savinglivesinisrael.netviewshop.com
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198.160.140.128
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Submitted URL: https://savelifeisrael.com/
Effective URL: https://savinglivesinisrael.netviewshop.com/DDAIP2
Submission: On June 10 via api from BE — Scanned from DE
Effective URL: https://savinglivesinisrael.netviewshop.com/DDAIP2
Submission: On June 10 via api from BE — Scanned from DE
Form analysis 1 forms found in the DOM
POST
<form id="donateForm" role="form" method="post" class="form-horizontal" target="_top" action="">
<input type="hidden" name="amount" id="amount" value="100.00">
<div class="form-group">
<div class="col-sm-2 col-xs-12"><label for="radio_amount">Amount<span class="nvs-requiredFlag"></span></label></div>
<div class="col-sm-10 col-xs-12">
<div class="form-group noBotMargin">
<div class="col-xs-12">
<input type="radio" id="radio_amount_0" name="radio_amount" value="25.00" onchange="updateRadioAmount();removeError('amount');"> $25.00
</div>
</div>
<div class="form-group noBotMargin">
<div class="col-xs-12">
<input type="radio" id="radio_amount_1" name="radio_amount" value="50.00" onchange="updateRadioAmount();removeError('amount');"> $50.00
</div>
</div>
<div class="form-group noBotMargin">
<div class="col-xs-12">
<input type="radio" id="radio_amount_2" name="radio_amount" value="100.00" checked="" onchange="updateRadioAmount();removeError('amount');"> $100.00
</div>
</div>
<div class="form-group noBotMargin">
<div class="col-xs-12">
<input type="radio" id="radio_amount_3" name="radio_amount" value="250.00" onchange="updateRadioAmount();removeError('amount');"> $250.00
</div>
</div>
<div class="form-group noBotMargin">
<div class="col-xs-12">
<input type="radio" class="nvs-donate-radioOther" id="radio_amount_other" name="radio_amount" value="other" onchange="updateRadioAmount();removeError('amount')">
<div class="nvs-donate-amountOtherDesc"> Other </div>
<input type="text" disabled="" class="form-control nvs-donate-amountOther tb-3" id="amount_other" name="amount_other" value="" onkeypress="return inputNumberOnly(event,2);" onkeyup="removeError('amount');" onblur="checkAmount(this);">
</div>
</div>
<div role="alert" id="amount_error" class="col-xs-12 nvs-entryError"></div>
</div>
</div>
<div class="form-group">
<div class="col-sm-10 col-sm-offset-2 col-xs-12">
<input type="checkbox" name="makePledge" id="makePledge" value="1" onclick="togglePledgeOptions();updateFirstPaymentAmount();checkPlgFreeGift();"> Click here to make this a recurring monthly gift
</div>
</div>
<div id="pledgeOptDiv" style="display: none;"><input type="hidden" id="pledgeInfo_0" name="pledgeInfo" value="RD|12|999|0">
<div class="form-group topMargin20">
<div class="col-sm-10 col-sm-offset-2 col-xs-12 leftIdent50">
<div id="autoPayPromptDiv"><input type="checkbox" name="autoPay" id="autoPay" onchange="checkPlgFreeGift();" value="1" checked=""> Please automatically charge my account every month on the <select id="autoPayDay" name="autoPayDay"
class="form-control-sm nvs-donate-autoPayMonthdays">
<option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9" selected="">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
</select> of the month.</div>
</div>
</div>
<div class="form-group ">
<div class="col-sm-10 col-sm-offset-2 col-xs-12 leftIdent50">
<input type="checkbox" name="makeFirstPayment" id="makeFirstPayment" value="1" onchange="checkPlgFreeGift();" checked=""> I want to give my first gift of <input class="form-control-sm nvs-donate-firstPaymentAmount" type="text"
id="firstPaymentAmount" name="firstPaymentAmount" onkeypress="return inputNumberOnly(event,2);" value="100.00" aria-errormessage="firstPaymentAmount_error" onblur="checkPlgAmount(this);checkPlgFreeGift();"> right now.
</div>
<div role="alert" id="firstPaymentAmount_error" class="col-sm-10 col-sm-offset-2 leftIdent50 nvs-entryError"></div>
</div>
</div>
<input type="hidden" id="fund" name="fund" value="1000|5200">
<div class="row nvs-percentUpsellPrompt">
<div class="col-sm-offset-2 col-sm-10 col-xs-12">
<div class="checkbox">
<label>
<input type="checkbox" id="addPercent" name="addPercent" value="1"> I would like to add 3% to cover processing cost. </label>
</div>
</div>
</div>
<div id="freeGiftDiv" style="display:none;" class="form-group nvs-donate-freeGiftSelect">
<div class="col-sm-2 col-xs-12"><label for="freeGift">Gift of Appreciation </label></div>
<div id="freeGiftSelectDiv" class="col-sm-5 col-xs-12">
</div>
<div role="alert" id="freeGift_error" class="col-sm-10 col-sm-offset-2 nvs-entryError">Please select a gift.</div>
</div>
<script language="javascript">
var oPledgeOptions = [{
"plgRespPledge": "Thank you for your pledge of [[PledgeAmount]].",
"promptPeriodsBefore": "Monthly for",
"minFirstPayment": "1.00",
"description": "Monthly",
"autoPayPrompt": "Please automatically charge my account every month on the [[MonthDay]] of the month.",
"plgRespAutoPay": "You will automatically be charged on the [[MonthDay]] of the month.",
"type": "RD",
"plgRespFirstPayment": "Your first payment of [[FirstPayment]] will be charged now.",
"promptPeriodsAfter": "months",
"mode": "12",
"promptPeriods": false,
"periods": "999",
"minPeriods": "1"
}];
var aFreeGifts = [{
"minAmount": "300.00",
"requireAutoPay": true,
"minPlgAmount": "300.00",
"fundCode": "ALL",
"itemCode": "HERO-AUTOPK",
"description": "Hero Partner Pack (Auto)",
"requirePledge": true,
"applyDonToProd": false,
"useSelectedFund": false,
"plgMode": "12",
"plgType": "ALL"
}, {
"minAmount": "100.00",
"requireAutoPay": true,
"minPlgAmount": "100.00",
"fundCode": "ALL",
"itemCode": "DEFENDER-AUTOPK",
"description": "Defender Partner Package (Auto)",
"requirePledge": true,
"applyDonToProd": false,
"useSelectedFund": false,
"plgMode": "12",
"plgType": "ALL"
}, {
"minAmount": "35.00",
"requireAutoPay": true,
"minPlgAmount": "35.00",
"fundCode": "ALL",
"itemCode": "GUARDIAN-AUTOPK",
"description": "Guardian Partner Pack (Auto)",
"requirePledge": true,
"applyDonToProd": false,
"useSelectedFund": false,
"plgMode": "12",
"plgType": "ALL"
}, {
"minAmount": "300.00",
"requireAutoPay": false,
"minPlgAmount": "300.00",
"fundCode": "ALL",
"itemCode": "HERO-PAK",
"description": "Hero Partner Pack",
"requirePledge": true,
"applyDonToProd": false,
"useSelectedFund": false,
"plgMode": "12",
"plgType": "ALL"
}, {
"minAmount": "100.00",
"requireAutoPay": false,
"minPlgAmount": "100.00",
"fundCode": "ALL",
"itemCode": "DEFENDER-PAK",
"description": "Defender Partner Package",
"requirePledge": true,
"applyDonToProd": false,
"useSelectedFund": false,
"plgMode": "12",
"plgType": "ALL"
}, {
"minAmount": "35.00",
"requireAutoPay": false,
"minPlgAmount": "35.00",
"fundCode": "ALL",
"itemCode": "GUARDIAN-PAK",
"description": "Guardian Partner Pack",
"requirePledge": true,
"applyDonToProd": false,
"useSelectedFund": false,
"plgMode": "12",
"plgType": "ALL"
}];
var vAutoPayMode = "checked";
var vMonthDayHTML =
'<select id="autoPayDay" name="autoPayDay" class="form-control-sm nvs-donate-autoPayMonthdays"><option value="1">1st</option><option value="2">2nd</option><option value="3">3rd</option><option value="4">4th</option><option value="5">5th</option><option value="6">6th</option><option value="7">7th</option><option value="8">8th</option><option value="9" selected>9th</option><option value="10">10th</option><option value="11">11th</option><option value="12">12th</option><option value="13">13th</option><option value="14">14th</option><option value="15">15th</option><option value="16">16th</option><option value="17">17th</option><option value="18">18th</option><option value="19">19th</option><option value="20">20th</option><option value="21">21st</option><option value="22">22nd</option><option value="23">23rd</option><option value="24">24th</option><option value="25">25th</option><option value="26">26th</option><option value="27">27th</option><option value="28">28th</option></select>';
var vWeekDayHTML =
'<select id="autoPayDay" name="autoPayDay" class="form-control-sm nvs-donate-autoPayWeekDays"><option value="1">Monday</option><option value="2">Tuesday</option><option value="3">Wednesday</option><option value="4">Thursday</option><option value="5">Friday</option><option value="6">Saturday</option><option value="7" selected>Sunday</option></select>';
updateFreeGiftList(100.00);
$(document).ready(function() {});
var bUseRadioAmounts = true;
var aFundData = [{
"minAmount": "0.01",
"bOverrideMinErr": false,
"pledgeFund": "5000",
"donateFund": "1000",
"description": "General",
"minErrMsg": "undefined"
}, {
"minAmount": "35.00",
"bOverrideMinErr": false,
"pledgeFund": "5100",
"donateFund": "1000",
"description": "Guardian Partner",
"minErrMsg": "undefined"
}, {
"minAmount": "100.00",
"bOverrideMinErr": false,
"pledgeFund": "5200",
"donateFund": "1000",
"description": "Defender Partner",
"minErrMsg": "undefined"
}, {
"minAmount": "300.00",
"bOverrideMinErr": false,
"pledgeFund": "5300",
"donateFund": "1000",
"description": "Hero Partner",
"minErrMsg": "undefined"
}];
var vNumFunds = $(aFundData).length;
$(document).ready(function() {
updateRadioAmount();
});
function donate_amountEntryValidate() {
var bReturn = true;
var vErrorMsg = '';
bReturn = validateAmount();
var bMakePledge = false;
if ($('#makePledge').prop("checked")) {
bMakePledge = true;
}
var bFirstPay = false;
if ($('#makeFirstPayment').prop("checked")) {
bFirstPay = true;
}
if (bMakePledge) {
var oPledgeInfo = getCurrentPledgeInfo();
if (bFirstPay) {
if (!validateFirstPayment()) {
bReturn = false;
}
}
if (oPledgeInfo.promptPeriods) {
vPeriodsEntered = $('#pledgePeriods_' + oPledgeInfo.vLoc).val() - 0;
if (vPeriodsEntered < oPledgeInfo.minPeriods) {
addError('pledgePeriods_' + oPledgeInfo.vLoc);
bReturn = false;
}
}
}
var oFg = $("#freeGift");
if (oFg.is(":visible")) {
if (oFg.is("select")) {
var fg = oFg.val();
if (fg == "select" || fg == "") {
addError('freeGift');
bReturn = false;
}
}
}
return bReturn;
}
function updateRadioAmount() {
value = $('[name=radio_amount]:checked').val();
if (value == 'other') {
value = $("#amount_other").val();
$("#amount_other").prop("disabled", false);
} else {
$("#amount_other").prop("disabled", true); // Disable other amount - if it exists
$("#amount_other").val('');
}
if (value === undefined) {
value = 0;
}
if (value == '') {
value = 0;
}
document.getElementById('amount').value = value;
resetFund();
updateFirstPaymentAmount();
updateFreeGiftList(value);
}
function checkAmount(oField) {
updateRadioAmount();
if (validateAmount()) {
oField.value = formatCurrency(oField.value, false);
}
}
function checkPlgAmount(oField) {
if (validateFirstPayment()) {
oField.value = formatCurrency(oField.value, false);
updateFreeGiftList(oField.value);
}
}
function resetFund() {
vAmount = document.getElementById('amount').value;
vAmount = vAmount - 0;
var aFundDataReversed = JSON.parse(JSON.stringify(aFundData)); // Make a clone of the fund array
$(aFundDataReversed.reverse()); // Reverse the array
$.each(aFundDataReversed, function(index, oFinfo) {
vMinFundAmt = oFinfo.minAmount;
if (vAmount >= vMinFundAmt) {
$('#fund').val(oFinfo.donateFund + '|' + oFinfo.pledgeFund);
return false;
}
});
}
function validateAmount() {
var bReturn = true;
var aFund = [];
var vFund = '';
var vAmount = 0;
var vMinAmount = 0.01;
var vMinFundAmt = 0;
var vErrorMsg = '';
var bOverrideMinErr = false;
var vMinErrMsg = '';
vAmount = document.getElementById('amount').value;
vAmount = vAmount - 0;
if (!isValidCurrency(vAmount)) {
vErrorMsg = 'Please enter a valid amount.';
}
if (vErrorMsg == '') {
resetFund();
}
aFund = $("#fund").val().split('|');
vFund = aFund[0];
$.each(aFundData, function(index, oFinfo) {
var xFund = oFinfo.donateFund;
if (xFund == vFund) {
vMinFundAmt = oFinfo.minAmount;
bOverrideMinErr = oFinfo.bOverrideMinErr;
vMinErrMsg = oFinfo.minErrMsg;
if (vMinFundAmt > vMinAmount) {
vMinAmount = vMinFundAmt;
}
return false;
}
});
if (vAmount < vMinAmount) {
if (bOverrideMinErr) {
vErrorMsg = vMinErrMsg;
} else {
vErrorMsg = transL8('Please enter an amount greater than or equal to %%1.', [formatCurrency(vMinAmount)]);
}
}
if (vErrorMsg != "") {
$('#amount_error').html(vErrorMsg);
addError('amount');
bReturn = false;
}
return bReturn;
}
function togglePledgeOptions() {
if (document.getElementById('makePledge').checked) {
document.getElementById('pledgeOptDiv').style.display = "inline";
} else {
document.getElementById('pledgeOptDiv').style.display = "none";
}
}
function toggleAutoPayPromptDiv() {
var oPledgeInfo = getCurrentPledgeInfo();
var vPledgeType = oPledgeInfo.type;
var vPledgeMode = oPledgeInfo.mode;
var vAutoPayHTML = '<input type="hidden" name="autoPay" id="autoPay" value=0>';
if (vAutoPayMode !== 'none') {
if (vPledgeType !== "OP") {
switch (vAutoPayMode) {
case "prompt":
vAutoPayHTML = '<input type="checkbox" name="autoPay" id="autoPay" onchange="checkPlgFreeGift();" value=1> ';
break;
case "checked":
vAutoPayHTML = '<input type="checkbox" name="autoPay" id="autoPay" onchange="checkPlgFreeGift();" value=1 checked> ';
break;
case "required":
vAutoPayHTML = '<input type="hidden" name="autoPay" id="autoPay" value=1>';
}
vAutoPayHTML += oPledgeInfo.autoPayPrompt;
}
}
var vBefore = vAutoPayHTML;
vAutoPayHTML = vAutoPayHTML.replace("[[MonthDay]]", vMonthDayHTML);
vAutoPayHTML = vAutoPayHTML.replace("[[WeekDay]]", vWeekDayHTML);
if (vBefore == vAutoPayHTML) {
if (vPledgeMode == 52) {
vAutoPayHTML = vAutoPayHTML + '<div style="display: none;">' + vWeekDayHTML + '</div>';
} else {
vAutoPayHTML = vAutoPayHTML + '<div style="display: none;">' + vMonthDayHTML + '</div>';
}
}
document.getElementById('autoPayPromptDiv').innerHTML = vAutoPayHTML;
}
function getCurrentPledgeInfo() {
var vInputType = $('input[name=pledgeInfo]').attr('type');
if (vInputType == "radio") {
var vId = $('input[name=pledgeInfo]:checked').attr('id');
var vTemp = vId.split("_");
var vLoc = vTemp[1];
} else {
var vLoc = 0; // Only one hidden pledge type
}
var oPledgeInfo = oPledgeOptions[vLoc];
oPledgeInfo.vLoc = vLoc;
return oPledgeInfo;
}
function updateFirstPaymentAmount() {
var vAmt = document.getElementById('amount').value;
var vMinDonation = "0.01";
var vFirstPayment = vMinDonation;
if ($("#firstPaymentAmount").length) {
oPledgeInfo = getCurrentPledgeInfo();
if (oPledgeInfo.type == "OP") {
vFirstPayment = oPledgeInfo.minFirstPayment;
} else {
vFirstPayment = vAmt;
}
if ((vFirstPayment - 0) < (vMinDonation - 0)) {
vFirstPayment = vMinDonation;
}
vFirstPayment = formatCurrency(vFirstPayment, false);
document.getElementById('firstPaymentAmount').value = vFirstPayment;
}
}
function checkMinAmount(vFund, vAmt) {
//var bReturn = true;
var vErrorMsg = '';
var vMinFundAmt = 0;
$.each(aFundData, function(index, oFinfo) {
var xFund = oFinfo.donateFund;
if (xFund == vFund) {
vMinFundAmt = oFinfo.minAmount;
if (vAmt - 0 < vMinFundAmt - 0) {
if (oFinfo.bOverrideMinErr) {
vErrorMsg = oFinfo.minErrMsg;
} else {
vErrorMsg = transL8('Please enter an amount greater than or equal to %%1.', [vMinFundAmt]);
}
}
}
});
return vErrorMsg;
}
function updateFreeGiftList(vDonTotal) {
var vCurrentlySelectedGift = $('#freeGift').val();
if (vCurrentlySelectedGift == undefined) {
vCurrentlySelectedGift = '';
}
if (aFreeGifts.length == 0) {
document.getElementById('freeGiftSelectDiv').innerHTML = ''; // Blank out any existing free gifts
return;
}
var bQualifies = true;
var aQualifyingGifts = [];
var vOptions = '';
var vLen = aFreeGifts.length;
var vMinAmt = 0;
var bMakePlg = false;
var bMakePlgPmt = false;
var vDonAmt = $('#amount').val();
var vPlgAmt = vDonAmt;
var bAutoPay = false;
var xPlgInfo = '';
var vPlgFirstPmt = 0;
var vPlgMode = '';
var vPlgType = '';
var xfunds = $('#fund').val();
var aFunds = xfunds.split('|');
// if ($('[name=pledgeInfo]').is(':checkbox')) {
if ($('input[name=pledgeInfo]').is(":radio")) {
xPlgInfo = $('[name=pledgeInfo]:checked').val();
} else {
xPlgInfo = $('#pledgeInfo_0').val();
}
if (xPlgInfo == undefined) {
bMakePlg = false;
bAutoPay = false;
bMakePlgPmt = false;
} else {
var aPlgInfo = xPlgInfo.split('|');
vPlgMode = aPlgInfo[1];
vPlgType = aPlgInfo[0];
if ($('#makePledge').prop('type') == 'checkbox') {
bMakePlg = $('#makePledge').is(':checked');
} else {
bMakePlg = $('#makePledge').val();
}
if ($('#autoPay').prop('type') == 'checkbox') {
bAutoPay = $('#autoPay').is(':checked');
} else {
bAutoPay = $('#autoPay').val();
}
if (bAutoPay == undefined) {
bAutoPay = false;
} else {
bAutoPay = bAutoPay - 0;
}
if ($('#makeFirstPayment').prop('type') == 'checkbox') {
bMakePlgPmt = $('#makeFirstPayment').is(':checked');
} else {
bMakePlgPmt = $('#makeFirstPayment').val() - 0;
}
if (bMakePlgPmt) {
if ($("#firstPaymentAmount").length) {
vPlgFirstPmt = $('#firstPaymentAmount').val();
} else {
vPlgFirstPmt = 0;
}
}
}
for (var i = 0; i < vLen; i++) {
bQualifies = true;
var oFreeGift = aFreeGifts[i];
if (oFreeGift.minAmount - 0 > vDonTotal - 0) {
bQualifies = false;
}
if (oFreeGift.fundCode != "ALL") {
if (bMakePlg) {
if (oFreeGift.fundCode != aFunds[1]) {
bQualifies = false;
}
} else {
if (oFreeGift.fundCode != aFunds[0]) {
bQualifies = false;
}
}
/* if ($.inArray(oFreeGift.fundCode,aFunds) == -1) {
bQualifies = false;
} */
}
if (oFreeGift.requirePledge) {
if (!bMakePlg) {
bQualifies = false;
}
if (oFreeGift.requireAutoPay) {
if (!bAutoPay) {
bQualifies = false;
}
}
if (oFreeGift.plgMode != "ALL") {
if (oFreeGift.plgMode != vPlgMode) {
bQualifies = false;
}
}
if (oFreeGift.plgType != "ALL") {
if (oFreeGift.plgType != vPlgType) {
bQualifies = false;
}
}
if (oFreeGift.minPlgAmount - 0 > vPlgAmt - 0) {
bQualifies = false;
}
}
if (bQualifies) {
aQualifyingGifts.push(oFreeGift);
}
}
vLen = aQualifyingGifts.length;
if (vLen > 0) {
document.getElementById('freeGiftSelectDiv').innerHTML = '<input id="freeGift" name="freeGift" type="hidden" value="' + aQualifyingGifts[0].itemCode + '">';
}
}
function validateFirstPayment() {
var oPledgeInfo = getCurrentPledgeInfo();
var vFirstAmt = document.getElementById('firstPaymentAmount').value;
var vMinAmtAllowed = oPledgeInfo.minFirstPayment;
var vErrorMsg = '';
if (!isValidCurrency(vFirstAmt)) {
vErrorMsg = transL8('Please enter a valid first payment amount.');
} else if (vFirstAmt - 0 < vMinAmtAllowed - 0) {
vErrorMsg = transL8('Please enter a first payment amount greater than or equal to %%1', [formatCurrency(vMinAmtAllowed)]);
}
if (vErrorMsg != '') {
$('#firstPaymentAmount_error').html(vErrorMsg);
addError('firstPaymentAmount');
return false;
}
return true;
}
function checkPlgFreeGift() {
var vPaymentAmt = document.getElementById('amount').value;
var bMakePlg = false;
var bMakePlgPmt = false;
if ($('#makePledge').prop('type') == 'checkbox') {
bMakePlg = $('#makePledge').is(':checked');
} else {
bMakePlg = $('#makePledge').val();
}
if (bMakePlg) {
if ($('#makeFirstPayment').prop('type') == 'checkbox') {
bMakePlgPmt = $('#makeFirstPayment').is(':checked');
} else {
bMakePlgPmt = $('#makeFirstPayment').val() - 0;
}
if (bMakePlgPmt) {
vPaymentAmt = document.getElementById('firstPaymentAmount').value;
} else {
vPaymentAmt = 0;
}
}
updateFreeGiftList(vPaymentAmt);
}
</script>
<script language="javascript">
toggleAutoPayPromptDiv();
</script>
<div class="nvs-donate-amountSpacer"></div>
<div id="napeEntryDiv">
<script src="//code.jquery.com/ui/1.11.4/jquery-ui.js"></script>
<script src="js/mailcheck-min.1670885506.js"></script>
<script>
$(document).ready(function() {
Mailcheck.defaultDomains.push('micahtek.com');
Mailcheck.defaultDomains.push('cox.net');
});
</script>
<div style="position:absolute; left: -2000px;">
<label for="emailaddress">Please do not change this field</label>
<input id="emailaddress" name="emailaddress" value="" autocomplete="off">
</div>
<input type="hidden" id="napeForm" name="napeForm" value="1">
<div class="form-group">
<div class="col-xs-12 col-sm-2"><label for="titleCode">Title<span class="nvs-requiredFlag"></span></label></div>
<div class="col-xs-12 col-sm-10"><select onchange="removeError("titleCode")" class="form-control nvs-form-title" id="titleCode" name="titleCode" aria-errormessage="titleCode_error">
<option value="0"></option>
<option value="1">Mr.</option>
<option value="4">Ms.</option>
<option value="2">Mrs.</option>
<option value="3">Miss</option>
<option value="5">Dr.</option>
<option value="11">Rev.</option>
<option value="32">Pastor</option>
<option value="12">Rabbi</option>
</select></div>
<div role="alert" id="titleCode_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Title is required.</div>
</div>
<div class="form-group nvs-form-firstMiddleGroup">
<div class="col-sm-2 col-xs-12"><label for="firstName">First Name<span class="nvs-requiredFlag"></span></label></div>
<div class="col-sm-6 col-xs-12"><input type="text" onkeyup="removeError("firstName")" placeholder="First Name" class="form-control nvs-form-firstName" name="firstName" id="firstName" aria-errormessage="firstName_error" required="">
</div>
<div role="alert" id="firstName_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">First name is required.</div>
</div>
<input type="hidden" name="middleName" id="middleName" value="">
<input type="hidden" name="suffix" id="suffix" value="">
<div class="form-group nvs-form-LastSuffixGroup">
<div class="col-sm-2 col-xs-12"><label for="lastName">Last Name<span class="nvs-requiredFlag"></span></label></div>
<div class="col-sm-6 col-xs-12"><input type="text" onkeyup="removeError("lastName")" placeholder="Last Name" class="form-control nvs-form-lastName" name="lastName" id="lastName" aria-errormessage="lastName_error" required=""></div>
<div role="alert" id="lastName_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Last name is required.</div>
</div>
<script>
function validateName() {
var bReturn = true;
var vTitleId = 'titleCode';
var vTitleCode = $("#" + vTitleId).val();
if (vTitleCode == 0 || vTitleCode == "") {
addError(vTitleId);
bReturn = false;
}
if (document.getElementById('firstName').value == "") {
addError('firstName');
bReturn = false;
}
if (document.getElementById('lastName').value == "") {
addError('lastName');
bReturn = false;
}
return bReturn;
}
</script>
<input type="hidden" name="organization" value="">
<div class="form-group nvs-form-countryGroup">
<div class="col-sm-2 col-xs-12"><label class="nvs-form-countryLabel" for="country">Country<span class="nvs-requiredFlag"></span></label></div>
<div class="col-sm-6 col-xs-12">
<select class="form-control nvs-form-country" id="country" name="country" required="">
<option value="US">United States</option>
<option value="AF">Afghanistan</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</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</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</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</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="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Cote d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curacao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="CD">Democratic Republic of Congo</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="TP">East Timor</option>
<option value="TL">East Timor</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="ET">Ethiopia</option>
<option value="FK">Falkland Islands</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="GU">Guam</option>
<option value="GT">Guatemala</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="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</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Laos</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">Macau</option>
<option value="MK">Macedonia</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="MH">Marshall Islands</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</option>
<option value="MD">Moldova</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="AN">Netherlands Antilles</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="KP">North Korea</option>
<option value="NN">Northern Ireland</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory</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 Islands</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="QA">Qatar</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russia</option>
<option value="RW">Rwanda</option>
<option value="SH">Saint Helena</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</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="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="KR">South Korea</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SX">St. Maarten</option>
<option value="MF">St. Martin</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syria</option>
<option value="TA">Tahiti</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</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="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican City</option>
<option value="VE">Venezuela</option>
<option value="VM">Vietnam</option>
<option value="WF">Wallis and Futuna</option>
<option value="WE">West Indies</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZR">Zaire</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
<div role="alert" id="country_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Country is required.</div>
</div>
<div class="form-group nvs-form-addr1Group">
<div class="col-sm-2 col-xs-12"><label class="nvs-form-addr1Label" for="addr1">Address<span class="nvs-requiredFlag"></span></label></div>
<div class="col-sm-6 col-xs-12"><input type="text" onkeyup="removeError("addr1");" placeholder="Address 1" class="form-control nvs-form-addr1" name="addr1" id="addr1" aria-errormessage="addr1_error" required=""></div>
<div role="alert" id="addr1_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Address is required.</div>
</div>
<div class="form-group nvs-form-addr2Group">
<div class="col-sm-2 col-xs-12"></div>
<div class="col-sm-6 col-xs-12"><input type="text" placeholder="Address 2" class="form-control nvs-form-addr2" name="addr2" id="addr2"></div>
</div>
<div class="form-group nvs-form-cityGroup">
<div class="col-sm-2 col-xs-12"><label class="nvs-form-cityLabel" for="city" id="cityLabel">City<span class="nvs-requiredFlag"></span></label></div>
<div class="col-sm-3 col-xs-12"><input type="text" onkeyup="removeError("city");" placeholder="City" class="form-control nvs-form-city" name="city" id="city" aria-errormessage="city_error" required=""></div>
<div class="col-sm-3 col-xs-6">
<select id="usStates" name="usStates" onchange="removeError("usStates");" class="states form-control nvs-form-state activeStateField" aria-errormessage="usStates_error" required="" style="">
<option value="" selected="">State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="AA">Armed Forces - Atlantic</option>
<option value="AE">Armed Forces - Europe</option>
<option value="AP">Armed Forces - Pacific</option>
<option value="AS">American Somoa</option>
<option value="FM">Micronesia</option>
<option value="GU">Guam</option>
<option value="MH">Marshall Islands</option>
<option value="MP">North Mariana Islds</option>
<option value="PW">Palau</option>
<option value="PR">Puerto Rico</option>
<option value="UM">Minor Islands</option>
<option value="VI">Virgin Islands</option>
</select>
<select style="display:none;" name="caProvinces" id="caProvinces" onchange="removeError("caProvinces");" class="states form-control nvs-form-province" aria-errormessage="caProvinces_error">
<option value="">Province</option>
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NL">Newfoundland and Labrador</option>
<option value="NT">Northwest Territories</option>
<option value="NS">Nova Scotia</option>
<option value="NU">Nunavut</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="QC">Quebec</option>
<option value="SK">Saskatchewan</option>
<option value="YT">Yukon</option>
</select>
<select style="display:none;" name="auStates" id="auStates" onchange="removeError("auStates");" class="states form-control nvs-form-state" aria-errormessage="auStates_error">
<option value="">State</option>
<option value="ACT">Australian Capital Territory</option>
<option value="NSW">New South Wales</option>
<option value="NT">Northern Territory</option>
<option value="QLD">Queensland</option>
<option value="SA">South Australia</option>
<option value="TAS">Tasmania</option>
<option value="VIC">Victoria</option>
<option value="WA">Western Australia</option>
</select>
<input type="text" style="display:none;" placeholder="State" class="form-control nvs-form-otherStates states" name="otherStates" id="otherStates" aria-errormessage="otherStates_error">
</div>
<div class="col-lg-2 col-sm-3 col-xs-6"><input type="text" onkeyup="removeError("postal");" placeholder="Zip" class="form-control nvs-form-zip" name="postal" id="postal" required=""></div>
<div role="alert" id="city_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">City is required.</div>
<div role="alert" id="usStates_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">State is required.</div>
<div role="alert" id="caProvinces_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Province is required.</div>
<div role="alert" id="auStates_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">State is required.</div>
<div role="alert" id="otherStates_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">State is required.</div>
<div role="alert" id="postal_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Please enter a valid zip code.</div>
</div>
<input type="hidden" id="state" name="state" value="">
<script language="javascript">
$(document).ready(function() {
$('#country').change(function() {
toggleCountry();
});
toggleCountry();
});
function toggleCountry() {
var aEuropeanUnionCountries = ["AT", "BE", "BG", "CY", "CZ", "DE", "DK", "EE", "ES", "FI", "FR", "GB", "GR", "HR", "HU", "IE", "IT", "LT", "LU", "LV", "MT", "NL", "PL", "PT", "RO", "SE", "SI", "SK"];
$('.states').hide();
$('.states').removeClass('activeStateField');
$('#country').prop('required', false);
$('#organization:visible').prop('required', false);
$('#addr1').prop('required', false);
$('#city').prop('required', false);
$('#usStates').prop('required', false);
$('#auStates').prop('required', false);
$('#caProvinces').prop('required', false);
$('#postal').prop('required', false);
$('#country:visible').prop('required', true);
$('#addr1:visible').prop('required', true);
$('#city:visible').prop('required', true);
var vSelectedCountry = $('#country').val();
switch (vSelectedCountry) {
case "US":
$('#usStates').show();
$('#usStates').addClass('activeStateField');
document.getElementById("postal").placeholder = "Zip";
document.getElementById("postal_error").innerHTML = "Please enter a valid zip code.";
$('#usStates:visible').prop('required', true);
$('#postal:visible').prop('required', true);
break;
case "CA":
$('#caProvinces').show();
$('#caProvinces').addClass('activeStateField');
document.getElementById("postal").placeholder = "Postal";
document.getElementById("postal_error").innerHTML = "Please enter a valid postal code.";
$('#caProvinces:visible').prop('required', true);
$('#postal:visible').prop('required', true);
break;
case "AU":
$('#auStates').show();
$('#auStates').addClass('activeStateField');
document.getElementById("postal").placeholder = "Postal";
document.getElementById("postal_error").innerHTML = "Please enter a valid postal code.";
$('#auStates:visible').prop('required', true);
$('#postal:visible').prop('required', true);
break;
default:
$("#otherStates").show();
$("#otherStates").addClass('activeStateField');
document.getElementById("postal").placeholder = "Postal";
document.getElementById("postal_error").innerHTML = "Please enter a valid postal code.";
break;
}
switch (vSelectedCountry) {
case "AU":
case "CA":
case "US":
$('#city').attr("placeholder", "City");
$('#cityLabel').html('City<span class=nvs-requiredFlag></span>');
break;
case "GB":
$('#city').attr("placeholder", "Post Town");
$('#otherStates').attr("placeholder", "County");
$('#cityLabel').html('Post Town<span class=nvs-requiredFlag></span>');
break;
case "HK":
$('#city').attr("placeholder", "Town/District");
$('#otherStates').attr("placeholder", "State/Region");
$('#cityLabel').html('Town/District<span class="nvs-requiredFlag"></span>');
break;
default:
$('#city').attr("placeholder", "City");
$('#otherStates').attr("placeholder", "State");
$('#cityLabel').html('City<span class="nvs-requiredFlag"></span>');
}
if ($.inArray(vSelectedCountry, aEuropeanUnionCountries) > -1) {
document.getElementById('contactWasPrompted').value = 1;
$('#contactPermissionDiv').show();
} else {
document.getElementById('contactWasPrompted').value = 0;
$('#contactPermissionDiv').hide();
}
}
function validateAddress() {
var bReturn = true;
if (document.getElementById('addr1').value == "") {
addError('addr1');
bReturn = false;
}
var vCountry = $("#country").val();
if (vCountry == null) {
addError('country');
bReturn = false;
}
if (document.getElementById('city').value == "") {
addError('city');
bReturn = false;
}
var vPostal = document.getElementById('postal').value.toString().trim();
switch (vCountry) {
case "US":
var us = new RegExp("^\\d{5}(-{0,1}\\d{4})?$");
if (vPostal == '') {
addError('postal');
bReturn = false;
} else if (us.test(vPostal)) {
document.getElementById('postal').value = vPostal;
} else {
addError('postal');
bReturn = false;
}
if (document.getElementById('usStates').value == "") {
addError('usStates');
bReturn = false;
}
break;
case "CA":
var ca = new RegExp(/([ABCEGHJKLMNPRSTVWXYZ]\d){3}/i);
vPostal = vPostal.toUpperCase();
vPostal = vPostal.toString().replace(/\W+/g, '');
if (vPostal == '') {
addError('postal');
bReturn = false;
} else if (ca.test(vPostal)) {
vPostal = vPostal.substr(0, 3) + ' ' + vPostal.substr(3, 3);
document.getElementById('postal').value = vPostal;
} else {
addError('postal');
bReturn = false;
}
if (document.getElementById('caProvinces').value == "") {
addError('caProvinces');
bReturn = false;
}
break;
case "AU":
var au = new RegExp("^\\d{4}?$");
if (vPostal == '') {
addError('postal');
bReturn = false;
} else if (au.test(vPostal.toString())) {
document.getElementById('postal').value = vPostal;
} else {
addError('postal');
bReturn = false;
}
if (document.getElementById('auStates').value == "") {
addError('auStates');
bReturn = false;
}
break;
}
var state = $(".activeStateField").val();
$("#state").val(state);
return bReturn;
}
</script>
<div class="input_phones_wrap">
<div class="row nvs-phoneRow">
<div class="col-sm-2 col-xs-12"><label for="phone_1">Phone</label></div>
<div class="col-sm-5 col-xs-12"><input onkeyup="removeError("phone_1");formatPhoneNum(this);" onchange="validatePhoneObject(this);" type="text" placeholder="Phone" class="form-control phone nvs-form-phone" name="phone[]"
id="phone_1"></div>
<div class="col-sm-2 col-xs-12">
<select class="phoneType form-control nvs-form-phoneType" id="phoneType_1">
<option value="C">Cell</option>
<option value="M">Misc</option>
</select>
</div>
<div class="col-sm-1 col-xs-12"><button type="button" class="add_phone_button form-control nvs-form-addPhone">+</button></div>
<div role="alert" id="phone_1_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Phone number is required.</div>
</div>
</div>
<div class="input_emails_wrap">
<div class="row nvs-emailRow">
<div class="col-sm-2 col-xs-12"><label for="email_1">Email<span class="nvs-requiredFlag"></span></label></div>
<div class="col-sm-5 col-xs-12"><input onkeyup="removeErrorAndWarning("email_1");" onchange="validateEmailObject(this);" type="text" placeholder="Email" class="form-control email nvs-form-email" name="email[]" id="email_1"
required=""></div>
<input type="hidden" id="emailType_1" class="emailType" value="M">
<div class="col-sm-1 col-xs-12"><button type="button" class="add_email_button form-control nvs-form-addEmail">+</button></div>
<div role="alert" id="email_1_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Email address is required.</div>
<div role="alert" id="email_1_warning" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryWarning"></div>
</div>
</div>
<div id="contactPermissionDiv" style="display: none;">
<div class="row nvs-contactPermissionRow">
<div class="col-sm-10 col-sm-offset-2 col-xs-12">
<fieldset id="contactPermissionFieldset">
<div class="nvs-contactPermissionText">
<p>American Friends of Magen David Adom will use the information you provided on this form to be in touch with you and to provide updates. Please let us know how you would like to hear from us:</p>
</div>
<input type="hidden" name="contactWasPrompted" id="contactWasPrompted" value="0">
<input type="checkbox" name="contactEmail" id="contactEmail" value="1"> Email<br>
<input type="checkbox" name="contactMail" id="contactMail" value="1"> Direct Mail<br>
<input type="checkbox" name="contactPhone" id="contactPhone" value="1"> Phone <div class="nvs-contactPermissionText">
<p>You can change your mind at any time by contacting us at <a href="mailto:SavingLives@AFMDA.org">SavingLives@AFMDA.org</a>. For more information about our privacy practices, please visit our website:
<a href="http://www.savinglivesinisrael.org" target="_blank">http://www.savinglivesinisrael.org</a></p>
</div>
</fieldset>
</div>
</div>
</div>
<input type="hidden" id="emailList" name="emailList" value="">
<input type="hidden" id="emailTypes" name="emailTypes" value="">
<input type="hidden" id="phoneList" name="phoneList" value="">
<input type="hidden" id="phoneTypes" name="phoneTypes" value="">
<input type="hidden" id="statusCodes" name="statusCodes" value="">
</div>
<script language="javascript">
addPhoneFields();
function validatePhoneObject(oPhone) {
formatPhoneNum(oPhone);
var bReturn = true;
var vPhone = oPhone.value.replace(/\D+/g, '');
var vPhoneId = oPhone.id;
if (vPhone !== '') {
var vCountry = $('#country').val();
if (vCountry == 'US') {
if (vPhone.length != 10) {
$('#' + vPhoneId + '_error').html('Please enter a valid 10 digit phone number.');
addError(vPhoneId);
bReturn = false;
}
}
}
return bReturn;
}
addEmailFields();
function validateEmailObject(oEmailObj) {
var bReturn = true;
vEmail = $(oEmailObj).val();
vEmail = $.trim(vEmail).toLowerCase();
$(oEmailObj).val(vEmail);
if (vEmail !== '') {
if (validateEmail(vEmail)) {
// Call plug-in to check for common typos. see https://github.com/mailcheck/mailcheck ?>
var vId = oEmailObj.id;
removeWarning(vId);
$(oEmailObj).mailcheck({
suggested: function(element, suggestion) {
// callback code
var vWarn = transL8("Did you mean %%1?", [suggestion.address + '@' + "<span class='nvs-eMailWarnDomain' onclick='$(\"#" + vId + "\").val(\"" + suggestion.full + "\");removeErrorAndWarning(\"" + vId + "\");'>" + suggestion.domain +
"</span>"
]);
document.getElementById(vId + "_warning").innerHTML = vWarn;
addWarning(vId);
}
});
} else {
addError(oEmailObj.id);
bReturn = false;
}
}
return bReturn;
}
var aDemogFields = [];
function napeValidate() {
var vEmail, vPhone;
var bReturn = true;
bReturn = validateName();
bReturn2 = validateAddress();
if (bReturn) {
bReturn = bReturn2;
}
$(".phone").each(function(i) {
bReturn2 = validatePhoneObject(this);
if (!bReturn2) {
bReturn = false;
}
});
vEmail = $('#email_1').val();
vEmail = $.trim(vEmail);
if (vEmail == "") {
$('#email_1_error').html("Email address is required.");
addError('email_1');
bReturn = false;
}
$(".email").each(function(i) {
bReturn2 = validateEmailObject(this);
if (!bReturn2) {
bReturn = false;
}
});
if (bReturn) {
bReturn = checkEmail();
}
if (bReturn) {
// Build Phone, E-mail and status code data for form submission
var phoneList = [],
phoneTypes = [];
$(".phone").each(function(i) {
var vPhone = $(this).val();
vPhone = $.trim(vPhone);
if (vPhone !== '') {
phoneList.push([vPhone]);
phoneTypes.push([$(this).parent().next().find(".phoneType").val()]);
}
});
$("#phoneList").val(phoneList);
$("#phoneTypes").val(phoneTypes);
var emailList = [],
emailTypes = [];
$(".email").each(function(i) {
var vEmail = $(this).val();
vEmail = $.trim(vEmail);
if (vEmail !== '') {
emailList.push([vEmail]);
emailTypes.push([$(this).parent().next().val()]);
}
});
$("#emailList").val(emailList);
$("#emailTypes").val(emailTypes);
var aStatusCodes = [];
$("[id^='statusOpt_']").each(function() {
if ($(this).prop("checked")) {
aStatusCodes.push($(this).val());
}
});
$("#statusCodes").val(aStatusCodes);
}
return bReturn;
}
function validateDemog(vArrayPos) {
var oDemogInfo = aDemogFields[vArrayPos];
var bRequired = oDemogInfo.required;
var vFieldNum = oDemogInfo.fieldNum;
var vFormat = oDemogInfo.format;
var vFieldDesc = oDemogInfo.prompt;
var vFieldName = "demog_" + vFieldNum;
var vErrorId = vFieldName + '_error';
var vFieldContents = document.getElementById(vFieldName).value.trim();
var vErrorMsg = '';
if (bRequired && vFieldContents == '') {
vErrorMsg = transL8('%%1 is required.', [vFieldDesc]);
$('#' + vErrorId).html(vErrorMsg);
addError(vFieldName);
return false;
}
if (vFormat == "$") {
if (!(vFieldContents == '') && !isValidCurrency(vFieldContents)) {
vErrorMsg = transL8('Please enter a valid amount.');
$('#' + vErrorId).html(vErrorMsg);
addError(vFieldName);
return false;
}
}
if (vFormat == "#") {
if (!(vFieldContents == '') && !$.isNumeric(vFieldContents)) {
vErrorMsg = transL8('Please enter a valid number.');
$('#' + vErrorId).html(vErrorMsg);
addError(vFieldName);
return false;
}
}
if (vFormat == "D") {
if (!doValidateDateOrEmpty(vFieldName, "Date", false)) {
vErrorMsg = transL8('Please enter a valid date. (mm/dd/yyyy)');
$('#' + vErrorId).html(vErrorMsg);
addError(vFieldName);
return false;
}
}
return true;
}
function validateEmail(emailStr) {
< !--The JavaScript Source!!http: //javascript.internet.com -->
< !--This script and many more are available free online at-- > < !--http: //javascript.internet.com/forms/email-address-validation.html -->
/* The following variable tells the rest of the function whether or not
to verify that the address ends in a two-letter country or well-known
TLD. 1 means check it, 0 means don't. */
var checkTLD = 1;
emailStr = emailStr.toLowerCase();
/* The following is the list of known TLDs that an e-mail address must end with. */
var knownDomsPat = /^(com|net|org|edu|int|mil|gov|arpa|biz|aero|name|coop|info|pro|museum|tv)$/;
/* The following pattern is used to check if the entered e-mail address
fits the user@domain format. It also is used to separate the username
from the domain. */
var emailPat = /^(.+)@(.+)$/;
/* The following string represents the pattern for matching all special
characters. We don't want to allow special characters in the address.
These characters include ( ) < > @ , ; : \ " . [ ] */
var specialChars = "\\(\\)><@,;:\\\\\\\"\\.\\[\\]";
/* The following string represents the range of characters allowed in a
username or domainname. It really states which chars aren't allowed.*/
var validChars = "\[^\\s" + specialChars + "\]";
/* The following pattern applies if the "user" is a quoted string (in
which case, there are no rules about which characters are allowed
and which aren't; anything goes). E.g. "jiminy cricket"@disney.com
is a legal e-mail address. */
var quotedUser = "(\"[^\"]*\")";
/* The following pattern applies for domains that are IP addresses,
rather than symbolic names. E.g. joe@[123.124.233.4] is a legal
e-mail address. NOTE: The square brackets are required. */
var ipDomainPat = /^\[(\d{1,3})\.(\d{1,3})\.(\d{1,3})\.(\d{1,3})\]$/;
/* The following string represents an atom (basically a series of non-special characters.) */
var atom = validChars + '+';
/* The following string represents one word in the typical username.
For example, in john.doe@somewhere.com, john and doe are words.
Basically, a word is either an atom or quoted string. */
var word = "(" + atom + "|" + quotedUser + ")";
// The following pattern describes the structure of the user
var userPat = new RegExp("^" + word + "(\\." + word + ")*$");
/* The following pattern describes the structure of a normal symbolic
domain, as opposed to ipDomainPat, shown above. */
var domainPat = new RegExp("^" + atom + "(\\." + atom + ")*$");
/* Finally, let's start trying to figure out if the supplied address is valid. */
/* Begin with the coarse pattern to simply break up user@domain into
different pieces that are easy to analyze. */
var matchArray = emailStr.match(emailPat);
if (matchArray == null) {
/* Too many/few @'s or something; basically, this address doesn't
even fit the general mould of a valid e-mail address. */
return false;
}
var user = matchArray[1];
var domain = matchArray[2];
// Start by checking that only basic ASCII characters are in the strings (0-127).
for (i = 0; i < user.length; i++) {
if (user.charCodeAt(i) > 127) {
return false;
}
}
for (i = 0; i < domain.length; i++) {
if (domain.charCodeAt(i) > 127) {
return false;
}
}
// See if "user" is valid
if (user.match(userPat) == null) {
// user is not valid
return false;
}
/* if the e-mail address is at an IP address (as opposed to a symbolic
host name) make sure the IP address is valid. */
var IPArray = domain.match(ipDomainPat);
if (IPArray != null) {
// this is an IP address
for (var i = 1; i <= 4; i++) {
if (IPArray[i] > 255) {
return false;
}
}
return true;
}
// Domain is symbolic name. Check if it's valid.
var atomPat = new RegExp("^" + atom + "$");
var domArr = domain.split(".");
var len = domArr.length;
for (i = 0; i < len; i++) {
if (domArr[i].search(atomPat) == -1) {
return false;
}
}
/* domain name seems valid, but now make sure that it ends in a
known top-level domain (like com, edu, gov) or a two-letter word,
representing country (uk, nl), and that there's a hostname preceding
the domain or country. */
if (checkTLD && domArr[domArr.length - 1].length != 2 && domArr[domArr.length - 1].search(knownDomsPat) == -1) {
return false;
}
// Make sure there's a host name preceding the domain.
if (len < 2) {
return false;
}
// If we've gotten this far, everything's valid!
return true;
}
function addPhoneFields() {
var max_fields = 10; //maximum input boxes allowed
var wrapper = $(".input_phones_wrap"); //Fields wrapper
var add_button = $(".add_phone_button"); //Add button ID
var vFieldId = '';
var x = 1; //initial text box count
$(add_button).click(function(e) { //on add input button click
e.preventDefault();
if (x < max_fields) { //max input box allowed
x++; //text box increment
vFieldId = 'phone_' + x;
$(wrapper).append('<div class="row nvs-phoneRow"><div class="col-sm-offset-2 col-sm-5 col-xs-12"><input type="text" placeholder="Phone" class="form-control phone nvs-form-phone" name="phone[]" id="phone_' + x +
'" onkeyup="removeError(this.id);formatPhoneNum(this);" onchange="validatePhoneObject(this);"></div><div class="col-sm-2 col-xs-12"><select class="phoneType form-control nvs-form-phoneType" id="phoneType_' + x +
'"><option value="C" >Cell</option><option value="M" >Misc</option></select></div><div class="col-sm-1 col-xs-12"><button type="button" class="remove_field form-control nvs-form-remove">-</button></div><div role="alert" id="phone_' +
x + '_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Please enter a valid phone number.</div></div>'); //add input box
}
});
$(wrapper).on("click", ".remove_field", function(e) { //user click on remove text
e.preventDefault();
$(this).parent('div').parent('div').remove();
x--;
});
}
function formatPhoneNum(oPhone) {
var vPhone = oPhone.value;
if (vPhone == '(999)' || vPhone == '(999') return; // They are backspacing. Don't try to format.
vPhone = vPhone.replace(/\D+/g, '');
if (vPhone.substring(0, 1) - 0 == 1) {
vPhone = vPhone.substring(1);
}
var vLen = vPhone.length;
if (vLen >= 3 && vLen <= 10) {
var vArea = vPhone.substring(0, 3);
var vPref = vPhone.substring(3, 6);
var vNum = vPhone.substring(6);
vPhone = '(' + vArea + ') ' + vPref;
if (vNum != '') {
vPhone += '-' + vNum;
}
oPhone.value = vPhone;
}
}
function addEmailFields() {
var max_fields = 10; //maximum input boxes allowed
var wrapper = $(".input_emails_wrap"); //Fields wrapper
var add_button = $(".add_email_button"); //Add button ID
var x = 1; //initial text box count
$(add_button).click(function(e) { //on add input button click
e.preventDefault();
if (x < max_fields) { //max input box allowed
x++; //text box increment
$(wrapper).append('<div class="row nvs-emailRow"><div class="col-sm-offset-2 col-sm-5 col-xs-12"><input type="text" placeholder="Email" class="form-control email nvs-form-email" onkeyup=\'removeErrorAndWarning("email_' + x +
'");\' onchange=\'validateEmailObject(this);\' name="email[]" id="email_' + x + '"></div><input type="hidden" class="emailType" id="emailType_' + x +
'" value="M"><div class="col-sm-1 col-xs-12"><button type="button" class="remove_field2 form-control nvs-form-remove2">-</button></div> <div role="alert" id="email_' + x +
'_error" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryError">Please enter a valid email address.</div><div role="alert" id="email_' + x + '_warning" class="col-sm-offset-2 col-sm-10 col-xs-12 nvs-entryWarning"></div></div>'
); //add input box
}
});
$(wrapper).on("click", ".remove_field2", function(e) { //user click on remove text
e.preventDefault();
$(this).parent('div').parent('div').remove();
x--;
});
}
</script>
<script language="javascript">
function commentValidate() {
return true;
}
</script>
<script language="javascript">
function prayerValidate() {
return true;
}
</script>
<input type="hidden" name="createLoginUserName" value="">
<input type="hidden" name="createLoginPassword" value="">
<input type="hidden" name="createLoginHintQuestion" value="">
<input type="hidden" name="createLoginHintAnswer" value="">
<script language="javascript">
function createLoginValidate() {
return true;
}
</script>
<div class="form-group">
<div class="col-md-12 submitDiv">
<span id="processingSpan" style="display: none;">Processing...</span>
<span id="submitButtonSpan" style="">
<button id="submitButton" class="btn btn-group btn-lg nvs-submitBtn g-recaptcha" data-sitekey="6LfAJAseAAAAABDlWCUD5QRmb5hIahlOLV_BtIXK" data-action="submit" data-callback="finishSubmit"> Complete Donation </button>
</span>
<div>
<div class="grecaptcha-badge" data-style="bottomright"
style="width: 256px; height: 60px; display: block; transition: right 0.3s ease 0s; position: fixed; bottom: 14px; right: -186px; box-shadow: gray 0px 0px 5px; border-radius: 2px; overflow: hidden;">
<div class="grecaptcha-logo"><iframe title="reCAPTCHA" width="256" height="60" role="presentation" name="a-ndfz1r2ckqg2" 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=6LfAJAseAAAAABDlWCUD5QRmb5hIahlOLV_BtIXK&co=aHR0cHM6Ly9zYXZpbmdsaXZlc2luaXNyYWVsLm5ldHZpZXdzaG9wLmNvbTo0NDM.&hl=de&v=9pvHvq7kSOTqqZusUzJ6ewaF&size=invisible&sa=submit&cb=yh9u0wibi3bq"></iframe>
</div>
<div class="grecaptcha-error"></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>
<input type="hidden" name="postback" value="1">
<script language="javascript">
function finishSubmit(recapKey) {
verifyForm();
}
$(document).ready(function() {
document.getElementById('submitButtonSpan').style.display = '';
$(document).ready(function() {
setTimeout(function() {
$('#submitButtonSpan').parent().append($('.grecaptcha-badge').parent());
}, 100);
});
});
</script>
</form>Text Content
For your security, we are about to time out your session. If you would like to keep your session active, please click on this message. Otherwise your session will be terminated momentarily. You must enable cookies to use this website × Modal Header Toggle navigation * Home * Login * Donate * Customer Service Your gift of any amount will help put emergency bandages, crucial medical supplies, precious blood reserves, and much more into the hands of Israel's EMTs and first responders. You make it possible for them to save lives. MAGEN DAVID ADOM's 34,000 paramedics and EMTs mobilize a fleet of more than 2,000 vehicles, including ambulances, Medicycles, helicopters, and more, to save every life possible. It is responsible for Israel's national blood supply, emergency medical services, and responds to all terrorist and mass-casualty situations. Please give to save lives in Israel. 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Address Address is required. City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces - AtlanticArmed Forces - EuropeArmed Forces - PacificAmerican SomoaMicronesiaGuamMarshall IslandsNorth Mariana IsldsPalauPuerto RicoMinor IslandsVirgin Islands ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon StateAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia City is required. State is required. Province is required. State is required. State is required. Please enter a valid zip code. Phone CellMisc + Phone number is required. Email + Email address is required. American Friends of Magen David Adom will use the information you provided on this form to be in touch with you and to provide updates. Please let us know how you would like to hear from us: Email Direct Mail Phone You can change your mind at any time by contacting us at SavingLives@AFMDA.org. For more information about our privacy practices, please visit our website: http://www.savinglivesinisrael.org Processing... Complete Donation CONTACT AMERICAN FRIENDS OF MAGEN DAVID ADOM PO Box: 11597 Newark, NJ 07101-4597 Phone: 800-379-0044 Website: www.SavingLivesInIsrael.org "Besides prayer, Bible-believing Christians can sow into American Friends of Magen David Adom as a meaningful way to put action into faith in order to answer the need of the hour." Dr. Robert Stearns Founder of Eagles Wings AFMDA is a 501(c)(3) tax-exempt organization. Our federal tax ID number is 13-1790719. Powered by MicahTek NetView Shop © 2015-2024 Disclaimer Log Off