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URL:
https://support.cancer.ca/site/Donation2?df_id=36739&mfc_pref=T&36739.donation=form1&s_locale=en_CA&utm_source=sfmc-solici...
Submission: On July 31 via manual from CA — Scanned from CA
Submission: On July 31 via manual from CA — Scanned from CA
Form analysis 1 forms found in the DOM
Name: process — POST https://support.cancer.ca/site/Donation2?mfc_pref=T&36739.donation=form1&s_locale=en_CA&utm_source=sfmc-solicitation&utm_medium=email&utm_campaign=mm_nw_monthlygiving2024_research_solicitation_e2_otg-inhon-inmem_en&utm_content=button1&utm_id=3284136&ccs_id=20125&ccs_campaign=monthlygiving2024&s_src=sfmc-solicitation_email_monthlygiving2024&s_subsrc=mm_nw_monthlygiving2024_research_solicitation_e2_otg-inhon-inmem_en_button1_3284136&question2=undefined&question4=35&fm=36739&df_id=36739
<form name="process" id="ProcessForm"
action="https://support.cancer.ca/site/Donation2?mfc_pref=T&36739.donation=form1&s_locale=en_CA&utm_source=sfmc-solicitation&utm_medium=email&utm_campaign=mm_nw_monthlygiving2024_research_solicitation_e2_otg-inhon-inmem_en&utm_content=button1&utm_id=3284136&ccs_id=20125&ccs_campaign=monthlygiving2024&s_src=sfmc-solicitation_email_monthlygiving2024&s_subsrc=mm_nw_monthlygiving2024_research_solicitation_e2_otg-inhon-inmem_en_button1_3284136&question2=undefined&question4=35&fm=36739&df_id=36739"
method="post" onsubmit="return checkDoubleClick();">
<div class="donation-form-container responsive">
<script type="text/javascript">
<!--
function reloadPage() {
window.location.reload(true);
}
function testAjax() {
var xmlHttp = null;
// Opera 8.0+, Firefox, Chrome, Safari
try {
xmlHttp = new XMLHttpRequest();
} catch (e) {
// Internet Explorer Browsers
try {
xmlHttp = new ActiveXObject("Msxml2.XMLHTTP");
} catch (e) {
try {
xmlHttp = new ActiveXObject("Microsoft.XMLHTTP");
} catch (e) {
return false;
}
}
}
xmlHttp.open('POST', 'AjaxHelper;jsessionid=00000000.app20097a?NONCE_TOKEN=65FCF64EAC3EF65D61135F2CAFAC879E', true);
xmlHttp.send();
}
addOnLoadHandler(testAjax);
//
-->
</script>
<div class="donation-form-content" id="markCardType">
<input type="hidden" name="user_donation_amt" id="user_donation_amt" value="35" tabindex="0">
<input type="hidden" name="company_min_matching_amt" id="company_min_matching_amt" value="" tabindex="0">
<input type="hidden" name="currency_locale" id="currency_locale" value="en_CA" tabindex="0">
<div class="form-row">
<div class="html-caption-container">
<!-- PageBuilder: DJ_NW_cancerca_wrpr_sideimg_override_DiTV -->
<style>
#side-image {
background: url(https://support.cancer.ca/images/content/pagebuilder/ditv-donationform-banner.jpg) !important;
background-position: center center !important;
background-size: cover !important;
background-repeat: no-repeat !important;
}
div.user-entered-level {
width: 100% !important;
}
@media only screen and (max-width: 991px) {
#side-image {
position: static;
background: none !important;
height: 100% !important;
}
}
</style>
<script type="text/javascript">
Y.use('jquery-noconflict', function() {
jQuery(document).ready(function() {
jQuery("#side-image img").attr("src", "https://support.cancer.ca/images/content/pagebuilder/ditv-donationform-banner.jpg");
jQuery("#side-image").css("background", "https://support.cancer.ca/images/content/pagebuilder/ditv-donationform-banner.jpg");
console.log('TEST1')
console.log('TEST1')
jQuery("#side-img-txt").html("Your monthly support will help fuel the most innovative, impactful and transformative cancer research to save and improve lives.");
});
});
</script>
</div>
</div>
<div class="form-row step-1-group" id="step-1-begins">
<div class="html-caption-container">
<!-- DO NOT REMOVE THIS CODE -->
<!-- //opening step-1 -->
<div id="step-1-start" class="step-1">
</div>
</div>
</div>
<div class="clearfix step-1-group"></div>
<h2 class="section-header-container step-1-group"><span class="section-title-wrap"> Donation amount </span>
<div class="custom-progress-bar">
<span class="active">1</span>
<span>2</span>
<span>3</span>
<span class="line-connect"></span>
</div>
</h2>
<div class="form-row givingType step-1-group">
<div class="html-caption-container">
<div id="giving-type">
<a href="https://support.cancer.ca/site/Donation2?df_id=36738&mfc_pref=T&36738.donation=form1&s_locale=en_CA&utm_source=sfmc-solicitation&utm_medium=email&utm_campaign=mm_nw_monthlygiving2024_research_solicitation_e2_otg-inhon-inmem_en&utm_content=button1&utm_id=3284136&ccs_id=20125&ccs_campaign=monthlygiving2024&s_src=sfmc-solicitation_email_monthlygiving2024&s_subsrc=mm_nw_monthlygiving2024_research_solicitation_e2_otg-inhon-inmem_en_button1_3284136" tabindex="5">Give once</a>
<a role="link" aria-disabled="true" class="active cta-call" tabindex="6">Give monthly <svg xmlns="https://www.w3.org/2000/svg" viewBox="0 0 30 30"><path class="donation-inside" d="M26.3 5.2c-2.7-2.9-7.1-2.9-9.9-.3l-.3.3L15 6.3l-1.1-1.2C12.6 3.8 10.7 3 8.8 3S5 3.8 3.7 5.2C.9 8.1.9 12.8 3.7 15.7l10.4 11c.2.3.5.4.8.4s.6-.1.8-.4l.1-.1 10.4-11c2.9-2.8 2.9-7.5.1-10.4z"></path><path d="M27.7 4c-3-3.2-8-3.3-11.1-.3l-.3.3L15 5.3 13.8 4c-1.5-1.6-3.6-2.4-5.7-2.4-2.2-.1-4.3.8-5.8 2.4-3.1 3.3-3.1 8.5 0 11.8L14 28.1c.2.3.6.4.9.4s.7-.1.9-.4l.1-.1 11.7-12.3c3.2-3.2 3.2-8.4.1-11.7zm-1.9 10L15 25.2 4.2 14a5.92 5.92 0 010-8.2c.9-1 2.2-1.6 3.6-1.7H8c1.5 0 2.8.6 3.8 1.7L14 8.1c.2.3.6.4.9.4s.7-.1.9-.4l.1-.1 2.2-2.3c1.9-2.1 5.2-2.3 7.3-.3l.3.3c2.2 2.4 2.2 6 .1 8.3z"></path></svg></a>
</div>
<div id="monthly-give-msg">
<p>When you join our monthly giving program, you are joining a community of people who provide unending support to people across the country who are affected by cancer.</p>
</div>
</div>
</div>
<div id="level_standard_row" class="step-1-group">
<div class="don-standard-levels form-row">
<div class="levels-label">
</div>
<div id="level_standard_row" class="form-row form-donation-level">
<div class="form-content">
<span class="field-required"></span> <span class="aural-only">Field Is Required</span>
<span class="FormLabelText">Enter A Gift Amount:</span>
<div class="donation-level-general-ask">
</div>
<div class="donation-levels">
<div class="donation-level-container" style="">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<div class="rfl-radio"><input type="radio" name="level_standardexpanded" id="level_standardexpanded63419" value="63419" checked="checked" onclick="evalMatchingGift('');
updateDonorCoverAmount('');" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<label for="level_standardexpanded63419" onclick="" class="" tabindex="7">
<div class="donation-level-label-container"> $35/mo </div>
</label>
<div class="donation-level-expanded-label activeDesc">
<div><i class="fa-solid fa-heart" aria-hidden="true"></i>
<p><span>$35/month donation</span>Ongoing support of $35 a month can help bring breakthroughs from the lab to life to change the lives of people affected by cancer.</p>
</div>
</div>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_63419expandedsubmit" value="true" tabindex="0">
</div>
</div>
<div class="donation-level-container" style="">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<div class="rfl-radio"><input type="radio" name="level_standardexpanded" id="level_standardexpanded63417" value="63417" onclick="evalMatchingGift('');
updateDonorCoverAmount('');" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<label for="level_standardexpanded63417" onclick="" tabindex="8">
<div class="donation-level-label-container"> $50/mo </div>
</label>
<div class="donation-level-expanded-label">
<div><i class="fa-solid fa-heart" aria-hidden="true"></i>
<p><span>$50/month donation</span>A donation of $50 a month can fuel Canada’s brightest researchers to save and improve lives and make CCS support programs available all year long.</p>
</div>
</div>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_63417expandedsubmit" value="true" tabindex="0">
</div>
</div>
<div class="donation-level-container" style="">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<div class="rfl-radio"><input type="radio" name="level_standardexpanded" id="level_standardexpanded63415" value="63415" onclick="evalMatchingGift('');
updateDonorCoverAmount('');" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<label for="level_standardexpanded63415" onclick="" tabindex="9">
<div class="donation-level-label-container"> $100/mo </div>
</label>
<div class="donation-level-expanded-label">
<div><i class="fa-solid fa-heart" aria-hidden="true"></i>
<p><span>$100/month donation</span>A donation of $100 can make the greatest impact for those facing cancer by helping Canada’s brightest researchers take their research to the next level and help people live fuller lives
with and beyond cancer.</p>
</div>
</div>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_63415expandedsubmit" value="true" tabindex="0">
</div>
</div>
<div class="donation-level-container user-entered-level">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<div class="rfl-radio"><input type="radio" name="level_standardexpanded" id="level_standardexpanded63427" value="63427" onclick="evalMatchingGift(document.getElementById('level_standardexpanded63427amount').value);
updateDonorCoverAmount(document.getElementById('level_standardexpanded63427amount').value);" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<label for="level_standardexpanded63427" onclick="" style="display: none;" tabindex="10">
<div class="donation-level-label-container"> Other amount </div>
</label>
<div class="donation-level-user-entered form-text">
<input type="text" name="level_standardexpanded63427amount" id="level_standardexpanded63427amount" value="" size="12" maxlength="50"
onfocus="var el = document.getElementById ('level_standardexpanded63427');if (el) el.click(); fire_obs_comp_event('level_standardexpanded63427amount', this, event);evalMatchingGift(value); "
onchange="fire_obs_comp_event('level_standardexpanded63427amount', this, event);evalMatchingGift(value);" onkeyup="fire_obs_comp_event('level_standardexpanded63427amount', this, event);evalMatchingGift(value);"
onblur="fire_obs_comp_event('level_standardexpanded63427amount', this);updateDonorCoverAmount(value);" tabindex="11"><label for="level_standardexpanded63427amount" style="display: none;" tabindex="12">Enter amount</label>
</div>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_63427expandedsubmit" value="true" tabindex="0">
</div>
</div>
</div>
</div>
<script type="text/javascript">
Y.use("jquery-ui", function(Y) {
jQuery(function() {
// subscribe observables
jQuery('div.donation-level-element-container').find('input[type="radio"]').each(function() {
var syncAction = function(obj) {
if (obj.is(':checked')) {
obj.closest('div.donation-level-container').addClass('selected');
} else {
obj.closest('div.donation-level-container').removeClass('selected');
};
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('div.donation-level-container').removeClass('selected');
syncAction(jQuery(this));
});
});
});
});
</script><noscript> </noscript>
</div>
<div class="levels-gift-aid">
</div>
<input type="hidden" name="level_standardsubmit" id="level_standardsubmit" value="true" tabindex="0">
<script type="text/javascript">
function updateDonorCoverAmount(gift) {
if (typeof updateAmount !== "undefined") {
updateAmount(gift);
}
};
function evalMatchingGift(gift) {}
</script><noscript> </noscript>
</div>
<div id="donationDescriptor">
<div><i class="fa-solid fa-heart" aria-hidden="true"></i>
<p><span>$35/month donation</span>Ongoing support of $35 a month can help bring breakthroughs from the lab to life to change the lives of people affected by cancer.</p>
</div>
</div>
<script type="text/javascript">
// subscribe listeners to make an ajax call to the server to calculate the total amount
Y.use('jquery-noconflict', function() {
var fetchAmountFunc = function() {
// find all the select, textarea, input, etc... and format them into key=val pairs.
var params = jQuery('#level_standard_row :input').serialize();
// parse the path and append the key/value pairs above to the url
var url = 'https://support.cancer.ca/site/Donation2?idb=537685707&level_standardajaxfetch=true&df_id=36739&mfc_pref=T&36739.donation=form1&level_standardtotalcalculateBtn=true';
var index = url.indexOf("?");
var path = url.substring(0, index);
var args = url.substring(index + 1, url.length);
args += '&' + params;
var recurringGiftTermsContainer = jQuery('#recurring_gift_terms_acceptance_message_container');
if (recurringGiftTermsContainer && recurringGiftTermsContainer.length > 0) {
jQuery.ajax(path, {
data: args,
success: function(data) {
jQuery('#recurring_gift_terms_acceptance_message_container').trigger("recurringTermsChange");
}
});
}
};
jQuery('#level_standard_row :input[type=text]').blur(function() {
fetchAmountFunc();
});
jQuery('#level_standard_row input:checkbox, #level_standard_row input:radio').click(function() {
fetchAmountFunc();
});
jQuery('#level_standard_row select').change(function() {
fetchAmountFunc();
});
// call it on page load
fetchAmountFunc();
});
</script><noscript> </noscript>
</div>
<div class="form-row step-1-group">
<div class="html-caption-container">
</div>
</div>
<div class="form-row step-1-group">
<div class="html-caption-container">
<p><strong>The selected amount will be applied to your chosen payment method today and on the 31st of each month.<br><br> Tax receipts for monthly donations will be issued at the beginning of the year for the total amount you have given in
the previous calendar year</strong>.</p>
</div>
</div>
<div id="additional_amount_row" class="form-row form-text step-1-group">
<div class="form-content">
<div class="form-input">
<input type="text" name="additional_amountname" id="additional_amountname" value="" maxlength="15" onchange="fire_obs_comp_event('additional_amount', this);" tabindex="13"><label for="additional_amountname">Additional Amount:</label><span
class="fa fa-times-circle clearx" aria-hidden="true"></span>
</div>
</div>
<input type="hidden" name="additional_amountsubmit" id="additional_amountsubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('additional_amount', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('additional_amount_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('additional_amountname')) {
document.getElementById('additional_amountname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('additional_amountname')) return document.getElementById('additional_amountname').checked;
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
<div id="tribute_show_honor_fields_row" class="form-row form-checkbox step-1-group">
<div class="form-content">
<span class="check-box-form-label-text">Give in memory or honour of someone</span>
<div class="rfl-checkbox"><input type="checkbox" name="tribute_show_honor_fieldsname" id="tribute_show_honor_fieldsname" checked="checked" onclick="fire_obs_comp_event('tribute_show_honor_fields', this);"
class="rfl-checkbox__native-control" tabindex="14">
<div class="rfl-checkbox__background"><svg class="rfl-checkbox__checkmark" viewBox="0 0 24 24">
<path class="rfl-checkbox__checkmark-path" fill="none" d="M1.73,12.91 8.1,19.28 22.79,4.59"></path>
</svg>
<div class="rfl-checkbox__mixedmark"></div>
</div>
</div>
<label for="tribute_show_honor_fieldsname">Give in memory or honour of someone</label>
<input type="hidden" name="tribute_show_honor_fieldssubmit" id="tribute_show_honor_fieldssubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_show_honor_fields', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_show_honor_fields_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('tribute_show_honor_fieldsname')) {
document.getElementById('tribute_show_honor_fieldsname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('tribute_show_honor_fieldsname')) {
return document.getElementById('tribute_show_honor_fieldsname').checked;
}
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_type_row" class="form-row form-selectlist step-1-group">
<div class="form-content">
<select name="tribute_type" id="tribute_type" size="1" tabindex="15">
<option></option>
<option value="tribute_type_value1">Memory</option>
<option value="tribute_type_value2">Honour</option>
</select><label class="FormLabel float" for="tribute_type">My donation is in*</label>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_type', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_type_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_typesubmit" id="tribute_typesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_type', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_type_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_type'));
function tribute_type_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_type', src);
}
}
var el = document.getElementById('tribute_type');
if (el) {
Utils.addEvent(el, 'change', tribute_type_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div class="form-row tributeType step-1-group">
<div class="html-caption-container">
<div id="tribute-type">
<span id="inMem" class="active">Memory</span>
<span id="inHon">Honour</span>
</div>
<style>
#tribute_type_row {
display: none;
}
</style>
</div>
</div>
<div class="custom-field-container form-row cardOpts form-selectlist step-1-group" style="display: block;">
<div class="form-content cardOpts">
<select name="card_type_dropdown" id="card_type_dropdown" size="1" tabindex="16">
<option value="None">None</option>
<option value="Print Card">Print Card</option>
<option value="Ecard">Ecard</option>
</select><label for="card_type_dropdown" class="float">Card Type</label>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('card_type_dropdown', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('card_type_dropdown_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="card_typesubmit" id="card_typesubmit" value="true" tabindex="0">
</div>
</div>
<div class="form-row cardOpts step-1-group">
<div class="html-caption-container">
<div id="card-options">
<label>Would you like to send someone a card for this gift?</label>
<div class="card-options-wrap">
<span id="mailCard">Mail card</span>
<span id="eCard">Ecard</span>
<span id="noCard" class="active">None</span>
</div>
</div>
<style>
.custom-field-container.cardOpts {
display: none !important;
}
#card-options label {
display: block;
width: 100%;
margin-bottom: 10px;
font-size: 18px;
line-height: 27px;
font-weight: 700;
margin-top: 20px;
}
</style>
</div>
</div>
<div class="form-row email-card-row hide step-1-group">
<div class="html-caption-container">
<h3 id="ecard-section-title">Email recipient information</h3>
</div>
</div>
<div class="form-row mail-card-row hide step-1-group">
<div class="html-caption-container">
<h3 id="printcard-section-title">Card recipient information</h3>
</div>
</div>
<div id="tribute_honoree_name_row" class="form-row form-text gen-card-row step-1-group" style="">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="tribute_honoree_namename" id="tribute_honoree_namename" value="" maxlength="50" tabindex="17"><label for="tribute_honoree_namename">In memory of*</label><span class="fa fa-times-circle clearx"
aria-hidden="true"></span>
<input type="hidden" name="tribute_honoree_namesubmit" id="tribute_honoree_namesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_honoree_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_honoree_name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_honoree_name'));
</script><noscript> </noscript>
</div>
</div>
<div class="custom-field-container form-row gen-card-row step-1-group" style="display: none;">
<div class="form-content">
<div class="form-input-label-block" style="display: none;">
<label for="in_memory_message_dropdown" class="float">In Memory message</label>
</div>
<select name="in_memory_message_dropdown" id="in_memory_message_dropdown" size="1" tabindex="18">
<option value="Choose a message">Choose a message</option>
<option value="My thoughts are with you at this time">My thoughts are with you at this time</option>
<option value="Our thoughts are with you at this time">Our thoughts are with you at this time</option>
<option value="With deepest sympathy">With deepest sympathy</option>
<option value="Our condolences to you and your family">Our condolences to you and your family</option>
<option value="Our condolences">Our condolences</option>
<option value="My condolences">My condolences</option>
<option value="Honouring you with a gift from the heart">Honouring you with a gift from the heart</option>
<option value="Wishing you the best">Wishing you the best</option>
<option value="Thinking of you">Thinking of you</option>
</select>
<p><em>Select one of the available messages or write your own personalized message to appear in the card.</em></p>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('in_memory_message_dropdown', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('in_memory_message_dropdown_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="in_memory_messagesubmit" id="in_memory_messagesubmit" value="true" tabindex="0">
</div>
</div>
<div class="form-row step-1-group" style="display: none;">
<div class="html-caption-container">
<input type="text" id="s_type" name="s_type" value="" style="display: none;" tabindex="19">
</div>
</div>
<div id="tribute_ecard_message_row" class="form-row form-text gen-card-row step-1-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<textarea cols="60" rows="4" name="tribute_ecard_messagename" id="tribute_ecard_messagename" maxlength="200" tabindex="20"></textarea><label for="tribute_ecard_messagename">Personalized card message*</label><span
class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="tribute_ecard_messagesubmit" id="tribute_ecard_messagesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_ecard_message', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_ecard_message_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
<p><em>Remaining characters: <span class="counter">200</span></em></p>
</div>
<div id="markPrintCardRecipient" class="form-row form-text mail-card-row hide step-1-group">
<div class="form-content">
<input type="text" name="tribute_signaturename" id="tribute_signaturename" value="" maxlength="70" tabindex="21"><label for="tribute_signaturename">Sign card as*</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="tribute_signaturesubmit" id="tribute_signaturesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_signature', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_signature_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_signature'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_name_row" class="form-row form-text mail-card-row hide step-1-group">
<div class="form-content">
<input type="text" name="tribute_notify_recip_namename" id="tribute_notify_recip_namename" value="" maxlength="70" tabindex="22"><label for="tribute_notify_recip_namename">Recipient name*</label><span class="fa fa-times-circle clearx"
aria-hidden="true"></span>
<input type="hidden" name="tribute_notify_recip_namesubmit" id="tribute_notify_recip_namesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_name'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_street1_row" class="form-row form-text mail-card-row hide step-1-group">
<div class="form-content">
<input type="text" name="tribute_notify_recip_street1name" id="tribute_notify_recip_street1name" value="" maxlength="50" tabindex="23"><label for="tribute_notify_recip_street1name">Recipient street address*</label><span
class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="tribute_notify_recip_street1submit" id="tribute_notify_recip_street1submit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_street1', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_street1_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_street1'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_street2_row" class="form-row form-text mail-card-row hide step-1-group">
<div class="form-content">
<input type="text" name="tribute_notify_recip_street2name" id="tribute_notify_recip_street2name" value="" maxlength="50" tabindex="24"><label for="tribute_notify_recip_street2name">Recipient apt./unit (optional)</label><span
class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="tribute_notify_recip_street2submit" id="tribute_notify_recip_street2submit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_street2', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_street2_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_street2'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_city_row" class="form-row form-text mail-card-row hide step-1-group">
<div class="form-content">
<input type="text" name="tribute_notify_recip_cityname" id="tribute_notify_recip_cityname" value="" maxlength="50" tabindex="25"><label for="tribute_notify_recip_cityname">Recipient city/town*</label><span class="fa fa-times-circle clearx"
aria-hidden="true"></span>
<input type="hidden" name="tribute_notify_recip_citysubmit" id="tribute_notify_recip_citysubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_city', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_city_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_city'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_state_row" class="form-row form-selectlist mail-card-row hide step-1-group">
<div class="form-content">
<select name="tribute_notify_recip_state" id="tribute_notify_recip_state" size="1" onchange="fire_obs_comp_event('tribute_notify_recip_state', this)" tabindex="26">
<option>Select province/state</option>
<option value="AB">AB - Alberta</option>
<option value="BC">BC - British Columbia</option>
<option value="MB">MB - Manitoba</option>
<option value="NB">NB - New Brunswick</option>
<option value="NL">NL - Newfoundland and Labrador</option>
<option value="NS">NS - Nova Scotia</option>
<option value="NT">NT - Northwest Territories</option>
<option value="NU">NU - Nunavut</option>
<option value="ON">ON - Ontario</option>
<option value="PE">PE - Prince Edward Island</option>
<option value="QC">QC - Quebec</option>
<option value="SK">SK - Saskatchewan</option>
<option value="YT">YT - Yukon</option>
<option value="AK">AK - Alaska</option>
<option value="AL">AL - Alabama</option>
<option value="AR">AR - Arkansas</option>
<option value="AZ">AZ - Arizona</option>
<option value="CA">CA - California</option>
<option value="CO">CO - Colorado</option>
<option value="CT">CT - Connecticut</option>
<option value="DC">DC - District of Columbia</option>
<option value="DE">DE - Delaware</option>
<option value="FL">FL - Florida</option>
<option value="GA">GA - Georgia</option>
<option value="HI">HI - Hawaii</option>
<option value="IA">IA - Iowa</option>
<option value="ID">ID - Idaho</option>
<option value="IL">IL - Illinois</option>
<option value="IN">IN - Indiana</option>
<option value="KS">KS - Kansas</option>
<option value="KY">KY - Kentucky</option>
<option value="LA">LA - Louisiana</option>
<option value="MA">MA - Massachusetts</option>
<option value="MD">MD - Maryland</option>
<option value="ME">ME - Maine</option>
<option value="MI">MI - Michigan</option>
<option value="MN">MN - Minnesota</option>
<option value="MO">MO - Missouri</option>
<option value="MS">MS - Mississippi</option>
<option value="MT">MT - Montana</option>
<option value="NC">NC - North Carolina</option>
<option value="ND">ND - North Dakota</option>
<option value="NE">NE - Nebraska</option>
<option value="NH">NH - New Hampshire</option>
<option value="NJ">NJ - New Jersey</option>
<option value="NM">NM - New Mexico</option>
<option value="NV">NV - Nevada</option>
<option value="NY">NY - New York</option>
<option value="OH">OH - Ohio</option>
<option value="OK">OK - Oklahoma</option>
<option value="OR">OR - Oregon</option>
<option value="PA">PA - Pennsylvania</option>
<option value="RI">RI - Rhode Island</option>
<option value="SC">SC - South Carolina</option>
<option value="SD">SD - South Dakota</option>
<option value="TN">TN - Tennessee</option>
<option value="TX">TX - Texas</option>
<option value="UT">UT - Utah</option>
<option value="VA">VA - Virginia</option>
<option value="VT">VT - Vermont</option>
<option value="WA">WA - Washington</option>
<option value="WI">WI - Wisconsin</option>
<option value="WV">WV - West Virginia</option>
<option value="WY">WY - Wyoming</option>
<option value="AS">AS - American Samoa</option>
<option value="FM">FM - Federated States of Micronesia</option>
<option value="GU">GU - Guam</option>
<option value="MH">MH - Marshall Islands</option>
<option value="MP">MP - Northern Mariana Islands</option>
<option value="PR">PR - Puerto Rico</option>
<option value="PW">PW - Palau</option>
<option value="VI">VI - Virgin Islands</option>
<option value="AA">AA - Armed Forces Americas</option>
<option value="AE">AE - Armed Forces</option>
<option value="AP">AP - Armed Forces Pacific</option>
<option value="None">None</option>
</select><label class="FormLabel float" for="tribute_notify_recip_state">Recipient province/state*</label>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_notify_recip_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_notify_recip_statesubmit" id="tribute_notify_recip_statesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_state_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_state'));
function tribute_notify_recip_state_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_notify_recip_state', src);
}
}
var el = document.getElementById('tribute_notify_recip_state');
if (el) {
Utils.addEvent(el, 'change', tribute_notify_recip_state_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_zip_row" class="form-row form-text mail-card-row hide step-1-group">
<div class="form-content">
<input type="text" name="tribute_notify_recip_zipname" id="tribute_notify_recip_zipname" value="" maxlength="50" tabindex="27"><label for="tribute_notify_recip_zipname">Recipient postal code/ZIP code*</label><span
class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="tribute_notify_recip_zipsubmit" id="tribute_notify_recip_zipsubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_zip', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_zip_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_zip'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_country_row" class="form-row form-selectlist mail-card-row hide step-1-group">
<div class="form-content">
<select name="tribute_notify_recip_country" id="tribute_notify_recip_country" size="1" onchange="fire_obs_comp_event('tribute_notify_recip_country', this)" tabindex="28">
<option selected="selected" value="Canada">Canada</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivarian Republic of Venezuela">Bolivarian Republic of Venezuela</option>
<option value="Bonaire, Sint Eustatios and Saba">Bonaire, Sint Eustatios and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'Ivoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Democratic People's Republic of Korea">Democratic People's Republic of Korea</option>
<option value="The Democratic Republic of the Congo">The Democratic Republic of the Congo</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Federated States of Micronesia">Federated States of Micronesia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="The Former Yugoslav Republic of Macedonia">The Former Yugoslav Republic of Macedonia</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Islamic Republic of Iran">Islamic Republic of Iran</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Plurinational State of Bolivia">Plurinational State of Bolivia</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republic of Korea">Republic of Korea</option>
<option value="Republic of Moldova">Republic of Moldova</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French)">Saint Martin (French)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="S. Georgia & S. Sandwich Isls.">S. Georgia & S. Sandwich Isls.</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch)">Sint Maarten (Dutch)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United Republic of Tanzania">United Republic of Tanzania</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="USA Minor Outlying Islands">USA Minor Outlying Islands</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands (British)">Virgin Islands (British)</option>
<option value="Virgin Islands (USA)">Virgin Islands (USA)</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><label class="FormLabel float" for="tribute_notify_recip_country">Recipient country*</label>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_notify_recip_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_country_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_notify_recip_countrysubmit" id="tribute_notify_recip_countrysubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_country_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_country'));
function tribute_notify_recip_country_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_notify_recip_country', src);
}
}
var el = document.getElementById('tribute_notify_recip_country');
if (el) {
Utils.addEvent(el, 'change', tribute_notify_recip_country_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div class="form-row mail-card-row hide step-1-group">
<div class="html-caption-container">
<div id="mail-card-previews">
<h3>Card image</h3>
<img src="https://support.cancer.ca/custom/donation_ecard/images/im_tribute_03.jpg" alt="In memory mail card preview" id="inMemCardPreview">
<img src="https://support.cancer.ca/custom/donation_ecard/images/ih_tribute_07.jpg" alt="In honour mail card preview" id="inHonCardPreview" style="display: none;">
</div>
</div>
</div>
<div id="send_ecard_row" class="form-row form-checkbox step-1-group markECardRecipient email-card-row">
<div class="form-content">
<span class="check-box-form-label-text">Yes, Send an eCard</span>
<div class="rfl-checkbox"><input type="checkbox" name="send_ecardname" id="send_ecardname" onclick="fire_obs_comp_event('send_ecard', this);" class="rfl-checkbox__native-control" tabindex="29">
<div class="rfl-checkbox__background"><svg class="rfl-checkbox__checkmark" viewBox="0 0 24 24">
<path class="rfl-checkbox__checkmark-path" fill="none" d="M1.73,12.91 8.1,19.28 22.79,4.59"></path>
</svg>
<div class="rfl-checkbox__mixedmark"></div>
</div>
</div>
<label for="send_ecardname">Yes, I would like to send an eCard.</label>
<input type="hidden" name="send_ecardsubmit" id="send_ecardsubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('send_ecard', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('send_ecard_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('send_ecardname')) {
document.getElementById('send_ecardname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('send_ecardname')) {
return document.getElementById('send_ecardname').checked;
}
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
</div>
<div id="ecard_recpients_row" class="form-row form-text email-card-row hide step-1-group">
<div class="form-content">
<span class="field-required"></span>
<textarea cols="60" rows="1" name="ecard_recpientsname" id="ecard_recpientsname" maxlength="200" tabindex="30"></textarea><label for="ecard_recpientsname">Email address*</label><span class="fa fa-times-circle clearx"
aria-hidden="true"></span>
<input type="hidden" name="ecard_recpientssubmit" id="ecard_recpientssubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('ecard_recpients', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('ecard_recpients_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
<p><em>Remaining characters: <span class="counter2">200</span></em></p>
<p class="hint">You can enter multiple recipient email addresses but they must be separated with a comma or a new line.</p>
</div>
<div id="tribute_ecard_subject_row" class="form-row form-text email-card-row hide step-1-group">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="tribute_ecard_subjectname" id="tribute_ecard_subjectname" value="Here is an Ecard for you." maxlength="50" tabindex="31"><label for="tribute_ecard_subjectname" class="float">Email subject line*</label><span
class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="tribute_ecard_subjectsubmit" id="tribute_ecard_subjectsubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_ecard_subject', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_ecard_subject_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="ecard_send_date_row" class="form-row form-date email-card-row hide step-1-group">
<div class="form-content">
<label for="ecard_send_date_MONTH" class="float">
<span class="label-text">Send date</span><span class="aural-only">Select month of credit card</span>
</label>
<label for="ecard_send_date_YEAR" class="float"><span class="aural-only">Select Expiration Year</span></label>
<div class="date-input-container">
<label for="ecard_send_date_MONTH" class="float"><span style="display:none;">Month</span></label>
<label for="ecard_send_date_DAY" class="float"><span style="display:none;">Day</span></label>
<label for="ecard_send_date_YEAR" class="float"><span style="display:none;">Year</span></label>
<select name="ecard_send_date_MONTH" id="ecard_send_date_MONTH" title="Month" tabindex="32">
<option value="1">Jan</option>
<option value="2">Feb</option>
<option value="3">Mar</option>
<option value="4">Apr</option>
<option value="5">May</option>
<option value="6">Jun</option>
<option value="7" selected="selected">Jul</option>
<option value="8">Aug</option>
<option value="9">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select>
<select name="ecard_send_date_DAY" id="ecard_send_date_DAY" title="Day" tabindex="33">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31" selected="selected">31</option>
</select>
<select name="ecard_send_date_YEAR" id="ecard_send_date_YEAR" title="Year" tabindex="34">
<option value="2025">2025</option>
<option value="2024" selected="selected">2024</option>
</select>
</div>
<input type="hidden" name="ecard_send_datesubmit" id="ecard_send_datesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('ecard_send_date', 'input');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('ecard_send_date_row', _display);
disable_submit_flag('ecard_send_datesubmit', _hidden);
}
comp.disable = function(_disabled) {
disable_element('ecard_send_date_MONTH', _disabled);
disable_element('ecard_send_date_DAY', _disabled);
disable_element('ecard_send_date_YEAR', _disabled);
disable_element('ecard_send_date_HOUR12', _disabled);
disable_element('ecard_send_date_HOUR24', _disabled); //For UK, 24 hour clock used
disable_element('ecard_send_date_MINUTE', _disabled);
disable_element('ecard_send_date_AMPM', _disabled);
}
</script><noscript> </noscript>
</div>
</div>
<div class="clearfix step-1-group"></div>
<h2 class="section-header-container email-card-row hide step-1-group"><span class="section-title-wrap"> Choose a visual </span>
<div class="custom-progress-bar">
<span class="active">1</span>
<span>2</span>
<span>3</span>
<span class="line-connect"></span>
</div>
</h2>
<div id="select_grid_row" class="form-row form-text email-card-row hide step-1-group">
<div class="form-content">
<label for="select_gridname">Select an eCard:</label>
<input type="hidden" name="stationery_layout_chooser" id="stationery_layout_chooser" value="true" tabindex="0">
<div class="layout-chooser-container clearfix">
<div class="layout-choice-thumbnail-container selectedImg">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21814" tabindex="35">
<img src="../custom/donation_ecard/images/im_tribute_01.jpg" alt="A close-up of a luminary floating on water in the dark." border="0" id="DJ_NW_IM_TRIBUTE_1">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21814" value="21814" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container" style="display: none;">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21795" tabindex="36">
<img src="../custom/donation_ecard/images/ih_tribute_01.jpg" alt="A close-up of two people sitting with their hands together on a table." border="0" id="DJ_NW_IH_TRIBUTE_1">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21795" value="21795" checked="checked" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container" style="display: none;">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21796" tabindex="37">
<img src="../custom/donation_ecard/images/ih_tribute_02.jpg" alt="The sun rising through the grass and birds flying in the sky." border="0" id="DJ_NW_IH_TRIBUTE_2">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21796" value="21796" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container" style="display: none;">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21797" tabindex="38">
<img src="../custom/donation_ecard/images/ih_tribute_03.jpg" alt="A person holding up a light towards the sky on a hill at dusk." border="0" id="DJ_NW_IH_TRIBUTE_3">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21797" value="21797" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container" style="display: none;">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21798" tabindex="39">
<img src="../custom/donation_ecard/images/ih_tribute_04.jpg" alt="Sun rays breaking through the clouds." border="0" id="DJ_NW_IH_TRIBUTE_4">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21798" value="21798" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container" style="display: none;">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21799" tabindex="40">
<img src="../custom/donation_ecard/images/ih_tribute_05.jpg" alt="A close-up of a lit candle in the palms of a person&#8217;s hands." border="0" id="DJ_NW_IH_TRIBUTE_5">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21799" value="21799" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container" style="display: none;">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21800" tabindex="41">
<img src="../custom/donation_ecard/images/ih_tribute_06.jpg" alt="Two people sitting in a park, putting their hands together to form a heart." border="0" id="DJ_NW_IH_TRIBUTE_6">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21800" value="21800" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container" style="display: none;">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21801" tabindex="42">
<img src="../custom/donation_ecard/images/ih_tribute_07.jpg" alt="A close-up of a daffodil with the sun shining brightly behind it." border="0" id="DJ_NW_IH_TRIBUTE_7">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21801" value="21801" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21815" tabindex="43">
<img src="../custom/donation_ecard/images/im_tribute_02.jpg" alt="A person standing on a rocky shore looking out at the water at dusk." border="0" id="DJ_NW_IM_TRIBUTE_2">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21815" value="21815" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21816" tabindex="44">
<img src="../custom/donation_ecard/images/im_tribute_03.jpg" alt="The sun shining through the branches of a tree in the woods." border="0" id="DJ_NW_IM_TRIBUTE_3">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21816" value="21816" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21817" tabindex="45">
<img src="../custom/donation_ecard/images/im_tribute_04.jpg" alt="A child standing in the grass with her bike at sunset while birds fly overhead." border="0" id="DJ_NW_IM_TRIBUTE_4">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21817" value="21817" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21818" tabindex="46">
<img src="../custom/donation_ecard/images/im_tribute_05.jpg" alt="A close-up of a dandelion and dandelion seeds floating away into the sky." border="0" id="DJ_NW_IM_TRIBUTE_5">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21818" value="21818" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21819" tabindex="47">
<img src="../custom/donation_ecard/images/im_tribute_06.jpg" alt="Daffodils in a vase, next to a lit candle." border="0" id="DJ_NW_IM_TRIBUTE_6">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21819" value="21819" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
<div class="layout-choice-thumbnail-container">
<label class="layout-choice-thumbnail-label" for="stationery_layout_id_21820" tabindex="48">
<img src="../custom/donation_ecard/images/im_tribute_07.jpg" alt="A close-up of a lit candle against a background of lights." border="0" id="DJ_NW_IM_TRIBUTE_7">
</label>
<div class="rfl-radio"><input type="radio" name="stationery_layout_id" id="stationery_layout_id_21820" value="21820" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
</div>
</div>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('select_grid', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('select_grid_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script><noscript> </noscript>
<input type="hidden" name="select_gridsubmit" id="select_gridsubmit" value="true" tabindex="0">
</div>
<div id="showPreview">
<div class="errorMessageContainer" style="display: none;" id="previewerror">
<div class="ErrorMessage page-error">
<span class="field-error-indicator"></span>
<span class="field-error-text">There was a problem processing your request. Please correct the highlighted problems and try again.</span>
</div>
</div>
<button id="btnPreview" type="button" class="btn btn-primary step-button action-button" data-toggle="modal" data-target="#divPreview" onclick="modalShow()" tabindex="49"> Preview </button>
</div>
</div>
<div class="form-row step-1-group mail-card-row" style="display: none;">
<div class="html-caption-container">
<style>
#divMailPreview .modal-header {
padding: 15px 15px 0 0;
border: none;
}
.close {
opacity: 100%;
}
.close span {
color: #000;
font-size: 28px;
font-weight: bold;
}
#divMailPreview .modal-body {
padding: 30px;
padding-top: 0;
border: none;
}
.card-info {
display: block;
}
#personal-msg-top {
margin-top: 30px;
}
#personal-msg-bottom {
margin-bottom: 30px;
}
</style>
<script type="text/javascript">
var lastFocus;
var modal = document.getElementById("btnMailPreview");
function modalShow() {
lastFocus = document.activeElement;
}
function modalClose() {
lastFocus.focus(); // place focus on the saved element
}
jQuery(document).ready(function($) {
// When the user clicks on the preview button, open the modal
jQuery("#btnMailPreview").click(function() {
alterStationaryAndDisplay();
});
document.getElementById("divMailPreview").onkeydown = function(evt) {
evt = evt || window.event;
if (evt.keyCode == 27) {
jQuery("button.close").click();
}
};
function alterStationaryAndDisplay() {
//Mail card recipient name
if (document.getElementById("tribute_notify_recip_namename")) {
document.getElementById("mailcard-recipient-name").innerHTML = document.getElementById("tribute_notify_recip_namename").value;
}
if (document.getElementById("tribute_notify_recip_namename")) {
document.getElementById("mailcard-recipient-name-to").innerHTML = document.getElementById("tribute_notify_recip_namename").value;
}
// if ($('#tribute_notify_recip_namename').val().length == 0) {
// document.getElementById("mailcard-recipient-name").innerHTML = "(Enter the name of the mail card recipient)";
// document.getElementById("mailcard-recipient-name-to").innerHTML = "(Enter the name of the mail card recipient)";
// }
if ($('#tribute_notify_recip_namename').val().length == 0) {
document.getElementById("mailcard-recipient-name").innerHTML = "<strong><i><<Recipient Name>></i></strong>";
document.getElementById("mailcard-recipient-name-to").innerHTML = "<strong><i><<Recipient Name>></i></strong>";
}
//Tribute name
if (document.getElementById("tribute_honoree_namename")) {
document.getElementById("tribute-name").innerHTML = document.getElementById("tribute_honoree_namename").value;
}
if ($('#tribute_honoree_namename').val().length == 0) {
document.getElementById("tribute-name").innerHTML = "<strong><i><<Tribute Name>></i></strong>";
}
//Mail card message
if (document.getElementById("tribute_ecard_messagename")) {
document.getElementById("mailcard-message").innerHTML = document.getElementById("tribute_ecard_messagename").value.replace(/(?:\r\n|\r|\n)/g, "<br /><br />");
}
if ($('#tribute_ecard_messagename').val().length == 0) {
document.getElementById("mailcard-message").innerHTML = "<strong><i><<Your personal message will go here>></i></strong>";
}
//Mail card signature
if (document.getElementById("tribute_signaturename")) {
document.getElementById("mailcard-signature").innerHTML = document.getElementById("tribute_signaturename").value;
}
// if ($('#tribute_signaturename').val().length == 0) {
// document.getElementById("mailcard-signature").innerHTML = "(Enter your name into the mail card signature field)";
// }
if ($('#tribute_signaturename').val().length == 0) {
document.getElementById("mailcard-signature").innerHTML = "<strong><i><<Your Name>></i></strong>";
}
jQuery("button.close").focus();
}
});
</script>
<div id="showMailPreview">
<div class="errorMessageContainer" style="display: none;" id="previewerror">
<div class="ErrorMessage page-error">
<span class="field-error-indicator"></span>
<span class="field-error-text">There was a problem processing your request. Please correct the highlighted problems and try again.</span>
</div>
</div>
<button id="btnMailPreview" type="button" class="btn btn-primary step-button action-button" data-toggle="modal" data-target="#divMailPreview" onclick="modalShow()" tabindex="50"> Preview mail card </button>
</div>
<div class="modal fade" id="divMailPreview" tabindex="1000" role="dialog" aria-hidden="true" onkeyup="if(event.keyCode == 13){this.click();}">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close" onclick="modalClose()" tabindex="51">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">
<div class="row">
<div class="col-12 text-center">
<h3>Preview your card for <span id="mailcard-recipient-name"></span></h3>
</div>
</div>
<div class="row">
<div class="col-12 col-md-6">
<h4 class="text-center">Outside view</h4>
</div>
<div class="col-6 d-none d-md-block">
<h4 class="text-center">Inside view</h4>
</div>
</div>
<div class="row">
<div class="col-12 col-md-6">
<div class="border-wrap">
<img id="mailcard-img" src="https://support.cancer.ca/custom/donation_ecard/images/im_tribute_03.jpg" alt="">
</div>
</div>
<div class="col-6 d-none d-md-block">
<div class="border-wrap" style="height: 100%; border-bottom: none;"></div>
</div>
</div>
<div class="row">
<div class="col-12 d-sm-block d-md-none">
<h4 class="text-center" style="margin-top:20px;">Inside view</h4>
</div>
</div>
<div class="row">
<div class="col-6 d-none d-md-block">
<div class="border-wrap" style="height: 100%; border-top: none;"></div>
</div>
<div class="col-12 col-md-6">
<div class="border-wrap" style="padding: 40px 20px 50px 20px;">
<p>Dear <span id="mailcard-recipient-name-to"></span>,</p>
<p id="personal-msg-top"><span id="tribute-message">A donation has been made to the Canadian Cancer Society to honour the memory of</span> <span id="tribute-name"></span></p>
<p id="personal-msg-bottom"><span id="mailcard-message"></span></p>
<p>From: <span id="mailcard-signature"></span></p>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<style type="text/css">
#divMailPreview {
padding-right: 0;
}
#divMailPreview img {
display: block;
}
#divMailPreview h4 {
margin-bottom: 20px;
}
.border-wrap {
border: 1px solid #000;
}
#divMailPreview .modal-dialog {
width: 1000px;
max-width: 95% !important;
margin: 20px auto;
}
#btnMailPreview {
width: fit-content;
max-width: fit-content;
margin: 30px auto;
background: #0179c1;
color: #FFF !important;
border-radius: 7px !important;
background-color: #0179c1 !important;
font-size: 18px;
font-family: 'Lato' sans-serif;
font-weight: 700;
}
#btnMailPreview:hover {
cursor: pointer;
background: #0179c1;
background-color: #0179c1 !important;
border-radius: 7px !important;
box-shadow: none !important;
}
#btnMailPreview::before {
box-shadow: none !important;
}
@media (max-width: 768px) {
.no-bm-wrap-mobile {
border-bottom: none;
}
}
</style>
<script type="text/javascript">
$(document).ready(function() {
$("#showMailPreview").parent().parent().addClass("mail-card-row");
$("#showMailPreview").parent().parent().hide();
var tribtypeval = $("#tribute_type").val();
console.log("tribtypeval = " + tribtypeval)
if ($("#tribute_type").val() == "tribute_type_value2") {
$("#mailcard-img").attr("src", "https://support.cancer.ca/custom/donation_ecard/images/ih_tribute_07.jpg");
$("#tribute-message").html("A donation has been made to the Canadian Cancer Society in honour of");
} else {
$("#mailcard-img").attr("src", "https://support.cancer.ca/custom/donation_ecard/images/im_tribute_03.jpg");
$("#tribute-message").html("A donation has been made to the Canadian Cancer Society to honour the memory of");
}
$("#tribute_type").change(function() {
if ($("#tribute_type").val() == "tribute_type_value2") {
$("#mailcard-img").attr("src", "https://support.cancer.ca/custom/donation_ecard/images/ih_tribute_07.jpg");
$("#tribute-message").html("A donation has been made to the Canadian Cancer Society in honour of");
} else {
$("#mailcard-img").attr("src", "https://support.cancer.ca/custom/donation_ecard/images/im_tribute_03.jpg");
$("#tribute-message").html("A donation has been made to the Canadian Cancer Society to honour the memory of");
}
});
$("inMem").click(function() {
$("#mailcard-img").attr("src", "https://support.cancer.ca/custom/donation_ecard/images/im_tribute_03.jpg");
$("#tribute-message").html("A donation has been made to the Canadian Cancer Society to honour the memory of");
});
$("inHon").click(function() {
$("#mailcard-img").attr("src", "https://support.cancer.ca/custom/donation_ecard/images/ih_tribute_07.jpg");
$("#tribute-message").html("A donation has been made to the Canadian Cancer Society in honour of");
});
});
</script>
</div>
</div>
<div class="form-row step-1-group" id="step-1-finish">
<div class="html-caption-container">
<!-- DO NOT REMOVE THIS CODE -->
<div id="step-1-end" class="step-1">
<button class="btn-next-step" type="button" tabindex="52">Continue to billing</button>
</div>
<!-- //closing step-1 -->
</div>
</div>
<div class="form-row step-2-group" id="step-2-begins" style="display: none;">
<div class="html-caption-container">
<!-- DO NOT REMOVE THIS CODE -->
<!-- //opening step-2 -->
<div id="step-2-start" class="step-2">
</div>
</div>
</div>
<div class="clearfix step-2-group" style="display: none;"></div>
<h2 class="section-header-container step-2-group" id="markIsCompany" style="display: none;"><span class="section-title-wrap"> Billing information </span>
<div class="custom-progress-bar">
<span class="complete">✓</span>
<span class="active">2</span>
<span>3</span>
<span class="line-connect"></span>
</div>
</h2>
<div class="custom-field-container form-row step-2-group" style="display: none;">
<div class="form-content">
<div class="form-input-label-block">
<label for="is_a_company_dropdown">Who is making this donation?</label>
</div>
<fieldset>
<div class="radio-button-container company-button-container">
<div class="rfl-radio company-button"><input type="radio" name="is_a_company_radio" id="is_a_company_radio_true" value="true" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
<div class="form-input-label-block">
<label for="is_a_company_radio_true" tabindex="53">A company/organization</label>
</div>
</div>
<div class="radio-button-container company-button-container">
<div class="rfl-radio company-button"><input type="radio" name="is_a_company_radio" id="is_a_company_radio_false" value="false" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div>
<div class="form-input-label-block">
<label for="is_a_company_radio_false" tabindex="54">I am</label>
</div>
</div>
</fieldset>
<input type="hidden" name="is_a_companysubmit" id="is_a_companysubmit" value="true" tabindex="0">
</div>
</div>
<div class="form-row step-2-group" style="display: none;">
<div class="html-caption-container">
<p>The Canada Revenue Agency requires that the name and address of the donor appear on the donation receipts.</p>
</div>
</div>
<div id="billing_first_name_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="billing_first_namename" id="billing_first_namename" value="" maxlength="50" tabindex="55"><label for="billing_first_namename">First name*</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="billing_first_namesubmit" id="billing_first_namesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_first_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_first_name_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_last_name_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="billing_last_namename" id="billing_last_namename" value="" maxlength="50" tabindex="56"><label for="billing_last_namename">Last name*</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="billing_last_namesubmit" id="billing_last_namesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_last_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_last_name_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="donor_email_address_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="donor_email_addressname" id="donor_email_addressname" value="" maxlength="255" tabindex="57"><label for="donor_email_addressname">Email address*</label><span class="fa fa-times-circle clearx"
aria-hidden="true"></span>
<input type="hidden" name="donor_email_addresssubmit" id="donor_email_addresssubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('donor_email_address', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor_email_address_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_country_row" class="form-row form-selectlist step-2-group" style="display: none;">
<div class="form-content">
<select name="billing_addr_country" id="billing_addr_country" size="1" onchange="fire_obs_comp_event('billing_addr_country', this)" tabindex="58">
<option selected="selected" value="Canada">Canada</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivarian Republic of Venezuela">Bolivarian Republic of Venezuela</option>
<option value="Bonaire, Sint Eustatios and Saba">Bonaire, Sint Eustatios and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'Ivoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Democratic People's Republic of Korea">Democratic People's Republic of Korea</option>
<option value="The Democratic Republic of the Congo">The Democratic Republic of the Congo</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Federated States of Micronesia">Federated States of Micronesia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="The Former Yugoslav Republic of Macedonia">The Former Yugoslav Republic of Macedonia</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Islamic Republic of Iran">Islamic Republic of Iran</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Plurinational State of Bolivia">Plurinational State of Bolivia</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republic of Korea">Republic of Korea</option>
<option value="Republic of Moldova">Republic of Moldova</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French)">Saint Martin (French)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="S. Georgia & S. Sandwich Isls.">S. Georgia & S. Sandwich Isls.</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch)">Sint Maarten (Dutch)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United Republic of Tanzania">United Republic of Tanzania</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="USA Minor Outlying Islands">USA Minor Outlying Islands</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands (British)">Virgin Islands (British)</option>
<option value="Virgin Islands (USA)">Virgin Islands (USA)</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value=""></option>
</select><label class="FormLabel float" for="billing_addr_country">Country*</label>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_addr_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_country_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="billing_addr_countrysubmit" id="billing_addr_countrysubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_country_row', _display);
this.disable_submit_flag(_hidden);
}
function billing_addr_country_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_addr_country', src);
}
}
var el = document.getElementById('billing_addr_country');
if (el) {
Utils.addEvent(el, 'change', billing_addr_country_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_street1_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="billing_addr_street1name" id="billing_addr_street1name" value="" maxlength="50" tabindex="59"><label for="billing_addr_street1name">Street address*</label><span class="fa fa-times-circle clearx"
aria-hidden="true"></span>
<input type="hidden" name="billing_addr_street1submit" id="billing_addr_street1submit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_street1', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_street1_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_street2_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<input type="text" name="billing_addr_street2name" id="billing_addr_street2name" value="" maxlength="50" tabindex="60"><label for="billing_addr_street2name">Apt./Unit (optional)</label><span class="fa fa-times-circle clearx"
aria-hidden="true"></span>
<input type="hidden" name="billing_addr_street2submit" id="billing_addr_street2submit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_street2', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_street2_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_city_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="billing_addr_cityname" id="billing_addr_cityname" value="" maxlength="50" tabindex="61"><label for="billing_addr_cityname">City/Town*</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="billing_addr_citysubmit" id="billing_addr_citysubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_city', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_city_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_state_row" class="form-row form-selectlist step-2-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<select name="billing_addr_state" id="billing_addr_state" size="1" onchange="fire_obs_comp_event('billing_addr_state', this)" tabindex="62">
<option selected="selected"></option>
<option value="AB">AB - Alberta</option>
<option value="BC">BC - British Columbia</option>
<option value="MB">MB - Manitoba</option>
<option value="NB">NB - New Brunswick</option>
<option value="NL">NL - Newfoundland and Labrador</option>
<option value="NS">NS - Nova Scotia</option>
<option value="NT">NT - Northwest Territories</option>
<option value="NU">NU - Nunavut</option>
<option value="ON">ON - Ontario</option>
<option value="PE">PE - Prince Edward Island</option>
<option value="QC">QC - Quebec</option>
<option value="SK">SK - Saskatchewan</option>
<option value="YT">YT - Yukon</option>
<option value="AK">AK - Alaska</option>
<option value="AL">AL - Alabama</option>
<option value="AR">AR - Arkansas</option>
<option value="AZ">AZ - Arizona</option>
<option value="CA">CA - California</option>
<option value="CO">CO - Colorado</option>
<option value="CT">CT - Connecticut</option>
<option value="DC">DC - District of Columbia</option>
<option value="DE">DE - Delaware</option>
<option value="FL">FL - Florida</option>
<option value="GA">GA - Georgia</option>
<option value="HI">HI - Hawaii</option>
<option value="IA">IA - Iowa</option>
<option value="ID">ID - Idaho</option>
<option value="IL">IL - Illinois</option>
<option value="IN">IN - Indiana</option>
<option value="KS">KS - Kansas</option>
<option value="KY">KY - Kentucky</option>
<option value="LA">LA - Louisiana</option>
<option value="MA">MA - Massachusetts</option>
<option value="MD">MD - Maryland</option>
<option value="ME">ME - Maine</option>
<option value="MI">MI - Michigan</option>
<option value="MN">MN - Minnesota</option>
<option value="MO">MO - Missouri</option>
<option value="MS">MS - Mississippi</option>
<option value="MT">MT - Montana</option>
<option value="NC">NC - North Carolina</option>
<option value="ND">ND - North Dakota</option>
<option value="NE">NE - Nebraska</option>
<option value="NH">NH - New Hampshire</option>
<option value="NJ">NJ - New Jersey</option>
<option value="NM">NM - New Mexico</option>
<option value="NV">NV - Nevada</option>
<option value="NY">NY - New York</option>
<option value="OH">OH - Ohio</option>
<option value="OK">OK - Oklahoma</option>
<option value="OR">OR - Oregon</option>
<option value="PA">PA - Pennsylvania</option>
<option value="RI">RI - Rhode Island</option>
<option value="SC">SC - South Carolina</option>
<option value="SD">SD - South Dakota</option>
<option value="TN">TN - Tennessee</option>
<option value="TX">TX - Texas</option>
<option value="UT">UT - Utah</option>
<option value="VA">VA - Virginia</option>
<option value="VT">VT - Vermont</option>
<option value="WA">WA - Washington</option>
<option value="WI">WI - Wisconsin</option>
<option value="WV">WV - West Virginia</option>
<option value="WY">WY - Wyoming</option>
<option value="AS">AS - American Samoa</option>
<option value="FM">FM - Federated States of Micronesia</option>
<option value="GU">GU - Guam</option>
<option value="MH">MH - Marshall Islands</option>
<option value="MP">MP - Northern Mariana Islands</option>
<option value="PR">PR - Puerto Rico</option>
<option value="PW">PW - Palau</option>
<option value="VI">VI - Virgin Islands</option>
<option value="AA">AA - Armed Forces Americas</option>
<option value="AE">AE - Armed Forces</option>
<option value="AP">AP - Armed Forces Pacific</option>
<option value="None">None</option>
</select><label class="FormLabel" for="billing_addr_state">Province/State*</label>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_addr_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="billing_addr_statesubmit" id="billing_addr_statesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_state_row', _display);
this.disable_submit_flag(_hidden);
}
function billing_addr_state_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_addr_state', src);
}
}
var el = document.getElementById('billing_addr_state');
if (el) {
Utils.addEvent(el, 'change', billing_addr_state_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_zip_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="billing_addr_zipname" id="billing_addr_zipname" value="" maxlength="50" tabindex="63"><label for="billing_addr_zipname">Postal code/ZIP code*</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="billing_addr_zipsubmit" id="billing_addr_zipsubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_zip', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_zip_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="donor_phone_row" class="form-row form-text step-2-group" style="display: none;">
<div class="form-content">
<input type="text" name="donor_phonename" id="donor_phonename" value="" maxlength="50" tabindex="64"><label for="donor_phonename">Phone number (optional)</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="donor_phonesubmit" id="donor_phonesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('donor_phone', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor_phone_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div class="form-row step-2-group" id="step-2-finish" style="display: none;">
<div class="html-caption-container">
<!-- DO NOT REMOVE THIS CODE -->
<div id="step-2-end" class="step-2">
<button class="btn-next-step" type="button" tabindex="65">Continue to payment</button>
</div>
<!-- //closing step-2 -->
</div>
</div>
<div class="form-row step-3-group" id="step-3-begins" style="display: none;">
<div class="html-caption-container">
<!-- DO NOT REMOVE THIS CODE -->
<!-- //opening step-3 -->
<div id="step-3-start" class="step-3">
</div>
</div>
</div>
<div class="clearfix step-3-group" style="display: none;"></div>
<h2 class="section-header-container step-3-group" style="display: none;"><span class="section-title-wrap"> Payment information </span>
<div class="custom-progress-bar">
<span class="complete">✓</span>
<span class="complete">✓</span>
<span class="active">3</span>
<span class="line-connect"></span>
</div>
</h2>
<div class="payment-type-element-container step-3-group" style="display: none;">
<div class="payment-type-selection-container payment-field-container">
<h3>Choose a payment method</h3>
<div id="responsive_payment_typepay_typeradio_row" class="form-row">
<div class="form-content">
<div class="payment-type-selections" id="responsive_payment_typepay_typeradio_payment_types">
<span class="internal-payment"><span class="payment-type-option selected">
<div class="rfl-radio"><input type="radio" name="responsive_payment_typepay_typeradio" id="responsive_payment_typepay_typeradiocredit" value="credit" checked="checked"
onclick="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" onkeypress="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div><label for="responsive_payment_typepay_typeradiocredit"><a href="javascript:void(0);" class="payment-type-label" tabindex="66"><i class="fa-regular fa-credit-card" aria-hidden="true"></i> Credit card</a></label>
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
</script><noscript> </noscript>
</span></span>
<span class="external-payment"><span class="payment-type-option">
<div class="rfl-radio"><input type="radio" name="responsive_payment_typepay_typeradio" id="responsive_payment_typepay_typeradiopaypal" value="paypal" onclick="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);"
onkeypress="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" class="rfl-radio__native-control" tabindex="0">
<div class="rfl-radio__background">
<div class="rfl-radio__outer-circle"></div>
<div class="rfl-radio__inner-circle"></div>
</div>
</div><label for="responsive_payment_typepay_typeradiopaypal"><a href="javascript:void(0);" class="payment-type-label" tabindex="67"><i class="fa-brands fa-paypal" aria-hidden="true"></i> PayPal</a></label>
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
</script><noscript> </noscript>
</span></span>
</div>
<input type="hidden" name="responsive_payment_typepay_typeradiosubmit" id="responsive_payment_typepay_typeradiosubmit" value="true" tabindex="0">
<script type="text/javascript">
Y.use("jquery-ui", function(Y) {
jQuery(function() {
// subscribe observable for payment type options
jQuery('.payment-type-option').each(function() {
var syncAction = function(obj) {
if (obj.hasClass('selected')) {
var radioGroupName = obj.find('input').attr('name');
obj.find('input').prop('checked', true);
fire_obs_comp_event(radioGroupName, obj.find('input').get());
}
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('.payment-type-option').removeClass('selected');
jQuery(this).addClass('selected');
syncAction(jQuery(this));
var selectedValue = jQuery(this).find('input').val();
if (selectedValue == 'paypal' || selectedValue == 'amazon') {
// open up a boxinator dialog
jQuery(document).trigger('redirect-external');
jQuery('#btn_next').click();
}
});
});
});
});
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typepay_typeradio_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
</div>
<div id="payment_cc_container" class="payment-field-container">
<h3>Credit card information</h3>
<div id="responsive_payment_typecc_type_row" class="form-row form-radio-array">
<div class="form-content">
<fieldset>
<legend>We accept</legend>
<ul class="radio-array-list">
<li class="tender-row ">
<img src="../images/content/pagebuilder/visa-credit-card.png" alt="Visa" name="responsive_payment_typecc_type_Visa" id="responsive_payment_typecc_type_Visa">
</li>
<li class="tender-row ">
<img src="../images/content/pagebuilder/mastercard-credit-card.png" alt="American Express" name="responsive_payment_typecc_type_American_Express" id="responsive_payment_typecc_type_American_Express">
</li>
<li class="tender-row ">
<img src="../images/content/pagebuilder/amex-credit-card.png" alt="MasterCard" name="responsive_payment_typecc_type_MasterCard" id="responsive_payment_typecc_type_MasterCard">
</li>
</ul>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_typesubmit" id="responsive_payment_typecc_typesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typecc_type', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_type_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_number_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<i class="fa-regular fa-credit-card" aria-hidden="true"></i><input type="text" name="responsive_payment_typecc_numbername" id="responsive_payment_typecc_numbername" value="" maxlength="22" autocomplete="off" tabindex="68"><label
for="responsive_payment_typecc_numbername">Card number*</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="responsive_payment_typecc_numbersubmit" id="responsive_payment_typecc_numbersubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typecc_number', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_number_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('null', new ComponentDisplayer('responsive_payment_typecc_number'));
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_exp_date_row" class="form-row form-date">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_exp_date_MONTH" class="float">
<span class="label-text">Expiration Date:</span><span class="aural-only">Select month of credit card</span>
</label>
<label for="responsive_payment_typecc_exp_date_YEAR" class="float"><span class="aural-only">Select Expiration Year</span></label>
<div class="date-input-container">
<fieldset class="cardExpGroup">
<select name="responsive_payment_typecc_exp_date_MONTH" id="responsive_payment_typecc_exp_date_MONTH" onchange="fire_obs_comp_event('responsive_payment_typecc_exp_date_MONTH', this)" tabindex="69">
<option value="MM">MM</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<select name="responsive_payment_typecc_exp_date_YEAR" id="responsive_payment_typecc_exp_date_YEAR" onchange="fire_obs_comp_event('responsive_payment_typecc_exp_date_YEAR', this)" tabindex="70">
<option value="YY">YY</option>
<option value="2024" selected="selected">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
<option value="2034">2034</option>
</select>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_exp_date_DAY" id="responsive_payment_typecc_exp_date_DAY" value="1" tabindex="0">
<script type="text/javascript">
<!--
var comp1 = new ObservableComponent('responsive_payment_typecc_exp_date_MONTH', '');
comp1.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag(_hidden);
}
var comp2 = new ObservableComponent('responsive_payment_typecc_exp_date_YEAR', '');
comp2.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script><noscript> </noscript>
</div>
<input type="hidden" name="responsive_payment_typecc_exp_datesubmit" id="responsive_payment_typecc_exp_datesubmit" value="true" tabindex="0">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typecc_exp_date', 'input');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_row', _display);
disable_submit_flag('responsive_payment_typecc_exp_datesubmit', _hidden);
}
comp.disable = function(_disabled) {
disable_element('responsive_payment_typecc_exp_date_MONTH', _disabled);
disable_element('responsive_payment_typecc_exp_date_DAY', _disabled);
disable_element('responsive_payment_typecc_exp_date_YEAR', _disabled);
disable_element('responsive_payment_typecc_exp_date_HOUR12', _disabled);
disable_element('responsive_payment_typecc_exp_date_HOUR24', _disabled); //For UK, 24 hour clock used
disable_element('responsive_payment_typecc_exp_date_MINUTE', _disabled);
disable_element('responsive_payment_typecc_exp_date_AMPM', _disabled);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_cvv_row" class="form-row form-text cvv-input">
<div class="form-content">
<span class="field-required"></span>
<input type="text" name="responsive_payment_typecc_cvvname" id="responsive_payment_typecc_cvvname" value="" maxlength="4" autocomplete="cc-csc" tabindex="71"><label for="responsive_payment_typecc_cvvname">
<span class="FormLabelText">CVV</span>
</label><span class="fa fa-times-circle clearx" aria-hidden="true"></span>
<input type="hidden" name="responsive_payment_typecc_cvvsubmit" id="responsive_payment_typecc_cvvsubmit" value="true" tabindex="0">
<script type="text/javascript">
//chrome is mapping cvv as card name
if (/CriOS/.test(navigator.userAgent) || (/Chrome/.test(navigator.userAgent) && /Google Inc/.test(navigator.vendor))) {
document.getElementById('responsive_payment_typecc_cvvname').autocomplete = 'cc-csc';
}
var comp = new ObservableComponent('responsive_payment_typecc_cvv', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_cvv_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div><a href="SPageServer/?pagename=GEN_CAN_cvv_whatisthis" target="_blank" tabindex="72">What is CVV?</a><i class="far fa-external-link-alt" aria-hidden="true"></i>
</div>
</div>
<div id="payment_check_container" class="payment-field-container" style="display: none;">
<h3>Check Information</h3>
</div>
<input type="hidden" name="responsive_payment_typesubmit" id="responsive_payment_typesubmit" value="true" tabindex="0">
<script type="text/javascript">
function PaymentObserver() {
this.observe = function(_event) {
var sVal = _event.component.get();
switch (sVal) {
case 'check':
hide_element('payment_cc_container');
hide_element('payment_bank_container');
show_element('payment_check_container');
break;
case 'credit':
hide_element('payment_bank_container');
hide_element('payment_check_container');
show_element('payment_cc_container');
break;
case 'ach':
hide_element('payment_cc_container');
hide_element('payment_check_container');
show_element('payment_bank_container');
break;
case 'paypal':
case 'amazon':
case 'mobilepay':
default:
// hide all
hide_element('payment_bank_container');
hide_element('payment_cc_container');
hide_element('payment_check_container');
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Monthly donation - Donate today | Canadian Cancer Society Fr Help 1-800-268-8874 DONATION AMOUNT 1 2 3 Give once Give monthly When you join our monthly giving program, you are joining a community of people who provide unending support to people across the country who are affected by cancer. Field Is Required Enter A Gift Amount: $35/mo $35/month donationOngoing support of $35 a month can help bring breakthroughs from the lab to life to change the lives of people affected by cancer. $50/mo $50/month donationA donation of $50 a month can fuel Canada’s brightest researchers to save and improve lives and make CCS support programs available all year long. $100/mo $100/month donationA donation of $100 can make the greatest impact for those facing cancer by helping Canada’s brightest researchers take their research to the next level and help people live fuller lives with and beyond cancer. Other amount Enter amount $35/month donationOngoing support of $35 a month can help bring breakthroughs from the lab to life to change the lives of people affected by cancer. The selected amount will be applied to your chosen payment method today and on the 31st of each month. Tax receipts for monthly donations will be issued at the beginning of the year for the total amount you have given in the previous calendar year. Additional Amount: Give in memory or honour of someone Give in memory or honour of someone Memory Honour My donation is in* Required Memory Honour None Print Card Ecard Card Type Required Would you like to send someone a card for this gift? Mail card Ecard None EMAIL RECIPIENT INFORMATION CARD RECIPIENT INFORMATION In memory of* In Memory message Choose a message My thoughts are with you at this time Our thoughts are with you at this time With deepest sympathy Our condolences to you and your family Our condolences My condolences Honouring you with a gift from the heart Wishing you the best Thinking of you Select one of the available messages or write your own personalized message to appear in the card. Required Personalized card message* Remaining characters: 200 Sign card as* Recipient name* Recipient street address* Recipient apt./unit (optional) Recipient city/town* Select province/state AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming AS - American Samoa FM - Federated States of Micronesia GU - Guam MH - Marshall Islands MP - Northern Mariana Islands PR - Puerto Rico PW - Palau VI - Virgin Islands AA - Armed Forces Americas AE - Armed Forces AP - Armed Forces Pacific None Recipient province/state* Required Recipient postal code/ZIP code* Canada Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivarian Republic of Venezuela Bonaire, Sint Eustatios and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Democratic People's Republic of Korea The Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Federated States of Micronesia Fiji Finland The Former Yugoslav Republic of Macedonia France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Plurinational State of Bolivia Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles S. Georgia & S. Sandwich Isls. Sierra Leone Singapore Sint Maarten (Dutch) Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States Uruguay USA Minor Outlying Islands Uzbekistan Vanuatu Viet Nam Virgin Islands (British) Virgin Islands (USA) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Recipient country* Required CARD IMAGE Yes, Send an eCard Yes, I would like to send an eCard. Email address* Remaining characters: 200 You can enter multiple recipient email addresses but they must be separated with a comma or a new line. Email subject line* Send dateSelect month of credit card Select Expiration Year Month Day Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2025 2024 CHOOSE A VISUAL 1 2 3 Select an eCard: There was a problem processing your request. Please correct the highlighted problems and try again. Preview There was a problem processing your request. Please correct the highlighted problems and try again. Preview mail card × PREVIEW YOUR CARD FOR OUTSIDE VIEW INSIDE VIEW INSIDE VIEW Dear , A donation has been made to the Canadian Cancer Society to honour the memory of From: Continue to billing BILLING INFORMATION ✓ 2 3 Who is making this donation? A company/organization I am The Canada Revenue Agency requires that the name and address of the donor appear on the donation receipts. First name* Last name* Email address* Canada Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivarian Republic of Venezuela Bonaire, Sint Eustatios and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Democratic People's Republic of Korea The Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Federated States of Micronesia Fiji Finland The Former Yugoslav Republic of Macedonia France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Plurinational State of Bolivia Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles S. Georgia & S. Sandwich Isls. Sierra Leone Singapore Sint Maarten (Dutch) Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States Uruguay USA Minor Outlying Islands Uzbekistan Vanuatu Viet Nam Virgin Islands (British) Virgin Islands (USA) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country* Required Street address* Apt./Unit (optional) City/Town* AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming AS - American Samoa FM - Federated States of Micronesia GU - Guam MH - Marshall Islands MP - Northern Mariana Islands PR - Puerto Rico PW - Palau VI - Virgin Islands AA - Armed Forces Americas AE - Armed Forces AP - Armed Forces Pacific None Province/State* Required Postal code/ZIP code* Phone number (optional) Continue to payment PAYMENT INFORMATION ✓ ✓ 3 CHOOSE A PAYMENT METHOD Credit card PayPal CREDIT CARD INFORMATION We accept * * * Card number* Expiration Date:Select month of credit card Select Expiration Year MM 01 02 03 04 05 06 07 08 09 10 11 12 YY 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 CVV What is CVV? CHECK INFORMATION Donor Processing Fee 2 Yes, I would like to cover the 2% processing fee so that 100% of my donation goes to funding world leading outcomes in prevention, research and support. Monthly donation $35 Transaction fee $0 Subtotal $35 We collect your personal information through forms, by phone or in person to process your donation, issue a tax receipt, and contact you to provide updates about our impact and other ways to support us or give. We may share your personal information with third parties including payment processors, consultants and agency partners within or outside your province or territory or outside Canada to carry out the purposes identified above, or as required by law. Your name may be displayed on your personal fundraising webpage or another participants personal fundraising webpage if you choose this option. We may contact you by mail, email, phone or text. You can exercise your right to access your information or have it corrected, unsubscribe from communications or withdraw your consent by calling 1-888-939-3333 or emailing connect@cancer.ca. For more information about our privacy practices, visit cancer.ca/privacy. 🔒 Donate $35/mo🔒 Donate $35/mo Your monthly support will help fuel the most innovative, impactful and transformative cancer research to save and improve lives. Have questions or need help? Contact us. Terms and conditions - Privacy Policy © 2024 Canadian Cancer Society. All rights reserved. Registered charity: 118829803 RR 0001 × To: Subject: