientCountry-select-container" title="United States">United States</span><span class="select2-selection__arrow"
role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-text RecipientPostalCode" id="NVContributionForm266675-RecipientInformation-RecipientPostalCode">Postal Code* <small>(Optional)</small><input type="tel" autocomplete="on" pattern="^\d{5}([\-]\d{4})?$" false=""
title="Postal Code*" name="RecipientPostalCode" value="" maxlength="10">
</label><label class="at-text RecipientCity" id="NVContributionForm266675-RecipientInformation-RecipientCity">City* <small>(Optional)</small><input type="text" autocomplete="on" false="" title="City*" name="RecipientCity" value=""
maxlength="25">
</label><label class="at-select RecipientStateProvince" id="NVContributionForm266675-RecipientInformation-RecipientStateProvince">State/Province* <small>(Optional)</small><select autocomplete="on" title="State/Province*"
name="RecipientStateProvince" class="" id="NVContributionForm266675-RecipientInformation-RecipientStateProvince-select">
<option value="">- State -</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="FM">FM</option>
<option value="GU">GU</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
</select>
</label></div>
<div class="at-row at-row-solo RecipientEmailAddress e-mail"><label class="at-text RecipientEmailAddress e-mail" id="NVContributionForm266675-RecipientInformation-RecipientEmailAddress">Email* <small>(Optional)</small><input type="email"
autocomplete="on" pattern="^([\w!#$%&'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" false=""
title="Email*" name="RecipientEmailAddress" value="" maxlength="100">
</label></div>
<div class="at-row at-row-solo Ecard">
<div class="form-unit form-unit-radio form-item-ecard" id="NVContributionForm266675-RecipientInformation-Ecard"></div>
</div>
<div class="at-row at-row-solo NotificationSendDate"><label class="at-date notificationsenddate" id="NVContributionForm266675-RecipientInformation-NotificationSendDate"></label></div>
<div class="at-row at-row-solo NotificationMessage"><label class="at-area NotificationMessage" id="NVContributionForm266675-RecipientInformation-NotificationMessage"></label></div>
</div>
<div class="at-row ecard-section e-mail">
<div class="at-recipient-msg" style="display: none;">
<div class="form-unit form-unit-radio form-item-ecard" id="NVContributionForm266675-RecipientInformation-Ecard">
<div class="at-title"> Select an Ecard </div>
<div class="at-ecards clearfix">
<div class="at-ecard IHO-card iho-msg-1 selected">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-1.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-1.gif" checked="">
</div>
<div class="at-ecard IHO-card iho-msg-2">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-2.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-2.gif">
</div>
<div class="at-ecard IHO-card iho-msg-3">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-3.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-3.gif">
</div>
<div class="at-ecard IHO-card iho-msg-4">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-4.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-4.gif">
</div>
<div class="at-ecard IHO-card iho-msg-5">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-5.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-5.gif">
</div>
<div class="at-ecard IHO-card iho-msg-6">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-6.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-iho-msg-6.gif">
</div>
<div class="at-ecard IMO-card imo-msg-1 card-hidden">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-imo-msg-1.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-imo-msg-1.gif">
</div>
<div class="at-ecard IMO-card imo-msg-2 card-hidden">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-imo-msg-2.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-imo-msg-2.gif">
</div>
<div class="at-ecard IMO-card imo-msg-3 card-hidden">
<div class="at-ecard-img">
<img src="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-imo-msg-3.gif" alt="A generous contribution has been made in memory of someone you care about.">
</div>
<input name="ecard" type="radio" value="//nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Online%20Actions/E-Card/ecard-imo-msg-3.gif">
</div>
<button type="button" class="at-preview-ecard btn-at btn-at-link">Preview Ecard</button>
</div>
</div><label class="at-date notificationsenddate" id="NVContributionForm266675-RecipientInformation-NotificationSendDate">Send Date <small>(Optional)</small><input type="text" title="Send Date" name="NotificationSendDate" value=""
maxlength="10" size="10" class="hasDatepicker" placeholder="MM/DD/YYYY" autocomplete="off" id="dp1730424168481">
</label><label class="at-area NotificationMessage" id="NVContributionForm266675-RecipientInformation-NotificationMessage" style="display: inline;">Message <small>(Optional)</small><textarea false="" title="Message"
name="NotificationMessage" maxlength="4000"></textarea>
</label>
</div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset PaymentMethodSection" id="NVContributionForm266675-PaymentMethodSection">
<div class="at-fields">
<div class="at-row at-row-full PaymentMethod">
<div class="at-payment-method-buttons" id="NVContributionForm266675-PaymentMethodSection-PaymentMethod">
<div class="at-radio-set at-radio-set-buttons at-align-flex-right">
<div class="at-btn-radio-wrapper at-credit-card-button-wrapper">
<input id="creditcard_radio_266675" type="radio" name="PaymentMethod" value="creditcard">
<label for="creditcard_radio_266675" class="at-btn-radio large" tabindex="0">Credit Card</label>
</div>
<div class="at-btn-radio-wrapper at-eft-button-wrapper">
<input id="eft_radio_266675" type="radio" name="PaymentMethod" value="eft">
<label for="eft_radio_266675" class="at-btn-radio large" tabindex="0"> Pay with Bank Account </label>
</div>
<div class="at-btn-radio-wrapper at-paypal-button-wrapper">
<input id="paypal_radio_266675" type="radio" name="PaymentMethod" value="paypal">
<label for="paypal_radio_266675" class="at-btn-radio small at-paypal-button" title="Pay with PayPal" aria-label="Pay with PayPal" tabindex="0">
<span aria-hidden="true"> </span>
</label>
</div>
</div>
</div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset ContactInformation" id="NVContributionForm266675-ContactInformation" style="display: none;">
<legend class="at-legend">Billing Information</legend>
<div class="at-fields">
<div class="at-row FirstName LastName"><label class="at-text FirstName" id="NVContributionForm266675-ContactInformation-FirstName">First Name<input type="text" autocomplete="given-name" x-autocompletetype="given-name" required=""
title="First Name (required)" name="FirstName" value="" maxlength="20">
</label><label class="at-text LastName" id="NVContributionForm266675-ContactInformation-LastName">Last Name<input type="text" autocomplete="family-name" x-autocompletetype="surname" required="" title="Last Name (required)" name="LastName"
value="" maxlength="25">
</label></div>
<div class="at-row AddressLine1 AddressLine2"><label class="at-text AddressLine1" id="NVContributionForm266675-ContactInformation-AddressLine1">Street Address<input type="text" autocomplete="address-line1" x-autocompletetype="address-line1"
required="" title="Street Address (required)" name="AddressLine1" value="" maxlength="99">
</label><label class="at-text AddressLine2" id="NVContributionForm266675-ContactInformation-AddressLine2">Address Line 2 <small>(Optional)</small><input type="text" autocomplete="address-line2" x-autocompletetype="address-line2" false=""
title="Address Line 2" name="AddressLine2" value="" maxlength="99">
</label></div>
<div class="at-row Country PostalCode City StateProvince"><label class="at-select Country" id="NVContributionForm266675-ContactInformation-Country">Country <small>(Optional)</small><select autocomplete="country-name"
x-autocompletetype="country" title="Country" name="Country" class="select2-hidden-accessible" id="NVContributionForm266675-ContactInformation-Country-select" tabindex="-1" aria-hidden="true">
<option value="">- Select -</option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia (Plurinational State of)</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="CV">Cabo Verde</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo (Democratic Republic of the)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czechia</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="SZ">Eswatini</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran (Islamic Republic of)</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea (Democratic People's Republic of)</option>
<option value="KR">Korea (Republic of)</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia (Federated States of)</option>
<option value="MD">Moldova (Republic of)</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MK">North Macedonia</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine (State of)</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania (United Republic of)</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela (Bolivarian Republic of)</option>
<option value="VN">Viet Nam</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 264px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Country" tabindex="0" aria-labelledby="select2-NVContributionForm266675-ContactInformation-Country-select-container"><span class="select2-selection__rendered"
id="select2-NVContributionForm266675-ContactInformation-Country-select-container" title="United States">United States</span><span class="select2-selection__arrow"
role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-text PostalCode" id="NVContributionForm266675-ContactInformation-PostalCode">Postal Code<input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code" pattern="^\d{5}([\-]\d{4})?$" required=""
title="Postal Code (required)" name="PostalCode" value="" maxlength="10">
</label><label class="at-text City" id="NVContributionForm266675-ContactInformation-City">City<input type="text" autocomplete="address-level2" x-autocompletetype="locality" required="" title="City (required)" name="City" value=""
maxlength="25">
</label><label class="at-select StateProvince" id="NVContributionForm266675-ContactInformation-StateProvince">State/Province<select required="" autocomplete="address-level1" x-autocompletetype="administrative-area" title="State/Province"
name="StateProvince" class=" required" id="NVContributionForm266675-ContactInformation-StateProvince-select">
<option value="" disabled="">- State -</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="FM">FM</option>
<option value="GU">GU</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
</select>
</label></div>
<div class="at-row EmailAddress MobilePhone"><label class="at-text EmailAddress" id="NVContributionForm266675-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
pattern="^([\w!#$%&'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
name="EmailAddress" value="" maxlength="100" placeholder="email@email.com">
</label><label class="at-text MobilePhone" id="NVContributionForm266675-ContactInformation-MobilePhone">Mobile Phone <small>(Optional)</small>
<div class="intl-tel-input iti iti--allow-dropdown">
<div class="iti__flag-container">
<div class="iti__selected-flag" role="combobox" aria-controls="iti-0__country-listbox" aria-owns="iti-0__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-0__item-us-preferred">
<div class="iti__flag iti__us"></div>
<div class="iti__arrow"></div>
</div>
</div><input type="tel" class="intl-phone-MobilePhone" name="MobilePhone" title="Mobile Phone" data-intl-tel-input-id="0">
</div>
</label></div>
<div class="at-row at-row-solo SmsSubscribeMobilePhone"><input id="SmsSubscribeMobilePhone_Value" type="hidden" name="SmsSubscribeMobilePhone.Value" value="true"></div>
<div class="at-row at-row-solo at-row-full SmsLegalDisclaimer">
<div class="at-markup SmsLegalDisclaimer at-legal" id="NVContributionForm266675-ContactInformation-SmsLegalDisclaimer">By providing your cell phone number, you agree to receive calls and texts to that number from Planned Parenthood
organizations that may be automatically dialed or prerecorded on Planned Parenthood issues and other ways to get involved. Msg freq varies. STOP to quit. Msg & Data Rates May Apply.
<a href="https://www.plannedparenthood.org/terms-use" target="_blank">Terms</a>.<br><br>
</div>
</div>
<div class="at-row at-row-solo at-row-full YesSignMeUpForUpdatesForBinder"><label class="at-check YesSignMeUpForUpdatesForBinder YesSignMeUpForUpdatesForBinder-hidden"
id="NVContributionForm266675-ContactInformation-YesSignMeUpForUpdatesForBinder"><input type="checkbox" checked="" required="" name="YesSignMeUpForUpdatesForBinder"> <span class="at-checkbox-title-container at-legal"
style="cursor: initial;"><span class="at-checkbox-title at-legal" id="NVContributionForm266675-ContactInformation-YesSignMeUpForUpdatesForBinder-label" style="cursor: initial;">You'll receive emails from Planned Parenthood organizations.
You may unsubscribe at any time.</span></span>
</label></div>
<div class="at-row "><label class="at-text PersonalUrl" id="NVContributionForm266675-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
</label></div>
<div class="at-row "><input id="SocialNetworkTrackingId_Value" type="hidden" name="SocialNetworkTrackingId.Value"></div>
<div class="at-row "><input id="SocialNetwork_Value" type="hidden" name="SocialNetwork.Value"></div>
<div class="at-row ">
<div class="at-markup TrackingPixel" id="NVContributionForm266675-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
src="https://secure.everyaction.com/v1/Track/cOJVhOyrzkq4uBcxVekXFA2?sourceid=1000065&affiliateID=090900&formSessionId=c30a4888-ac72-4ed6-bf43-7d469d442170&bName=chrome&dType=desktop&formVersion=10/22/2024 8:46:29 PM|11/2/2023 7:25:44 PM&fUrl=aHR0cHM6Ly93d3cud2VhcmVwbGFubmVkcGFyZW50aG9vZC5vcmcvY09KVmhPeXJ6a3E0dUJjeFZla1hGQTI%2Fc291cmNlaWQ9MTAwMDA2NSZhZmZpbGlhdGVJRD0wOTA5MDA%3D&fRef="
style="display:none"></div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset PaymentInformation" id="NVContributionForm266675-PaymentInformation" style="display: none;">
<legend class="at-legend">Payment Information</legend>
<div class="at-fields">
<div class="at-row "><label class="at-text at-cc-number" id="NVContributionForm266675-PaymentInformation-Account">Card Number<div class="cc-type-wrapper vgs-loading-placeholder" style="display: none;">
<div class="cc-type unknown"></div>
<input type="tel" autocomplete="cc-number" title="Credit Card Number" placeholder="•••• •••• •••• ••••" readonly="true">
</div>
<div id="vgs-Account-266675" class="vgs-cc-iframe-wrapper vgs-input-container vgs-collect-container__empty vgs-collect-container__invalid isEmpty" tabindex="-1"><iframe title="Secure card number input frame"
src="https://js.verygoodvault.com/vgs-collect/2.18.4/lib/index.html#name=Account&placeholder=%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2&type=card-number&validations%5B0%5D=validCardNumber&validations%5B1%5D=required&autoComplete=cc-number&formId=randomId107747127347351268&fieldId=randomId1011519248689061179&createdAt=1730424170809&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=2562260f-6e0b-4d29-8133-cadabcb4c6fc&css%5BfontSize%5D=.875rem&css%5BfontFamily%5D=monospace&css%5BlineHeight%5D=1&css%5BbackgroundColor%5D=%23fff&css%5B%26%3A%3Aplaceholder%5D%5Bcolor%5D=%23ced4da&css%5B%26%3A%3Aplaceholder%5D%5BfontWeight%5D=bold"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId1011519248689061179" form-id="randomId107747127347351268" data-gtm-yt-inspected-61934708_454="true" data-gtm-yt-inspected-666187_821="true"></iframe></div>
</label><label class="at-text at-cc-expiration" id="NVContributionForm266675-PaymentInformation-ExpirationDate">Expiration Date<div class="vgs-loading-placeholder" style="display: none;">
<input type="tel" autocomplete="cc-exp" title="Expiration Date (MM / YY)" placeholder="MM / YY" readonly="true">
</div>
<div id="vgs-ExpirationDate-266675" class="vgs-ccexpiration-iframe-wrapper vgs-input-container vgs-collect-container__empty vgs-collect-container__invalid isEmpty"><iframe title="Secure card expiration date input frame"
src="https://js.verygoodvault.com/vgs-collect/2.18.4/lib/index.html#name=ExpirationDate&placeholder=MM%20%2F%20YY&type=card-expiration-date&serializers=W3sibmFtZSI6InNlcGFyYXRlIiwib3B0aW9ucyI6eyJtb250aE5hbWUiOiJFeHBpcmF0aW9uTW9udGgiLCJ5ZWFyTmFtZSI6IkV4cGlyYXRpb25ZZWFyIn19XQ%3D%3D&validations%5B0%5D=validCardExpirationDate&validations%5B1%5D=required&autoComplete=cc-exp&formId=randomId107747127347351268&fieldId=randomId108879758005776093&createdAt=1730424170820&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=2562260f-6e0b-4d29-8133-cadabcb4c6fc&css%5BfontSize%5D=.875rem&css%5BfontFamily%5D=monospace&css%5BlineHeight%5D=1&css%5BbackgroundColor%5D=%23fff&css%5B%26%3A%3Aplaceholder%5D%5Bcolor%5D=%23ced4da&css%5B%26%3A%3Aplaceholder%5D%5BfontWeight%5D=bold"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId108879758005776093" form-id="randomId107747127347351268" data-gtm-yt-inspected-61934708_454="true" data-gtm-yt-inspected-666187_821="true"></iframe></div>
</label></div>
<div class="at-row ">
<div class="at-markup UpdateMyProfile at-mode-person-only" id="NVContributionForm266675-PaymentInformation-UpdateMyProfile">
<div class="updateMyProfileSection" style=""><label style="display:inline;"><input type="checkbox" name="updateMyProfile" checked="checked"><span><span class="text">Remember me so that I can use <i>Fast</i><b>Action</b> next
time.</span></span></label></div>
</div>
</div>
<div class="at-row">
<div class="at-paypal-accepted-here" style="display: none;">
<div class="at-payment-integration-container" style="display: none;">
<img src="//static.everyaction.com/ea-actiontag/assets/images/paypal-logo.png" alt="PayPal">
<p>You’ve authorized this payment through PayPal.</p>
<div>Contribution Amount: <b class="at-paypal-amount"></b></div>
<div>Account: <b class="at-paypal-account-info"></b></div>
</div>
<label class="paypal-label">
<input type="hidden" name="paypalNonce" value="">
</label>
</div>
</div>
<div class="at-row">
<div class="at-eft-accepted-here" style="display: none;">
<label class="account-type-label">Account Type <select title="Account Type" name="bankAccountType" id="bankAccountType" style="width:50%;" class="eft-input">
<option value="Checking">Checking</option>
<option value="Savings">Savings</option>
</select>
</label>
<label class="routing-number-label at-row-half">Routing Number <a class="at-whatsthis" tabindex="0">What's This?</a>
<input type="tel" name="routingNumber" id="routingNumber" placeholder="•••••••••" style="width:100%;" maxlength="9" class="eft-input">
</label>
<label class="account-number-label at-row-half">Account Number <a class="at-whatsthis" tabindex="0">What's This?</a>
<input type="tel" name="bankAccountNumber" id="bankAccountNumber" placeholder="•••••••••••••••••" style="width:100%;" maxlength="17" class="eft-input">
</label>
<label class="confirm-account-number-label at-row-half">Confirm Account Number <input type="tel" name="confirmBankAccountNumber" id="confirmBankAccountNumber" placeholder="•••••••••••••••••" style="width:100%;" maxlength="17"
class="eft-input">
</label>
<label class="at-check authorize-payment-label">
<input type="checkbox" name="authorizePayment" id="authorizePayment" class="eft-input">
<span>I authorize the use of my bank account as a payment method and authorize this organization to debit my bank account via the Automated Clearing House system to fulfill my donation commitment. This authority will remain in effect
until revoked in writing by the account holder.</span>
</label>
</div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset AdditionalInformation" id="NVContributionForm266675-AdditionalInformation" style="display: none;">
<legend class="at-legend">Additional Information</legend>
<div class="at-fields">
<div class="at-row at-row-full CustomFieldHeaderHtml">
<div class="at-markup CustomFieldHeaderHtml" id="NVContributionForm266675-AdditionalInformation-CustomFieldHeaderHtml" style="display: none;"></div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39">
<label class="at-text CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39" id="NVContributionForm266675-AdditionalInformation-CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39">Organization
<small>(Optional)</small><input type="text" autocomplete="on" false="" title="Organization" name="CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40">
<label class="at-text CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40" id="NVContributionForm266675-AdditionalInformation-CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40">Percentage
<small>(Optional)</small><input type="text" autocomplete="on" pattern="^(\d+(\.\d{0,2})?)|((\.\d{1,2}))$" false="" title="Percentage" name="CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40" value="" maxlength="">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_1288352966866823_MappedCustomFormFieldQuestion_44" style="display: none;">
<label class="at-text CustomFormFieldQuestion_1288352966866823_MappedCustomFormFieldQuestion_44" id="NVContributionForm266675-AdditionalInformation-CustomFormFieldQuestion_1288352966866823_MappedCustomFormFieldQuestion_44">Google Analytics
clientId <small>(Optional)</small><input type="text" autocomplete="on" false="" title="Google Analytics clientId" name="CustomFormFieldQuestion_1288352966866823_MappedCustomFormFieldQuestion_44" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_638071427361273_MappedCustomFormFieldQuestion_46" style="display: none;">
<label class="at-text CustomFormFieldQuestion_638071427361273_MappedCustomFormFieldQuestion_46" id="NVContributionForm266675-AdditionalInformation-CustomFormFieldQuestion_638071427361273_MappedCustomFormFieldQuestion_46">Salesforce Code
<small>(Optional)</small><input type="text" autocomplete="on" false="" title="Salesforce Code" name="CustomFormFieldQuestion_638071427361273_MappedCustomFormFieldQuestion_46" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFieldFooterHtml">
<div class="at-markup CustomFieldFooterHtml" id="NVContributionForm266675-AdditionalInformation-CustomFieldFooterHtml" style="display: none;"></div>
</div>
</div>
</fieldset>
<div class="at-form-submit clearfix">
<input type="submit" value="Donate Monthly Now" class="at-submit btn-at btn-at-primary" style="display: none;">
<div class="at-markup secure-processing-single-step-div" style="display: none;">
<label class="secure-processing-label at-text"> Your donation will be securely processed.<div class="glyphicons glyphicons-lock" aria-hidden="true"></div>
</label>
</div>
<div id="PrivacyPolicy" style="display: block;">
<p class="legal">PPFA respects your privacy, and works to ensure your information is kept confidential. Feel free to review our <a href="https://www.plannedparenthood.org/privacy-policy" target="_blank" title="Privacy Policy">privacy policy</a>
and our website's <a href="https://www.plannedparenthood.org/terms-use" target="_blank" title="Terms of Use">terms of use</a>, and <a href="https://www.plannedparenthood.org/donor-services" target="_blank" title="Contact Us">reach out</a>
with any questions.</p>
<p>
<img class="seal" src="https://nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Themes/Evergreen/Web/Seals/seal_CharityNav.png" alt="Charity Navigator Four Star Charity">
<img class="seal" src="https://nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Themes/Evergreen/Web/Seals/seal_BBB.png" alt="Better Business Bureau Accredited Charity">
</p>
</div>
</div>
</form>Text Content
Donate Online Today PROTECT AND RESTORE ABORTION ACCESS. PLANNED PARENTHOOD NEEDS YOU — GIVE NOW. From the Supreme Court to statehouses nationwide, the right to control our bodies and make personal health care decisions is under attack like never before. Together, we must protect and restore access to sexual and reproductive health care, including abortion. Planned Parenthood health centers will continue to provide care as best they can, and we will keep fighting to ensure you have access to the health care services, education, and access you need to control your body, your life, and your future. Patients need us, and we need you. Make your tax‑deductible gift today so we can continue to protect and provide care, no matter what. * Give to Planned ParenthoodGive Now * Specific Giving Your gift will go to the Planned Parenthood organization of your choice. ? Take future action with a single click. Log in or Sign up for FastAction Organization- Select -Planned Parenthood Federation of AmericaPlanned Parenthood Federation of America Global ProgramsAL - Planned Parenthood SoutheastAK - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, KentuckyAR - Planned Parenthood Great PlainsAZ - Planned Parenthood ArizonaCA - Planned Parenthood Los AngelesCA - Planned Parenthood Pasadena and San Gabriel ValleyCA - Planned Parenthood of the Pacific SouthwestCA - Planned Parenthood Mar MonteCA - Planned Parenthood of Orange & San Bernardino CountiesCA - Planned Parenthood California Central CoastCA - Planned Parenthood Northern CaliforniaCO - Planned Parenthood of the Rocky MountainsCT - Planned Parenthood of Southern New EnglandDC - Planned Parenthood of Metropolitan Washington, DCDE - Planned Parenthood of DelawareFL - Planned Parenthood of Southwest and Central FloridaFL - Planned Parenthood of South, East and North FloridaGA - Planned Parenthood SoutheastHI - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, KentuckyIA - Planned Parenthood North Central StatesID - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, KentuckyID - Planned Parenthood of Greater Washington and North IdahoIL - Planned Parenthood of IllinoisIL - Planned Parenthood Great RiversIN - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, KentuckyKS - Planned Parenthood Great PlainsKY - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, KentuckyKY - Planned Parenthood Southwest Ohio RegionLA - Planned Parenthood Gulf CoastMA - Planned Parenthood League of MassachusettsMD - Planned Parenthood of MarylandMD - Planned Parenthood of Metropolitan Washington, DCME - Planned Parenthood of Northern New EnglandMI - Planned Parenthood of MichiganMN - Planned Parenthood North Central StatesMO - Planned Parenthood Great PlainsMO - Planned Parenthood Great RiversMS - Planned Parenthood of Tennessee and North MississippiMS - Planned Parenthood SoutheastMT - Planned Parenthood of MontanaNC - Planned Parenthood South AtlanticND - Planned Parenthood North Central StatesNE - Planned Parenthood North Central StatesNH - Planned Parenthood of Northern New EnglandNJ - Planned Parenthood of Northern, Central, and Southern New JerseyNJ - Planned Parenthood of Metropolitan New JerseyNM - Planned Parenthood of the Rocky MountainsNV - Planned Parenthood Mar MonteNV - Planned Parenthood of the Rocky MountainsNY - Upper Hudson Planned ParenthoodNY - Planned Parenthood of Central and Western New YorkNY - Planned Parenthood of Greater New YorkNY - Planned Parenthood of the North Country New YorkNY - Planned Parenthood Hudson PeconicOH - Planned Parenthood of Greater OhioOH - Planned Parenthood Southwest Ohio RegionOK - Planned Parenthood Great PlainsOR - Planned Parenthood of Southwestern OregonOR - Planned Parenthood Columbia WillamettePA - Planned Parenthood Southeastern PennsylvaniaPA - Planned Parenthood of Western PennsylvaniaPA - Planned Parenthood KeystoneRI - Planned Parenthood of Southern New EnglandSC - Planned Parenthood South AtlanticSD - Planned Parenthood North Central StatesTN - Planned Parenthood of Tennessee and North MississippiTX - Planned Parenthood of Greater TexasTX - Planned Parenthood Gulf CoastTX - Planned Parenthood South TexasUT - Planned Parenthood Association of UtahVA - Planned Parenthood South AtlanticVA - Planned Parenthood of Metropolitan Washington, DCVA - Virginia League for Planned ParenthoodVT - Planned Parenthood of Northern New EnglandWA - Mt. Baker Planned ParenthoodWA - Planned Parenthood Columbia WillametteWA - Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, KentuckyWA - Planned Parenthood of Greater Washington and North IdahoWI - Planned Parenthood of WisconsinWV - Planned Parenthood South AtlanticWY - Planned Parenthood of the Rocky Mountains Gift Information One-Time Monthly A monthly gift does even more to protect reproductive rights $50 $35 $25 $15 Other $ I'd like to help cover the transaction fees for my contributionI'd like to cover the processing fees, making my total gift $36.14, so $35.00 goes to protect reproductive health. You are making a monthly gift of $. If you do not want to make a monthly gift, please select another option above. I'd like to make this gift in honor or in memory of someone special Is this an Honorary or Memorial Gift? In honor of In memory of Honoree Name I'd like to notify someone of this contribution I'd like an e-card to be sent via email (delivered instantly or on a specific date of your choosing) I'd like a physical card to be sent via the mail (delivered within 2 - 3 weeks) Who would you like to notify? We will send an email notification to the email address you provide below. We are unable to send anonymous notifications — the recipient will see your name and email address. 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