cparf.salsalabs.org
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Submitted URL: https://default.salsalabs.org/T40c88cce-25ff-4de8-9eac-9ff3ddfcb7c5/dafb0a67-da7d-4687-a83e-d361cfe15410
Effective URL: https://cparf.salsalabs.org/give/index.html?eType=EmailBlastContent&eId=e730918c-927b-4d60-9b5d-d957af1d12aa
Submission: On January 19 via manual from IN — Scanned from DE
Effective URL: https://cparf.salsalabs.org/give/index.html?eType=EmailBlastContent&eId=e730918c-927b-4d60-9b5d-d957af1d12aa
Submission: On January 19 via manual from IN — Scanned from DE
Form analysis 1 forms found in the DOM
<form class="sli-form fv-form fv-form-salsa" data-fv-framework="salsa" novalidate="novalidate" data-ignite-form-id="59af96b8-775d-46cf-b3a7-1f6d519620a6" id="form_igZqluGdcVEH">
<div class="sli-step-navigation-wrapper sli-element" id="id_42c1e527-2e62-469f-b752-21148816c193">
<div class="sli-step-navigation-steps sli-flex-container">
<div class="sli-step-navigation-step sli-flex-item sli-vertical-align-top sli-selected" data-ignite-for-step-id="1" tabindex="0" role="button"> <a class="sli-step-marker">1</a>
<div class="sli-step-label"> <span class="sli-step-check">✓</span>Amount </div>
</div>
<div class="sli-step-navigation-step sli-flex-item sli-vertical-align-top" data-ignite-for-step-id="2" tabindex="0" role="button"> <a class="sli-step-marker">2</a>
<div class="sli-step-label"> <span class="sli-step-check">✓</span>Your Info </div>
</div>
<div class="sli-step-navigation-step sli-flex-item sli-vertical-align-top" data-ignite-for-step-id="3" tabindex="0" role="button"> <a class="sli-step-marker">3</a>
<div class="sli-step-label"> <span class="sli-step-check">✓</span>Payment </div>
</div>
<div class="sli-progress-line"></div>
</div>
</div>
<div class="sli-row" id="id_d5161527-1676-44c2-8ca5-3b7f0ee795fb">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="elementStep" id="id_ebad4ff3-c3e5-42a0-bc25-ded1f5bea712" data-ignite-step-id="1">
<div class="sli-row" id="id_7d850530-33a8-4128-9e24-07e84fe9d15e">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_22ecf250-e6e6-48d4-8aa6-583551eb5fe3">
<div class="sli-element sli-text" id="id_ad00aab3-096d-4f88-8189-f0466e79da65">
<div id="id_ad00aab3-096d-4f88-8189-f0466e79da65_inner">
<h3> Choose Your Gift Amount </h3>
</div>
</div>
</div>
</div>
<div class="sli-row" id="id_e928d5e6-e2f3-4d2c-91ce-258f359c2660">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_0f004903-e8e9-445e-a365-8e1ee93e082a">
<div class="sli-donation-amountblock sli-element sli-align-center-for-small sli-text-center-for-small" id="id_4d924abb-9c67-4750-aed6-490434f2adea" data-ignite-enable-onetime="true" data-ignite-enable-recurring-amounts="true"
data-ignite-field-id="DonationAmount">
<div class="sli-donationAmounts">
<div class="sli-oneTimeDonation" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_oneTime" data-ignite-onetime-amount="data-ignite-onetime-amount">
<ul class="sli-oneTimeDonationAmounts sli-style-button" style="justify-content: center;">
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_25" type="radio" data-ignite-amount="25.00" checked="checked" data-fv-onetimeamount="true"
data-sli-widget="_igZqluGdcVEH" data-fv-row=".sli-oneTimeDonation" data-fv-err-container=".sli-oneTimeDonationError" data-fv-onetimeamount-message="Please select a donation amount, or enter your own amount"
data-fv-field="donationAmtToggle"><label class="sli-oneTimeAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_25_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_25">$25</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_50" type="radio" data-ignite-amount="50.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igZqluGdcVEH"><label class="sli-oneTimeAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_50_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_50">$50</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_75" type="radio" data-ignite-amount="75.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igZqluGdcVEH"><label class="sli-oneTimeAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_75_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_75">$75</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_100" type="radio" data-ignite-amount="100.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igZqluGdcVEH"><label class="sli-oneTimeAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_100_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_100">$100</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_200" type="radio" data-ignite-amount="200.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igZqluGdcVEH"><label class="sli-oneTimeAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_200_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_200">$200</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_500" type="radio" data-ignite-amount="500.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igZqluGdcVEH"><label class="sli-oneTimeAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_500_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_amt_500">$500</label></li>
<li style=" display: block;"><input class="sli-oneTimeAmountRadio sli-oneTimeCustomAmount" name="donationAmtToggleOther" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_custom_radio" type="radio"
data-ignite-custom-onetime="data-ignite-custom-onetime" aria-label="custom one-time donation amount" data-sli-widget="_igZqluGdcVEH">
<div class="sli-input-group"> <label class="sli-oneTimeAmountLabel sli-amount-label sli-customAmount sli-input-group-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_custom_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_custom" autocomplete="off">$</label> <input class="sli-oneTimeAmountInput sli-customAmount sli-input sli-input-group-field sli-small" size="5"
id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_onetime_custom" type="text" placeholder="Other" name="customOneTime" autocomplete="off" data-ignite-custom-onetime-input="donationAmtToggle"
data-fv-row=".sli-oneTimeDonation" data-fv-err-container=".sli-oneTimeDonationError" data-fv-numeric="true" data-fv-numeric-message="Please enter a dollar amount" data-fv-notempty="true"
data-fv-notempty-message="An amount is required" data-fv-greaterthan="true" data-fv-greaterthan-inclusive="false" data-fv-greaterthan-value="0.0" data-fv-greaterthan-message="Please enter a positive amount"
data-fv-field="customOneTime"> </div>
</li>
</ul>
<div class="sli-oneTimeDonationError sli-field-error"><small class="sli-field-error" data-fv-validator="onetimeAmount" data-fv-for="donationAmtToggle" data-fv-result="NOT_VALIDATED" style="display: none;">Please select a donation
amount, or enter your own amount</small><small class="sli-field-error" data-fv-validator="greaterThan" data-fv-for="customOneTime" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a positive amount</small><small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="customOneTime" data-fv-result="NOT_VALIDATED" style="display: none;">An amount is required</small><small class="sli-field-error" data-fv-validator="numeric"
data-fv-for="customOneTime" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a dollar amount</small></div>
</div>
<div class="sli-recurringDonation" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurring" data-ignite-recurring-amount="data-ignite-recurring-amount" style="display:none;">
<p data-ignite-recurrence-frequency="Monthly" class=" sli-recurringFrequency" style="margin: 0;">Donation will repeat monthly.</p>
<ul class="sli-recurringDonationAmounts sli-style-button" style="justify-content: center;">
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_10" type="radio" data-ignite-amount="10.00" data-fv-recurringamount="true"
data-sli-widget="_igZqluGdcVEH" data-fv-row=".sli-recurringDonation" data-fv-err-container=".sli-recurringDonationError" data-fv-recurringamount-message="Please select a donation amount, or enter your own amount"
data-fv-field="donationAmtToggle2"><label class="sli-recurringAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_10_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_10">$10</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_25" type="radio" data-ignite-amount="25.00" checked="checked"
data-fv-field="donationAmtToggle2" data-sli-widget="_igZqluGdcVEH"><label class="sli-recurringAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_25_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_25">$25</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_50" type="radio" data-ignite-amount="50.00" data-fv-field="donationAmtToggle2"
data-sli-widget="_igZqluGdcVEH"><label class="sli-recurringAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_50_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_50">$50</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_75" type="radio" data-ignite-amount="75.00" data-fv-field="donationAmtToggle2"
data-sli-widget="_igZqluGdcVEH"><label class="sli-recurringAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_75_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_75">$75</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_100" type="radio" data-ignite-amount="100.00" data-fv-field="donationAmtToggle2"
data-sli-widget="_igZqluGdcVEH"><label class="sli-recurringAmountLabel sli-amount-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_100_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_100">$100</label></li>
<li style=" display: block;"><input class="sli-recurringAmountRadio sli-recurringCustomAmount" name="donationAmtToggle2Other" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_custom_radio" type="radio"
aria-label="recurring donation custom amount" data-sli-widget="_igZqluGdcVEH">
<div class="sli-input-group"> <label class="sli-recurringAmountLabel sli-amount-label sli-customAmount sli-input-group-label sli-small sli-floating" id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_custom_label"
for="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_custom" autocomplete="off">$</label> <input class="sli-recurringAmountInput sli-customAmount sli-input sli-input-group-field sli-small" size="5"
id="id_4d924abb-9c67-4750-aed6-490434f2adea_owXWlFjkBU_recurringAmt_custom" type="text" placeholder="Other" name="customRecurringAmount" data-fv-row=".sli-recurringDonation" data-fv-err-container=".sli-recurringDonationError"
data-fv-numeric="true" data-fv-numeric-message="Please enter a dollar amount" data-fv-notempty="true" data-fv-notempty-message="An amount is required" data-fv-greaterthan="true" data-fv-greaterthan-inclusive="false"
data-fv-greaterthan-value="0.0" data-fv-greaterthan-message="Please enter a positive amount" autocomplete="off" data-fv-field="customRecurringAmount"> </div>
</li>
</ul>
<div class="sli-recurringDonationError sli-field-error"><small class="sli-field-error" data-fv-validator="recurringAmount" data-fv-for="donationAmtToggle2" data-fv-result="NOT_VALIDATED" style="display: none;">Please select a donation
amount, or enter your own amount</small><small class="sli-field-error" data-fv-validator="greaterThan" data-fv-for="customRecurringAmount" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a positive
amount</small><small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="customRecurringAmount" data-fv-result="NOT_VALIDATED" style="display: none;">An amount is required</small><small class="sli-field-error"
data-fv-validator="numeric" data-fv-for="customRecurringAmount" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a dollar amount</small></div>
</div>
</div>
</div>
<div class="sli-selectRecurring sli-element " id="id_cd9b8f4f-e984-44e2-b68a-9a4aba8924eb_blwvjcPotj" data-ignite-field-id="MakeRecurring"> <label class="sli-label"
for="id_cd9b8f4f-e984-44e2-b68a-9a4aba8924eb_blwvjcPotj_makeRecurring_input"><input class="sli-input" id="id_cd9b8f4f-e984-44e2-b68a-9a4aba8924eb_blwvjcPotj_makeRecurring_input" type="checkbox" name="makeRecurring" value="true"
style="margin-right: 5px;" salsa-reference-name="makerecurringcb">I want to make this a monthly donation.</label> </div>
<div class="sli-donorPaysFees sli-element " id="id_689ad655-f60f-484b-8612-43cc76e3acd0_gsnsFGSLpK" data-ignite-field-id="DonorPaysFees"> <label class="sli-label"
for="id_689ad655-f60f-484b-8612-43cc76e3acd0_gsnsFGSLpK_donorPaysFees_input"><input class="sli-input" id="id_689ad655-f60f-484b-8612-43cc76e3acd0_gsnsFGSLpK_donorPaysFees_input" type="checkbox" name="donorPaysFees" value="true"
style="margin-right: 5px;" salsa-reference-name="donorpaysfeescb">I want to increase my donation slightly to cover processing fees.</label> </div>
</div>
</div>
<div class="sli-row" id="id_7f8c9ff2-afe0-4efb-9c38-40c5ca8e2776">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_98ce4e61-c8ae-49d5-b4e4-e72ec2fda312">
<div class="sli-element sli-button-element" id="id_f652e0a0-e9aa-468a-9694-9c12aeb58ead">
<a class="sli-button sli-floating sli-expand" track="true" data-ignite-button-step="2" data-ignite-skip-validation="false" tabindex="0" role="button">Next</a> </div>
</div>
</div>
</div>
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="elementStep" id="id_7b628f1f-f9b2-4872-a54f-41ad1a9fccfb" style="display: none;" data-ignite-step-id="2">
<div class="sli-element sli-text" id="id_2134e197-0e5c-4085-bc7a-830af5506c94">
<div id="id_2134e197-0e5c-4085-bc7a-830af5506c94_inner">
<p> <strong><span style="font-size:22px">Your Info</span></strong> </p>
</div>
</div>
<div class="sli-row" id="id_c3e120ab-a958-442c-9dac-cc83654a70bb">
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_230baab7-65d8-4d11-bff9-ffa4f409cd18">
<div class="sli-field-person-firstname sli-form-field sli-element" data-ignite-field-id="5d5a2165-f19e-4371-851b-183a6b92402b" id="id_a3e8d4b7-9d70-4af2-a4fb-44c2258c84e5"> <label class="sli-required-true sli-label"
for="id_a3e8d4b7-9d70-4af2-a4fb-44c2258c84e5_input" id="id_a3e8d4b7-9d70-4af2-a4fb-44c2258c84e5_label">First Name*</label> <input class="sli-input sli-input-person-firstname" type="text"
data-ignite-field-id="5d5a2165-f19e-4371-851b-183a6b92402b" name="field-person-firstname" maxlength="36" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 36 characters." id="id_a3e8d4b7-9d70-4af2-a4fb-44c2258c84e5_input" salsa-reference-name="person-firstname" data-fv-field="field-person-firstname"> <small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-person-firstname" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error"
data-fv-validator="stringLength" data-fv-for="field-person-firstname" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_34b45816-5c4f-4e7b-9478-c259bd4c57b1">
<div class="sli-field-person-lastname sli-form-field sli-element" data-ignite-field-id="8d21a878-287a-491f-a362-b8ee2aa71819" id="id_15ce84c2-597b-4b03-a7e3-3a9aed651e1f"> <label class="sli-required-true sli-label"
for="id_15ce84c2-597b-4b03-a7e3-3a9aed651e1f_input" id="id_15ce84c2-597b-4b03-a7e3-3a9aed651e1f_label">Last Name*</label> <input class="sli-input sli-input-person-lastname" type="text"
data-ignite-field-id="8d21a878-287a-491f-a362-b8ee2aa71819" name="field-person-lastname" maxlength="100" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 100 characters." id="id_15ce84c2-597b-4b03-a7e3-3a9aed651e1f_input" salsa-reference-name="person-lastname" data-fv-field="field-person-lastname"> <small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-person-lastname" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error"
data-fv-validator="stringLength" data-fv-for="field-person-lastname" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
</div>
<div class="sli-row" id="id_6dcc3279-2097-4ff4-95d2-ade47b7c9802">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_d33e0b48-812f-4e64-aee4-b07afe4115c8">
<div class="sli-field-address-line1 sli-form-field sli-element" data-ignite-field-id="f775c79a-df41-43fb-96de-ee2360254689" id="id_20f2623c-b04f-4be6-ad4a-809ead537544"> <label class="sli-required-true sli-label"
for="id_20f2623c-b04f-4be6-ad4a-809ead537544_input" id="id_20f2623c-b04f-4be6-ad4a-809ead537544_label">Address, line 1*</label> <input class="sli-input sli-input-address-line1" type="text"
data-ignite-field-id="f775c79a-df41-43fb-96de-ee2360254689" name="field-address-line1" maxlength="128" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 128 characters." id="id_20f2623c-b04f-4be6-ad4a-809ead537544_input" salsa-reference-name="address-line1" data-fv-field="field-address-line1"> <small class="sli-field-error"
data-fv-validator="notEmpty" data-fv-for="field-address-line1" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="stringLength"
data-fv-for="field-address-line1" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
</div>
<div class="sli-row" id="id_565057ce-4f6c-43f6-85ed-b2b25b5a7e6b">
<div class="sli-large-4 sli-medium-4 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_1639ae1c-b533-4172-8108-a51db860ca03">
<div class="sli-field-address-city sli-form-field sli-element" data-ignite-field-id="a102d60f-f8ab-47eb-8ee0-864cfa1fc5b2" id="id_a664e10d-a1e4-44f7-8905-6d7adc1e57d3"> <label class="sli-required-true sli-label"
for="id_a664e10d-a1e4-44f7-8905-6d7adc1e57d3_input" id="id_a664e10d-a1e4-44f7-8905-6d7adc1e57d3_label">City*</label> <input class="sli-input sli-input-address-city" type="text" data-ignite-field-id="a102d60f-f8ab-47eb-8ee0-864cfa1fc5b2"
name="field-address-city" maxlength="64" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 64 characters." id="id_a664e10d-a1e4-44f7-8905-6d7adc1e57d3_input" salsa-reference-name="address-city" data-fv-field="field-address-city"> <small class="sli-field-error"
data-fv-validator="notEmpty" data-fv-for="field-address-city" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="stringLength"
data-fv-for="field-address-city" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-large-4 sli-medium-4 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_c78fdf7c-97fa-4e3e-8d9b-2c4880c29e7f">
<div class="sli-field-address-state sli-form-field sli-element" data-ignite-field-id="3f8b9098-ff2d-4384-bb95-425f113028c0" id="id_c0a72643-0373-4191-aa57-a3f9a5a0d3d6"> <label class="sli-required-true sli-label"
for="id_c0a72643-0373-4191-aa57-a3f9a5a0d3d6_input" id="id_c0a72643-0373-4191-aa57-a3f9a5a0d3d6_label">State*</label> <select class="sli-select-address-state sli-input" name="field-address-state"
data-ignite-field-id="3f8b9098-ff2d-4384-bb95-425f113028c0" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" id="id_c0a72643-0373-4191-aa57-a3f9a5a0d3d6_input"
salsa-reference-name="address-state" data-fv-field="field-address-state">
<option value="" selected="selected"> Choose one...</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="AA">Armed Forces America</option>
<option value="AE">Armed Forces Europe</option>
<option value="AP">Armed Forces Pacific</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-address-state" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small></div>
</div>
<div class="sli-large-4 sli-medium-4 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_150c1081-4855-4cf0-bda3-f81dc526866b">
<div class="sli-field-address-zip sli-form-field sli-element" data-ignite-field-id="44e5ad15-1fdd-4ba8-bf38-f5cbaad023c2" id="id_fca539b0-d627-439f-827a-c28eed788218"> <label class="sli-required-true sli-label"
for="id_fca539b0-d627-439f-827a-c28eed788218_input" id="id_fca539b0-d627-439f-827a-c28eed788218_label">Zip Code*</label> <input class="sli-input sli-input-address-zip" type="text"
data-ignite-field-id="44e5ad15-1fdd-4ba8-bf38-f5cbaad023c2" name="field-address-zip" maxlength="20" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 20 characters." data-fv-zipcode="true" data-fv-zipcode-priority="1" data-fv-zipcode-country="US" data-fv-zipcode-message="This value is not valid as a %s postal code"
data-fv-regexp="true" data-fv-regexp-priority="2" data-fv-regexp-regexp="^(\d{5}|\d{5}-\d{4})?$" data-fv-regexp-message="Zip Code must be formatted as: "55555" or "55555-5555""
id="id_fca539b0-d627-439f-827a-c28eed788218_input" salsa-reference-name="address-zip" data-fv-field="field-address-zip"> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-address-zip"
data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="regexp" data-fv-for="field-address-zip" data-fv-result="NOT_VALIDATED" style="display: none;">Zip
Code must be formatted as: "55555" or "55555-5555"</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="field-address-zip" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not
valid</small><small class="sli-field-error" data-fv-validator="zipCode" data-fv-for="field-address-zip" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid as a %s postal code</small></div>
</div>
</div>
<div class="sli-row" id="id_ae67bf28-f32c-4c20-bfc2-e3d60fe78537">
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_7428fc69-e7c4-4dd1-be76-033736db567d">
<div class="sli-field-contact-email sli-form-field sli-element" data-ignite-field-id="2851b463-606f-40c8-bb3d-d31f399e6896" id="id_d82ee44f-2f51-44ca-8f62-a5e5a6d41b3a"> <label class="sli-required-true sli-label"
for="id_d82ee44f-2f51-44ca-8f62-a5e5a6d41b3a_input" id="id_d82ee44f-2f51-44ca-8f62-a5e5a6d41b3a_label">Email Address*</label> <input class="sli-input sli-input-contact-email" type="email"
data-ignite-field-id="2851b463-606f-40c8-bb3d-d31f399e6896" name="field-contact-email" maxlength="128" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 128 characters." data-fv-regexp="true" data-fv-regexp-regexp="^[^@\s]+@([^@\s]+\.)+[^@\s]+$" data-fv-regexp-message="Please enter a valid email address"
id="id_d82ee44f-2f51-44ca-8f62-a5e5a6d41b3a_input" salsa-reference-name="contact-email" data-fv-field="field-contact-email"> <small class="sli-field-error" data-fv-validator="emailAddress" data-fv-for="field-contact-email"
data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-contact-email" data-fv-result="NOT_VALIDATED"
style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="regexp" data-fv-for="field-contact-email" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a valid email
address</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="field-contact-email" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_14e59ccd-d45e-4777-94d4-9e7763b7a36d">
<div class="sli-field-person-home_phone sli-form-field sli-element" data-ignite-field-id="6e201e0b-8208-453f-b393-a5f0d9059726" id="id_e217d6ff-bd9e-41a7-ad70-2fc292f00a18"> <label class="sli-required-false sli-label"
for="id_e217d6ff-bd9e-41a7-ad70-2fc292f00a18_input" id="id_e217d6ff-bd9e-41a7-ad70-2fc292f00a18_label">Phone</label> <input class="sli-input sli-input-person-home_phone" type="text"
data-ignite-field-id="6e201e0b-8208-453f-b393-a5f0d9059726" name="field-person-home_phone" placeholder="555-555-5555" maxlength="12" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 128 characters." id="id_e217d6ff-bd9e-41a7-ad70-2fc292f00a18_input" salsa-reference-name="person-home_phone" data-fv-field="field-person-home_phone"> <small
class="sli-field-error" data-fv-validator="stringLength" data-fv-for="field-person-home_phone" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
</div>
<div class="sli-row" id="id_472262b8-325d-44c1-98e4-4c60e25b98fd">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_7e4febbf-4a25-491d-ba45-55399f30c53a">
<div class="sli-field-af385b76-bae7-4fba-98a3-ebea45bf57fa sli-form-field sli-element" data-ignite-field-id="af385b76-bae7-4fba-98a3-ebea45bf57fa" id="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb"> <label class="sli-required-false sli-label"
for="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb_input" id="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb_label">Direct my donation to the Remarkable US Disability Tech Accelerator.</label>
<div class="sli-select-radio sli-orientation-horizontal" id="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb_input" salsa-reference-name="scf_remarkable_us_disability_tech_accelerator"> <label class="sli-label"
for="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb_Yes"><input data-ignite-field-id="af385b76-bae7-4fba-98a3-ebea45bf57fa" id="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb_Yes" type="radio" name="field-af385b76-bae7-4fba-98a3-ebea45bf57fa"
value="true"> Yes</label> <label class="sli-label" for="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb_No"><input data-ignite-field-id="af385b76-bae7-4fba-98a3-ebea45bf57fa" id="id_20c0c763-71fa-4bdc-86ea-07d3aecf22bb_No" type="radio"
name="field-af385b76-bae7-4fba-98a3-ebea45bf57fa" value="false" checked="checked"> No</label> </div>
</div>
<div class="sli-donationsummary-dedication sli-columns sli-large-12 sli-select-radio sli-element " id="id_52286eea-3905-4a00-bae9-ca1a43377406_dedication" salsa-reference-name="dedication_type">
<div> <label class="sli-label" for="id_52286eea-3905-4a00-bae9-ca1a43377406_dedication">Donation Dedication</label>
<ul>
<li><input name="dedicationType" id="id_52286eea-3905-4a00-bae9-ca1a43377406_NONE" value="NONE" type="radio" checked="checked">None</li>
<li><input name="dedicationType" id="id_52286eea-3905-4a00-bae9-ca1a43377406_InHonorOf" value="InHonorOf" type="radio">In Honor Of</li>
<li><input name="dedicationType" id="id_52286eea-3905-4a00-bae9-ca1a43377406_InMemoryOf" value="InMemoryOf" type="radio">In Memory Of</li>
</ul> <input class="sli-input" type="text" disabled="" name="dedication" data-fv-row=".sli-donationsummary-dedication" data-fv-nohtml="true" data-fv-nohtml-message="Your input is invalid" maxlength="250" data-fv-stringlength="true"
data-fv-stringlength-message="Please limit your input to less than 250 characters" data-fv-notempty="true" data-fv-notempty-message="Please provide a dedication" data-ignite-field-id="6a921941-0a96-474a-9c1d-f51aa791811b"
salsa-reference-name="donationsummary-dedication" placeholder="Name" data-fv-field="dedication">
<div class="sli-dedicationError"></div>
<style ignite-allow-style="ignite-allow-style">
#id_52286eea-3905-4a00-bae9-ca1a43377406_dedication li {
display: inline;
padding: 8px;
}
#id_52286eea-3905-4a00-bae9-ca1a43377406_dedication input[type=radio] {
margin-right: 4px;
}
#id_52286eea-3905-4a00-bae9-ca1a43377406_dedication ul {
margin: 4px;
padding: 0px;
}
@media screen and (max-width:640px) {
#id_52286eea-3905-4a00-bae9-ca1a43377406_dedication li {
display: block;
padding: 2px 0 0 0;
}
}
</style>
</div> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="dedication" data-fv-result="NOT_VALIDATED" style="display: none;">Please provide a dedication</small><small class="sli-field-error"
data-fv-validator="stringLength" data-fv-for="dedication" data-fv-result="NOT_VALIDATED" style="display: none;">Please limit your input to less than 250 characters</small><small class="sli-field-error" data-fv-validator="nohtml"
data-fv-for="dedication" data-fv-result="NOT_VALIDATED" style="display: none;">Your input is invalid</small>
</div>
<div class="sli-donationsummary-notify sli-element sli-form-field sli-columns sli-large-12 " id="id_541cf6c0-62df-4630-b204-90ac3e9b070d">
<div> <label class="sli-label" for="id_541cf6c0-62df-4630-b204-90ac3e9b070d_notify_input">If you’re making an honorary or memorial gift, please share the name and address of the person you'd like us to notify.</label> <input
class="sli-input" id="id_541cf6c0-62df-4630-b204-90ac3e9b070d_notify_input" type="text" name="field-donationsummary-notify" data-ignite-field-id="4abbf015-7829-4bda-a574-94ac97994229" data-fv-nohtml="true"
data-fv-nohtml-message="Your input is invalid" maxlength="250" data-fv-stringlength="true" data-fv-stringlength-message="Please limit your input to less than 250 characters" salsa-reference-name="donationsummary-notify"
placeholder="Address of Person to be Notified" data-fv-field="field-donationsummary-notify"> </div> <small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="field-donationsummary-notify"
data-fv-result="NOT_VALIDATED" style="display: none;">Please limit your input to less than 250 characters</small><small class="sli-field-error" data-fv-validator="nohtml" data-fv-for="field-donationsummary-notify"
data-fv-result="NOT_VALIDATED" style="display: none;">Your input is invalid</small>
</div>
<div id="id_e15ecffb-d928-4ced-83aa-085cb61755dc"> <label class="sli-label" for="dd-company-name-input">Check to see if your company will match your gift.</label>
<div id="dd-company-name-input" data-doublethedonation-widget-id="G__4">
<div class="dtd-streamlined-plugin"><input type="hidden" name="doubledonation_status" value="no_interaction"><input type="hidden" name="doublethedonation_status" value="no_interaction"><input type="hidden"
name="doublethedonation_entered_text"><input type="hidden" name="doubledonation_company_id"><input type="hidden" name="doublethedonation_company_id"><input type="hidden" name="doubledonation_company_name"><input type="hidden"
name="doublethedonation_company_name">
<div class="dtd-search-box" style="width: 100%; margin-bottom: 0px;">
<div aria-live="assertive" style="display: block; font-size: 0px; color: rgb(255, 255, 255); opacity: 0; position: absolute; height: 0px; margin: 0px; z-index: -99999;"></div>
<div aria-live="polite" style="display: block; font-size: 0px; color: rgb(255, 255, 255); opacity: 0; position: absolute; height: 0px; margin: 0px; z-index: -99999;"></div><input role="listbox" aria-expanded="false"
name="doublethedonation_company_name_input" autocomplete="new-password" type="text" id="dd-input" class="dtd-search-input form-control BBFormTextbox" aria-label="Search company" style="width: 100%;"
placeholder="Search company name...">
</div>
</div>
</div>
</div>
<div class="sli-contact-types sli-element " id="id_14c73c51-5c50-4fd7-8ff6-0a06ebb6c821" data-ignite-field-id="ContactOptIn"> <label class="sli-label"><input class="sli-input sli-contact-type Email" type="checkbox"
id="id_14c73c51-5c50-4fd7-8ff6-0a06ebb6c821_contact_types_input" checked="checked" name="contactOptIn" value="accepted" style="margin-right: 5px;" data-ignite-contact-value="Email" salsa-reference-name="contactoptincb"> I'd like
to receive updates from Cerebral Palsy Alliance Research Foundation.</label>
<div class="sli-contact-type"></div>
</div>
<div class="sli-field-19740e6b-fbc5-4907-9862-4b0bc9b5c111 sli-form-field sli-element" data-ignite-field-id="19740e6b-fbc5-4907-9862-4b0bc9b5c111" id="id_28cd2704-9ba1-49bb-b6ff-63756a7d2e48"> <label class="sli-required-false sli-label"
for="id_28cd2704-9ba1-49bb-b6ff-63756a7d2e48_input" id="id_28cd2704-9ba1-49bb-b6ff-63756a7d2e48_label">What moved you to give today?</label> <select class="sli-select-19740e6b-fbc5-4907-9862-4b0bc9b5c111 sli-input"
name="field-19740e6b-fbc5-4907-9862-4b0bc9b5c111" data-ignite-field-id="19740e6b-fbc5-4907-9862-4b0bc9b5c111" id="id_28cd2704-9ba1-49bb-b6ff-63756a7d2e48_input" salsa-reference-name="scf_what_moved_you_to_give_today_">
<option value="I want to support Remarkable US and disability tech.">I want to support Remarkable US and disability tech.</option>
<option value="I have cerebral palsy.">I have cerebral palsy.</option>
<option value="I support cerebral palsy research.">I support cerebral palsy research.</option>
<option value="Make a selection" selected="selected">Make a selection</option>
<option value="One of my friends or family members has cerebral palsy.">One of my friends or family members has cerebral palsy.</option>
</select> </div>
<div class="sli-element sli-text" id="id_ce112601-c683-41a1-a4a0-cfb4af266ae7">
<div id="id_ce112601-c683-41a1-a4a0-cfb4af266ae7_inner">
<p style="text-align:center"> <span style="color:#808080"><em><span style="font-size:12px">Privacy is our priority. We will never share your email address with a third party.</span></em></span> </p>
</div>
</div>
</div>
</div>
<div class="sli-row" id="id_ad30ee8c-511e-4847-a3b3-523e52fa081b">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_18970c6e-8d5b-4139-9a64-15fb47210139">
<div class="sli-element sli-button-element" id="id_204bc87f-c854-48ff-9fd8-1b629f5261a2">
<a class="sli-button sli-floating sli-expand" track="true" data-ignite-button-step="3" data-ignite-skip-validation="false" tabindex="0" role="button">Next</a> </div>
<div class="sli-element sli-button-element" id="id_93ea8c5b-a378-4579-98dd-57f39eb4af6b">
<a class="sli-button sli-floating sli-small" track="true" data-ignite-button-step="1" data-ignite-skip-validation="true" style="color:rgb(150,150,150);background-color:rgb(209,209,209);" tabindex="0" role="button"><< Back</a> </div>
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<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="elementStep" id="id_a9ee34ef-af97-4c25-9971-6dbd99e1e432" style="display: none;" data-ignite-step-id="3">
<div class="sli-row" id="id_296e0707-4720-46bc-8ec7-bb0e19d04090">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_d67d2143-bbca-4e06-a12e-43237a4905b8">
<div class="sli-element sli-text" id="id_64d6c0f1-a823-4f73-83bb-1ea78ee332f4">
<div id="id_64d6c0f1-a823-4f73-83bb-1ea78ee332f4_inner">
<p> <span style="font-size:22px"><strong>Payment Info</strong></span> </p>
</div>
</div>
<div class="sli-donation-paymentblock sli-element" id="id_52f76e78-66bb-40bb-a978-9931424c2675">
<div class="sli-paymentType" id="id_52f76e78-66bb-40bb-a978-9931424c2675_paymentType" style="display: block;">
<div class="sli-ccType sli-label" for="payment_type"> Payment Type: </div>
<div style="display:inline-block;"> <input name="payment_type" type="radio" value="CREDIT_CARD" checked="checked" id="vCJHulowHB"> <label class="sli-label" for="vCJHulowHB">Credit Card</label> </div>
<div style="display:inline-block;"> <input name="payment_type" sli-payment-type="ACH" style="" type="radio" value="ACH" id="JNtQpJYGku"> <label class="sli-label" style="" sli-payment-type="ACH" for="JNtQpJYGku">eCheck</label> </div>
<div style="display:inline-block;"> <input name="payment_type" sli-payment-type="PAYPAL" style="" type="radio" value="PAYPAL" id="ukTLydFiwN"> <label class="sli-label" style="" sli-payment-type="PAYPAL" for="ukTLydFiwN">PayPal</label>
</div>
</div>
<div id="id_52f76e78-66bb-40bb-a978-9931424c2675_echeck_wepay" data-ignite-echeck-wepay="ignite-echeck-wepay"> <label class="sli-ccLabel sli-label" for="OmLvPwuHsB">Bank Account*</label>
<div class="sli-row">
<div class="sli-columns sli-medium-4 sli-large-4 sli-end sli-form-field"></div> <input class="sli-ccInput sli-input" type="text" id="OmLvPwuHsB" data-fv-field="wepay_bank" data-fv-notempty-message="Bank Account is required"
readonly="readonly" required="required" name="wepay_bank">
<div class="sli-columns sli-large-8 sli-medium-8"> <input class="sli-button" id="id_52f76e78-66bb-40bb-a978-9931424c2675_bankSelect" type="button" value="Select a Bank Account" name="bank-popup"> <small
class="sli-field-error sli-wepay-error" style="display: none;"></small> </div> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="wepay_bank" data-fv-result="NOT_VALIDATED" style="display: none;">Bank Account
is required</small>
</div>
</div>
<div id="id_52f76e78-66bb-40bb-a978-9931424c2675_echeck" data-ignite-echeck="ignite-echeck">
<div class="sli-row">
<div class="sli-columns sli-medium-8 sli-large-8 sli-small-12 sli-end sli-form-field"> <label class="sli-ccLabel sli-label" for="uDgHltOMKi">Name on Account*</label> <input class="sli-ccInput sli-input" type="text" name="holder_name"
id="uDgHltOMKi" required="required" data-fv-notempty="true" data-fv-notemtpy-message="Please enter the holder name" pattern="^.+\s+.*$" data-fv-regexp-message="Holder name must have at least 2 parts" data-fv-field="holder_name">
<small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="holder_name" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="regexp"
data-fv-for="holder_name" data-fv-result="NOT_VALIDATED" style="display: none;">Holder name must have at least 2 parts</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-8 sli-medium-8 sli-form-field"> <label class="sli-ccLabel sli-label" for="lNquhTLofS">Bank Routing Number*</label> <input class="sli-ccInput sli-input" type="text" name="bank_routing" id="lNquhTLofS"
required="required" maxlength="9" dava-fv-field="bank_routing" data-fv-notempty="true" data-fv-notemtpy-message="Bank Routing Number is required" data-fv-stringlength="true" data-fv-stringlength-min="9"
data-fv-stringlength-max="9" data-fv-stringlength-message="Bank Routing Number must be 9 characters long" data-fv-digits="true" data-fv-digits-message="Please enter only digits" data-fv-field="bank_routing"> <small
class="sli-field-error" data-fv-validator="digits" data-fv-for="bank_routing" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter only digits</small><small class="sli-field-error" data-fv-validator="notEmpty"
data-fv-for="bank_routing" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="bank_routing"
data-fv-result="NOT_VALIDATED" style="display: none;">Bank Routing Number must be 9 characters long</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-8 sli-medium-8 sli-form-field"> <label class="sli-ccLabel sli-label" for="tTOuNyGgyn">Bank Account Number*</label> <input class="sli-bankAccount sli-ccInput sli-input" type="text" name="bank_account"
id="tTOuNyGgyn" required="required" maxlength="17" dava-fv-field="bank_account" data-fv-notempty="true" data-fv-notemtpy-message="Bank Account Number is required" data-fv-stringlength="true" data-fv-stringlength-min="4"
data-fv-stringlength-max="17" data-fv-stringlength-message="Bank Account Number must be from 4 to 17 characters long" data-fv-digits="true" data-fv-digits-message="Please enter only digits" data-fv-field="bank_account"> <small
class="sli-field-error" data-fv-validator="digits" data-fv-for="bank_account" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter only digits</small><small class="sli-field-error" data-fv-validator="notEmpty"
data-fv-for="bank_account" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="bank_account"
data-fv-result="NOT_VALIDATED" style="display: none;">Bank Account Number must be from 4 to 17 characters long</small></div>
</div>
</div>
<div id="id_52f76e78-66bb-40bb-a978-9931424c2675_cc" data-ignite-cc="ignite-cc">
<ul class="sli-cards">
<li class="sli-visa off" style=""></li>
<li class="sli-mastercard off" style=""></li>
<li class="sli-discover off" style=""></li>
<li class="sli-amex off" style=""></li>
</ul>
<div class="sli-row">
<div class="sli-columns sli-large-8 sli-medium-8 sli-form-field"> <label class="sli-ccLabel sli-label" for="rflUnaRsTg">Card Number*</label> <input class="sli-ccInput sli-input" name="card_number" id="rflUnaRsTg" type="text"
required="required" data-fv-notempty-message="A credit card number is required" maxlength="16" autocomplete="off" data-fv-creditcard="true" data-fv-creditcard-message="Please enter a valid credit card number"
data-fv-field="card_number"> <small class="sli-field-error" data-fv-validator="creditCard" data-fv-for="card_number" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a valid credit card number</small><small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="card_number" data-fv-result="NOT_VALIDATED" style="display: none;">A credit card number is required</small><small class="sli-field-error"
data-fv-validator="stringLength" data-fv-for="card_number" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
<div class="sli-columns sli-large-4 sli-medium-4 sli-end sli-form-field"> <label class="sli-ccExpCcvLabel sli-label" for="ODedkFdtXw">Security Code*</label> <input class="sli-ccExpCcvInput sli-input" name="cvv" id="ODedkFdtXw"
type="text" required="required" data-fv-notempty-message="CVV/CCV is required" maxlength="4" size="4" autocomplete="off" data-fv-cvv="true" data-fv-cvv_ccfield="card_number" data-dv-cvv-message="Your CVV is invalid"
data-fv-field="cvv"> <small class="sli-field-error" data-fv-validator="cvv" data-fv-for="cvv" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error"
data-fv-validator="notEmpty" data-fv-for="cvv" data-fv-result="NOT_VALIDATED" style="display: none;">CVV/CCV is required</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="cvv"
data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-6 sli-medium-6 sli-form-field"> <label class="sli-ccExpMonthLabel sli-label" for="TLmhHVfXdz">Expiration Month*</label> <select class="sli-ccInput sli-input" name="expiry_month" id="TLmhHVfXdz"
required="required" data-fv-notempty-message="Month is required" style="display: block;" data-fv-field="expiry_month">
<option value="" selected="selected">MM</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="expiry_month" data-fv-result="NOT_VALIDATED" style="display: none;">Month is required</small></div>
<div class="sli-columns sli-large-6 sli-medium-6 sli-end sli-form-field"> <label class="sli-ccExpMonthLabel sli-label" for="WvgeyIrdrr">Expiration Year*</label> <select class="sli-ccInput sli-input" name="expiry_year" id="WvgeyIrdrr"
required="required" data-fv-notempty-message="Year is required" style="display: block;" data-fv-field="expiry_year">
<option value="" selected="">YYYY</option>
<option value="23">2023</option>
<option value="24">2024</option>
<option value="25">2025</option>
<option value="26">2026</option>
<option value="27">2027</option>
<option value="28">2028</option>
<option value="29">2029</option>
<option value="30">2030</option>
<option value="31">2031</option>
<option value="32">2032</option>
<option value="33">2033</option>
<option value="34">2034</option>
<option value="35">2035</option>
<option value="36">2036</option>
<option value="37">2037</option>
<option value="38">2038</option>
<option value="39">2039</option>
<option value="40">2040</option>
<option value="41">2041</option>
<option value="42">2042</option>
</select> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="expiry_year" data-fv-result="NOT_VALIDATED" style="display: none;">Year is required</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-12 sli-small-12 sli-end sli-form-field"> <label class="sli-ccNameLabel sli-label" for="HvhPmhuOjN">Name on Card*</label> <input class="sli-ccNameInput sli-input" name="name_on_card" id="HvhPmhuOjN"
type="text" autocomplete="off" required="required" data-fv-callback="true" data-fv-callback-callback="validateCCName" data-fv-field="name_on_card"> <small class="sli-field-error" data-fv-validator="callback"
data-fv-for="name_on_card" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="name_on_card" data-fv-result="NOT_VALIDATED"
style="display: none;">This value is not valid</small></div>
</div>
</div>
</div>
</div>
</div>
<div class="sli-row" id="id_8b581867-be0d-4fff-beee-690d94dbf1e7">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns sli-end " data-ignite-container-type="DEFAULT" id="id_edd1664b-e73d-4125-b408-32735cdf5996">
<div class="sli-element sli-button-element" id="id_15b757c9-c65a-4d70-be67-95d0073942e6">
<a class="sli-button sli-floating sli-expand" track="true" data-ignite-submit-button="data-ignite-submit-button" tabindex="0" role="button">Donate Now</a>
<div class="sli-processing" style="display:none;"></div>
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<div class="sli-element sli-button-element" id="id_f2d0f228-0ef3-49c7-b4f1-ea90d9e3dae0">
<a class="sli-button sli-floating sli-small" track="true" data-ignite-button-step="2" data-ignite-skip-validation="true" style="color:rgb(150,150,150);background-color:rgb(210,210,210);" tabindex="0" role="button"><< Back</a> </div>
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</form>Text Content
Loading.... Cerebral Palsy Alliance Research Foundation funds US-based research to change what’s possible for people with cerebral palsy, implements proven science, and advances innovation to benefit all people with disabilities around the world. Help us move our mission forward. 1 ✓Amount 2 ✓Your Info 3 ✓Payment CHOOSE YOUR GIFT AMOUNT * $25 * $50 * $75 * $100 * $200 * $500 * $ Please select a donation amount, or enter your own amountPlease enter a positive amountAn amount is requiredPlease enter a dollar amount Donation will repeat monthly. * $10 * $25 * $50 * $75 * $100 * $ Please select a donation amount, or enter your own amountPlease enter a positive amountAn amount is requiredPlease enter a dollar amount I want to make this a monthly donation. I want to increase my donation slightly to cover processing fees. Next Your Info First Name* This field requires a valueThis value is not valid Last Name* This field requires a valueThis value is not valid Address, line 1* This field requires a valueThis value is not valid City* This field requires a valueThis value is not valid State* Choose one...AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces AmericaArmed Forces EuropeArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUnited States Minor Outlying IslandsUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming This field requires a value Zip Code* This field requires a valueZip Code must be formatted as: "55555" or "55555-5555"This value is not validThis value is not valid as a %s postal code Email Address* This value is not validThis field requires a valuePlease enter a valid email addressThis value is not valid Phone This value is not valid Direct my donation to the Remarkable US Disability Tech Accelerator. Yes No Donation Dedication * None * In Honor Of * In Memory Of Please provide a dedicationPlease limit your input to less than 250 charactersYour input is invalid If you’re making an honorary or memorial gift, please share the name and address of the person you'd like us to notify. Please limit your input to less than 250 charactersYour input is invalid Check to see if your company will match your gift. I'd like to receive updates from Cerebral Palsy Alliance Research Foundation. What moved you to give today? I want to support Remarkable US and disability tech.I have cerebral palsy.I support cerebral palsy research.Make a selectionOne of my friends or family members has cerebral palsy. Privacy is our priority. We will never share your email address with a third party. Next << Back Payment Info Payment Type: Credit Card eCheck PayPal Bank Account* Bank Account is required Name on Account* This value is not validHolder name must have at least 2 parts Bank Routing Number* Please enter only digitsThis value is not validBank Routing Number must be 9 characters long Bank Account Number* Please enter only digitsThis value is not validBank Account Number must be from 4 to 17 characters long * * * * Card Number* Please enter a valid credit card numberA credit card number is requiredThis value is not valid Security Code* This value is not validCVV/CCV is requiredThis value is not valid Expiration Month* MM010203040506070809101112 Month is required Expiration Year* YYYY20232024202520262027202820292030203120322033203420352036203720382039204020412042 Year is required Name on Card* This value is not validThis value is not valid Donate Now << Back Please review before submitting your payment. Item Charge Registrations $0.00 Purchases $0.00 Donation $25.00 Fees NONE Total $25.00 MAKE A GIFT BY MAIL If you’d prefer to mail your gift, please send your check to: Cerebral Palsy Alliance Research Foundation Attn: James Renard 142 West 57th Street, Floor 11 New York, NY 10019 DONATE VIA APPRECIATED SECURITIES You can give a gift of stock or mutual funds. By using appreciated securities to fulfill your contribution, you may be able to receive tax benefits. For more information, including transfer instructions, please get in touch with us at info@cparf.org. DOUBLE YOUR IMPACT You can increase the impact of your donation with a matching gift. Check to see if your company or your spouse’s offers a match. TAX SUBSTANTIATION A tax statement will be issued to you at the end of the calendar year for all qualifying payments of $250 or more. If you have any questions or need a statement before then, please get in touch. Contact Us info@cparf.org | 646.340.1208 Thank You For Your Donation! Does your employer match charitable donations? Cerebral Palsy Alliance Research Foundation (CPARF) thanks you for checking to see if you can double your impact through your workplace. If your company matches donations, that means your gift will go twice as far to support cerebral palsy research and disability innovation. * In-depth chronic pain studies and the discovery of non-opioid treatment alternatives. * Exploring ethically sourced and engineered stem cells to repair brain damage. * Thought-to-speech technology that unlocks the ability to communicate for millions of people with CP and other disabilities like ALS and Parkinson’s Disease. With your generosity and our reach, we’ll make a difference for people living with CP — and for future generations as we work toward prevention and a cure. See if your employer will match your donation Let's Check All information provided by Double the Donation Facebook Twitter Pinterest LinkedIn Tumblr Contact Us info@cparf.org | 646.340.1208