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Submitted URL: https://click.e.doctorswithoutborders.org/?qs=183e52e2081ccf5995fd486ce1ef743b51320ae96046963160345f08f27dfc0092334b9b4830826885487463f573...
Effective URL: https://donate.doctorswithoutborders.org/secure/monthly?source=ADC2401U1D10&utm_source=SFMC&utm_medium=email&utm_campaign=2024-01-04-On-T...
Submission: On January 04 via api from US — Scanned from DE
Effective URL: https://donate.doctorswithoutborders.org/secure/monthly?source=ADC2401U1D10&utm_source=SFMC&utm_medium=email&utm_campaign=2024-01-04-On-T...
Submission: On January 04 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /secure/monthly?source=ADC2401U1D10&utm_campaign=2024-01-04-On-The-Ground-Thank-You-Lapsed-E2&utm_medium=email&utm_source=SFMC
<form
class="webform-client-form form-layouts one-column fundraiser-donation-form jquery-once-4-processed title-select-processed jquery-once-5-processed jquery-once-6-processed jquery-once-7-processed phone-mask-processed revenue-chart-processed modal-preview-processed tooltips-processed jquery-once-8-processed ecard-sender-processed premium-processed eft-disclaimer-processed eft-state-link-processed tribute-multiple-processed recipient-name-processed opt-in-disclaimer-processed multistep-processing-processed donation-messages-processed jquery-once-11-processed donation-interactions-processed modal-country-processed jquery-once-13-processed"
enctype="multipart/form-data" action="/secure/monthly?source=ADC2401U1D10&utm_campaign=2024-01-04-On-The-Ground-Thank-You-Lapsed-E2&utm_medium=email&utm_source=SFMC" method="post" id="webform-client-form-2215" accept-charset="UTF-8"
novalidate="novalidate">
<div class="step-group fieldset-step active" id="step-1">
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation">
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-markup control-group" id="webform-component-donation--form-description">
<p><strong>Doctors Without Borders/Médecins Sans Frontières (MSF) is on the ground in over 70 countries—providing urgently needed humanitarian aid in moments of crisis and conflict. Make a gift today to help us continue providing medical
aid where it is needed most.</strong><br><br>Your 100 percent tax-deductible gift helps MSF respond quickly to emergencies in places like Ukraine, Haiti, Yemen, and beyond.<br><br>For MSF, the ability to respond quickly to medical
humanitarian emergencies is crucial to saving more lives. Unrestricted funds allow us to allocate our resources most efficiently and where the needs are greatest.</p>
</div>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--1-amount">
<legend><span class="fieldset-legend">1. Amount</span></legend>
<div class="fieldset-wrapper"></div>
</fieldset>
<div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--recurs-monthly">
<div id="edit-submitted-donation-recurs-monthly">
<div class="form-item form-type-radio form-item-submitted-donation-recurs-monthly control-group">
<input type="radio" id="edit-submitted-donation-recurs-monthly-1" name="submitted[donation][recurs_monthly]" value="NO_RECURR"> <label class="option" for="edit-submitted-donation-recurs-monthly-1">One-time </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-recurs-monthly control-group">
<input type="radio" id="edit-submitted-donation-recurs-monthly-2" name="submitted[donation][recurs_monthly]" value="recurs" checked="checked"> <label class="option" for="edit-submitted-donation-recurs-monthly-2">Monthly </label>
<div class="description">Increase the impact of your gift. Make it monthly.</div>
</div>
</div>
</div>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--increase-the-impact-of-your-gift-make-it-monthly">
<div class="fieldset-wrapper"></div>
</fieldset>
<div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--amount" style="display: none;">
<label for="edit-submitted-donation-amount">Please select your tax-deductible gift amount below </label>
<div id="edit-submitted-donation-amount" class="odd">
<div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
<input type="radio" id="edit-submitted-donation-amount-1" name="submitted[donation][amount]" value="50"> <label class="option" for="edit-submitted-donation-amount-1">$50 </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
<input type="radio" id="edit-submitted-donation-amount-2" name="submitted[donation][amount]" value="100"> <label class="option" for="edit-submitted-donation-amount-2">$100 </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
<input type="radio" id="edit-submitted-donation-amount-3" name="submitted[donation][amount]" value="250" checked="checked"> <label class="option" for="edit-submitted-donation-amount-3">$250 </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
<input type="radio" id="edit-submitted-donation-amount-4" name="submitted[donation][amount]" value="500"> <label class="option" for="edit-submitted-donation-amount-4">$500 </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
<input type="radio" id="edit-submitted-donation-amount-5" name="submitted[donation][amount]" value="1000"> <label class="option" for="edit-submitted-donation-amount-5">$1,000 </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-amount control-group other">
<input type="radio" id="edit-submitted-donation-amount-6" name="submitted[donation][amount]" value="other"> <label class="option" for="edit-submitted-donation-amount-6">Other </label>
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donation--other-amount" style="display: none;">
<label for="edit-submitted-donation-other-amount">Other </label>
<div class="field-prefix">$</div><input class="input-medium form-text other-field" type="text" id="edit-submitted-donation-other-amount" name="submitted[donation][other_amount]" value="" size="10" maxlength="128" placeholder="Other">
<div class="description">Minimum payment $5.00.</div>
</div>
</div>
</div>
<div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--recurring-amount">
<label for="edit-submitted-donation-recurring-amount">Please select your tax-deductible gift amount below <span class="form-required">*</span></label>
<div id="edit-submitted-donation-recurring-amount" class="odd">
<div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
<input type="radio" id="edit-submitted-donation-recurring-amount-1" name="submitted[donation][recurring_amount]" value="10"> <label class="option" for="edit-submitted-donation-recurring-amount-1">$10 <span
class="form-required">*</span></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
<input type="radio" id="edit-submitted-donation-recurring-amount-2" name="submitted[donation][recurring_amount]" value="15"> <label class="option" for="edit-submitted-donation-recurring-amount-2">$15 <span
class="form-required">*</span></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
<input type="radio" id="edit-submitted-donation-recurring-amount-3" name="submitted[donation][recurring_amount]" value="30" checked="checked"> <label class="option" for="edit-submitted-donation-recurring-amount-3">$30 <span
class="form-required">*</span></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
<input type="radio" id="edit-submitted-donation-recurring-amount-4" name="submitted[donation][recurring_amount]" value="60"> <label class="option" for="edit-submitted-donation-recurring-amount-4">$60 <span
class="form-required">*</span></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
<input type="radio" id="edit-submitted-donation-recurring-amount-5" name="submitted[donation][recurring_amount]" value="90"> <label class="option" for="edit-submitted-donation-recurring-amount-5">$90 <span
class="form-required">*</span></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group other">
<input type="radio" id="edit-submitted-donation-recurring-amount-6" name="submitted[donation][recurring_amount]" value="other"> <label class="option" for="edit-submitted-donation-recurring-amount-6">Other <span
class="form-required">*</span></label>
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donation--recurring-other-amount">
<label for="edit-submitted-donation-recurring-other-amount">Other </label>
<div class="field-prefix">$</div><input class="input-medium form-text other-field" type="text" id="edit-submitted-donation-recurring-other-amount" name="submitted[donation][recurring_other_amount]" value="" size="10" maxlength="128"
placeholder="Other">
<div class="description">Minimum payment $10.00.</div>
</div>
</div>
</div>
</div>
<fieldset class="webform-component-fieldset form-wrapper element-invisible" id="webform-component-donation--tribute-section">
<div class="fieldset-wrapper">
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--tribute-section--tribute-information">
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-checkboxes control-group" id="webform-component-donation--tribute-section--tribute-information--tribute-memorial">
<div id="edit-submitted-donation-tribute-section-tribute-information-tribute-memorial">
<div class="form-item form-type-checkbox form-item-submitted-donation-tribute-section-tribute-information-tribute-memorial-1 control-group">
<input type="checkbox" id="edit-submitted-donation-tribute-section-tribute-information-tribute-memorial-1" name="submitted[donation][tribute_section][tribute_information][tribute_memorial][1]" value="1" class="form-checkbox">
<label class="option" for="edit-submitted-donation-tribute-section-tribute-information-tribute-memorial-1">Give in tribute or honor of someone </label>
</div>
</div>
</div>
<fieldset class="webform-component-fieldset form-wrapper wrapper--tribute-fields" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper">
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-markup control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--send-a-tribute-gift-card">
<h3>Send a Tribute Gift Card</h3>
<p>Send a complimentary acknowledgment with your gift to MSF made in honor or in memory of someone dear.</p>
</div>
<div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--tribute-card-type">
<div id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type">
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type control-group">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type-1" name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][tribute_card_type]"
value="Email"> <label class="option" for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type-1">Send an Ecard </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type control-group">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type-2" name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][tribute_card_type]"
value="Postal Mail"> <label class="option" for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type-2">Send a Letter by Mail </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type control-group">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type-3" name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][tribute_card_type]"
value="Do Not Notify"> <label class="option" for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-tribute-card-type-3">Don't Send a Notification </label>
</div>
</div>
</div>
<fieldset class="webform-component-fieldset form-wrapper wrapper--ecard-tribute" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute" style="display: none;">
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--ecard-image">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image">Select an eCard design </label>
<div id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image">
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image control-group image-option">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-1"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][ecard_image]" value="1" checked="checked"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-1" data-url="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard1.jpg "><span>1</span><img
src="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard1.jpg " alt="eCard image 1"></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image control-group image-option">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-2"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][ecard_image]" value="2"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-2" data-url="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard2.jpg "><span>2</span><img
src="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard2.jpg " alt="eCard image 2"></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image control-group image-option">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-3"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][ecard_image]" value="3"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-3" data-url="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard3.jpg "><span>3</span><img
src="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard3.jpg " alt="eCard image 3"></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image control-group image-option">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-4"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][ecard_image]" value="4"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-4" data-url="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard4.jpg "><span>4</span><img
src="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard4.jpg " alt="eCard image 4"></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image control-group image-option">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-5"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][ecard_image]" value="5"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-5" data-url="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard5.jpg "><span>5</span><img
src="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard5.jpg " alt="eCard image 5"></label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image control-group image-option">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-6"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][ecard_image]" value="6"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-ecard-image-6" data-url="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard6.jpg "><span>6</span><img
src="https://msfusa.gospringboard.com/files/msfusa/MSF_Ecard6.jpg " alt="eCard image 6"></label>
</div>
</div>
</div>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details">
<legend><span class="fieldset-legend">Honoree Details</span></legend>
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--tribute-type">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type">Choose the type of honoree to customize the card’s message. </label>
<div id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type">
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type control-group">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type-1"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][tribute_type]" value="Honor"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type-1">A gift in someone's honor </label>
</div>
<div class="form-item form-type-radio form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type control-group">
<input type="radio" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type-2"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][tribute_type]" value="Memorial"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-tribute-type-2">A gift in someone's memory </label>
</div>
</div>
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--honoree-first-name">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-first-name">Honoree First Name </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-first-name"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][honoree_first_name]" value="" size="60" maxlength="64" class="form-text">
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--honoree-last-name">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-last-name">Honoree Last Name </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-last-name"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][honoree_last_name]" value="" size="60" maxlength="64" class="form-text">
</div>
<div class="form-item webform-component webform-component-checkboxes control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--honoree-additional">
<div id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-additional">
<div class="form-item form-type-checkbox form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-additional-1 control-group">
<input type="checkbox" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-additional-1"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][honoree_additional][1]" value="1" class="form-checkbox"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-honoree-additional-1">Add another honoree </label>
</div>
</div>
</div>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--add-another-honoree">
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--add-another-honoree--honoree-first-name-2">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-add-another-honoree-honoree-first-name-2">2nd Honoree First Name </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-add-another-honoree-honoree-first-name-2"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][add_another_honoree][honoree_first_name_2]" value="" size="60" maxlength="64" class="form-text">
</div>
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--add-another-honoree--honoree-last-name-2">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-add-another-honoree-honoree-last-name-2">2nd Honoree Last Name </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-add-another-honoree-honoree-last-name-2"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][add_another_honoree][honoree_last_name_2]" value="" size="60" maxlength="64" class="form-text">
</div>
</div>
</fieldset>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--ecard-sender-information">
<legend><span class="fieldset-legend">Who is this gift coming from?</span></legend>
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-checkboxes control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--ecard-sender-information--sender-anonymous">
<div id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-sender-information-sender-anonymous">
<div class="form-item form-type-checkbox form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-sender-information-sender-anonymous-1 control-group">
<input type="checkbox" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-sender-information-sender-anonymous-1"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][ecard_sender_information][sender_anonymous][1]" value="1" class="form-checkbox"> <label
class="option" for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-sender-information-sender-anonymous-1">I prefer to be anonymous. Do not include
my name on the card. </label>
</div>
</div>
</div>
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--ecard-sender-information--ecard-sender-names">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-sender-information-ecard-sender-names">Sender's name(s) </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-sender-information-ecard-sender-names"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][ecard_sender_information][ecard_sender_names]" value="" size="60" maxlength="75" class="form-text">
</div>
</div>
</fieldset>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information">
<legend><span class="fieldset-legend">Who should we send the card to?</span></legend>
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-first-name">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-first-name">Recipient First Name </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-first-name"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_first_name]" value="" size="60" maxlength="64" class="form-text">
</div>
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-last-name">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-last-name">Recipient Last Name </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-last-name"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_last_name]" value="" size="60" maxlength="64" class="form-text">
</div>
<div class="form-item webform-component webform-component-email control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-email-address">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-email-address">Recipient e-mail address </label>
<input class="email form-text form-email" type="email" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-email-address"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_email_address]" size="60">
</div>
<fieldset class="webform-component-fieldset form-wrapper"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-mailing">
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-mailing--recipient-address">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-address">Billing Address </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-address"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_mailing][recipient_address]" value="" size="60"
maxlength="100" class="form-text">
</div>
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-mailing--recipient-address-2">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-address-2">Billing Address Line 2 </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-address-2"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_mailing][recipient_address_2]" value="" size="60"
maxlength="75" class="form-text">
</div>
<div class="form-item webform-component webform-component-select control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-mailing--recipient-country">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-country">Country </label>
<div class="select-wrapper"><select id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-country"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_mailing][recipient_country]" class="form-select"
placeholder="">
<option value="" selected="selected">- None -</option>
<option value="AF">Afghanistan</option>
<option value="AX">Aland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="BQ">Caribbean Netherlands</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo (Brazzaville)</option>
<option value="CD">Congo (Kinshasa)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong S.A.R., China</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="CI">Ivory Coast</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Laos</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao S.A.R., China</option>
<option value="MK">Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia</option>
<option value="MD">Moldova</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="KP">North Korea</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russia</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="KR">South Korea</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syria</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="VI">U.S. Virgin Islands</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican</option>
<option value="VE">Venezuela</option>
<option value="VN">Vietnam</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select></div>
</div>
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-mailing--recipient-zip">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-zip">ZIP/Postal Code </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-zip"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_mailing][recipient_zip]" value="" size="60" maxlength="55"
class="form-text">
</div>
<div class="form-item webform-component webform-component-textfield control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-mailing--recipient-city">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-city">City </label>
<input type="text" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-city"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_mailing][recipient_city]" value="" size="60" maxlength="57"
class="form-text">
</div>
<div class="form-item webform-component webform-component-select control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--recipient-send-information--recipient-mailing--recipient-state">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-state">State/Province </label>
<div class="select-wrapper"><select id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-recipient-send-information-recipient-mailing-recipient-state"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][recipient_send_information][recipient_mailing][recipient_state]" class="form-select"
placeholder="">
<option value="" selected="selected">- None -</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="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="MH">Marshall Islands</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 Marianas Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PW">Palau</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="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></div>
</div>
</div>
</fieldset>
</div>
</fieldset>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--ecard-send-date">
<legend><span class="fieldset-legend">When should we send the eCard?</span></legend>
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-date control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--ecard-send-date--ecard-delivery">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery">eCard Delivery </label>
<div class="webform-container-inline">
<div class="form-item form-type-select form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-month control-group">
<label class="element-invisible" for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-month">Month </label>
<div class="select-wrapper"><select class="month form-select" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-month"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][ecard_send_date][ecard_delivery][month]" placeholder="">
<option value="">Month</option>
<option value="1" selected="selected">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">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></div>
</div>
<div class="form-item form-type-select form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-day control-group">
<label class="element-invisible" for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-day">Day </label>
<div class="select-wrapper"><select class="day form-select" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-day"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][ecard_send_date][ecard_delivery][day]" placeholder="">
<option value="">Day</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4" selected="selected">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">31</option>
</select></div>
</div>
<div class="form-item form-type-textfield form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-year control-group">
<label class="element-invisible" for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-year">Year </label>
<input class="year form-text dateUS jquery-once-9-processed" type="text"
id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-delivery-year"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][ecard_send_date][ecard_delivery][year]" value="2024" size="5" maxlength="4">
</div>
</div>
</div>
<div class="form-item webform-component webform-component-checkboxes control-group"
id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--ecard-send-date--ecard-copy">
<div id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-copy">
<div class="form-item form-type-checkbox form-item-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-copy-1 control-group">
<input type="checkbox" id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-copy-1"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][ecard_send_date][ecard_copy][1]" value="1" class="form-checkbox"> <label class="option"
for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-ecard-send-date-ecard-copy-1">Please send me a copy of the eCard when it is delivered to the
recipient. </label>
</div>
</div>
</div>
</div>
</fieldset>
<div class="form-item webform-component webform-component-textarea control-group" id="webform-component-donation--tribute-section--tribute-information--toggle-wrapper--ecard-tribute--honoree-details--card-message">
<label for="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-card-message">Message </label>
<textarea id="edit-submitted-donation-tribute-section-tribute-information-toggle-wrapper-ecard-tribute-honoree-details-card-message"
name="submitted[donation][tribute_section][tribute_information][toggle_wrapper][ecard_tribute][honoree_details][card_message]" cols="60" rows="5" class="form-textarea counter-processed"></textarea>
<div class="card-message--counter"><span>500</span> characters remaining.</div>
</div>
</div>
</fieldset>
</div>
<div class="btn btn-preview jquery-once-7-processed" data-toggle="modal" data-target="#previewModal">Preview Card</div>
</fieldset>
</div>
</fieldset>
</div>
</fieldset>
<div class="form-item webform-component webform-component-email control-group" id="webform-component-donation--tribute-section--ecard-sender-email">
<input class="email form-text form-email" type="email" id="edit-submitted-donation-tribute-section-ecard-sender-email" name="submitted[donation][tribute_section][ecard_sender_email]" size="60">
</div>
</div>
</fieldset>
</fieldset>
<div class="progress-buttons"><span class="step continue submit" data-step-current="step-1" data-step-next="step-2">Next Step</span></div>
</div>
<input type="hidden" name="submitted[cid]" value="">
<div class="step-group fieldset-step" id="step-2">
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-payment-information">
<legend><span class="fieldset-legend">2. Payment Method</span></legend>
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-radios control-group" id="webform-component-payment-information--payment-method">
<label for="edit-submitted-payment-information-payment-method">Payment Method <span class="form-required" title="This field is required.">*</span></label>
<div id="edit-submitted-payment-information-payment-method">
<div class="form-item form-type-radio form-item-submitted-payment-information-payment-method control-group">
<input class="fundraiser-payment-methods" type="radio" id="edit-submitted-payment-information-payment-method-1" name="submitted[payment_information][payment_method]" value="credit" checked="checked"> <label class="option"
for="edit-submitted-payment-information-payment-method-1">Credit Card </label>
</div>
<div class="form-item form-type-radio form-item-submitted-payment-information-payment-method control-group">
<input class="fundraiser-payment-methods" type="radio" id="edit-submitted-payment-information-payment-method-2" name="submitted[payment_information][payment_method]" value="bank account"> <label class="option"
for="edit-submitted-payment-information-payment-method-2">Bank Account </label>
</div>
<div class="form-item form-type-radio form-item-submitted-payment-information-payment-method control-group element-invisible">
<input class="fundraiser-payment-methods" type="radio" id="edit-submitted-payment-information-payment-method-3" name="submitted[payment_information][payment_method]" value="paypal"> <label class="option"
for="edit-submitted-payment-information-payment-method-3">Paypal </label>
</div>
</div>
</div>
<div class="webform-component-fieldset form-wrapper" id="webform-component-payment-information--payment-fields">
<fieldset class="fundraiser-payment-fields form-wrapper" id="edit-submitted-payment-information-payment-fields-credit">
<div class="fieldset-wrapper">
<div class="form-item form-type-textfield form-item-submitted-payment-information-payment-fields-credit-card-number control-group">
<label for="edit-submitted-payment-information-payment-fields-credit-card-number">Credit card number <span class="form-required">*</span></label>
<input class="input-large form-text" autocomplete="off" type="text" id="edit-submitted-payment-information-payment-fields-credit-card-number" name="submitted[payment_information][payment_fields][credit][card_number]" value=""
size="20" maxlength="128">
</div>
<div class="expiration-date-wrapper clear-block">
<div class="form-item form-type-select form-item-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-month control-group">
<label for="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-month">Expiration date <span class="form-required">*</span></label>
<div class="expiration-select"><label for="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-month">Exp. Month<span class="form-required">*</span></label><label
for="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-year">Exp. Year<span class="form-required">*</span></label>
<div class="select-wrapper"><select class="input-small form-select" id="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-month"
name="submitted[payment_information][payment_fields][credit][expiration_date][card_expiration_month]" placeholder="">
<option value="1" selected="selected">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select></div>
<div class="select-wrapper"><select class="input-small form-select" id="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-year"
name="submitted[payment_information][payment_fields][credit][expiration_date][card_expiration_year]" placeholder="">
<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>
<option value="2035">2035</option>
<option value="2036">2036</option>
<option value="2037">2037</option>
<option value="2038">2038</option>
<option value="2039">2039</option>
</select></div>
</div>
</div>
</div>
<div class="form-item form-type-textfield form-item-submitted-payment-information-payment-fields-credit-card-cvv control-group tooltip--element">
<label for="edit-submitted-payment-information-payment-fields-credit-card-cvv">CVV <span class="form-required">*</span></label>
<input class="input-small form-text" autocomplete="off" type="text" id="edit-submitted-payment-information-payment-fields-credit-card-cvv" name="submitted[payment_information][payment_fields][credit][card_cvv]" value="" size="6"
maxlength="128">
<span class="tooltip--wrapper"><span class="tooltip--content" data-name="edit-submitted-payment-information-payment-fields-credit-card-cvv" title="cvv"> The verification code for <strong>Visa, Master Card, and Discover</strong> is a
3-digit number printed on the back of your card. The <strong>American Express</strong> verification code is a 4-digit number printed on the front of your card. </span></span>
</div><input type="hidden" name="submitted[payment_information][payment_fields][credit][card_type]" value="">
<input type="hidden" name="submitted[payment_information][payment_fields][credit][device_fingerprint_id]" value="77a45562a406190c9a07944baa7fc9134e4548d3ac5adbef8495bcd33611c78e">
</div>
</fieldset>
<fieldset class="fundraiser-payment-fields form-wrapper" id="edit-submitted-payment-information-payment-fields-bank-account" style="display: none;">
<div class="fieldset-wrapper account-type-processed">
<div class="form-item form-type-select form-item-submitted-payment-information-payment-fields-bank account-account-type control-group">
<label for="edit-submitted-payment-information-payment-fields-bank-account-account-type">Account Type </label>
<div class="select-wrapper"><select id="edit-submitted-payment-information-payment-fields-bank-account-account-type" name="submitted[payment_information][payment_fields][bank account][account_type]" class="form-select" placeholder="">
<option value="Checking">Checking</option>
<option value="Savings">Savings</option>
</select></div>
</div>
<div class="form-item form-type-textfield form-item-submitted-payment-information-payment-fields-bank account-routing-number control-group">
<label for="edit-submitted-payment-information-payment-fields-bank-account-routing-number">Routing Number </label>
<input type="text" id="edit-submitted-payment-information-payment-fields-bank-account-routing-number" name="submitted[payment_information][payment_fields][bank account][routing_number]" value="" size="60" maxlength="128"
class="form-text">
</div>
<div class="form-item form-type-textfield form-item-submitted-payment-information-payment-fields-bank account-account-number control-group">
<label for="edit-submitted-payment-information-payment-fields-bank-account-account-number">Account Number </label>
<input type="text" id="edit-submitted-payment-information-payment-fields-bank-account-account-number" name="submitted[payment_information][payment_fields][bank account][account_number]" value="" size="60" maxlength="128"
class="form-text">
</div>
<div id="eft-disclaimer" class="donation-total-token-container" style="display: none;">By continuing with this gift, I authorize Doctors Without Borders USA to debit my Checking account for a donation in the amount of $30.00 on 1/4/2024
and once a month in that amount thereafter.</div>
<div class="field-help">
<p><a target="_blank" href="http://www.firstdata.com/support/telecheck_returned_check/returned_check_fees.htm">View Your State's Returned Check Fee.</a></p>
</div><input type="hidden" name="submitted[payment_information][payment_fields][bank account][device_fingerprint_id]" value="77a45562a406190c9a07944baa7fc9134e4548d3ac5adbef8495bcd33611c78e">
</div>
</fieldset>
<fieldset class="fundraiser-payment-fields form-wrapper" id="edit-submitted-payment-information-payment-fields-paypal" style="display: none;">
<div class="fieldset-wrapper">
<div id="payment-details" class="form-wrapper">
<div id="braintree-payment-form-outer">
<div class="braintree-payment-form form-wrapper" id="edit-submitted-payment-information-payment-fields-paypal-braintree-new">
<div id="paypal-container" class="form-wrapper">
<div id="braintree-paypal-loggedin" class="form-wrapper"><span id="bt-pp-name">PayPal</span><span id="bt-pp-email"></span><button id="bt-pp-cancel">Cancel</button></div>
</div>
</div>
</div>
</div><input type="hidden" name="braintree[errors]" value="">
<input type="hidden" name="payment_method_nonce" value="">
<input type="hidden" name="submitted[payment_information][payment_fields][paypal][braintree_card_type]" value="">
<input type="hidden" name="submitted[payment_information][payment_fields][paypal][braintree_last4]" value="">
</div>
</fieldset>
</div><input type="hidden" name="submitted[payment_information][processing_fee_amount]" value="">
<input type="hidden" name="submitted[payment_information][cybersource_eft_disclaimer_text]" value="">
</div>
</fieldset>
<div class="progress-buttons"><span class="step back" data-step-current="step-2" data-step-next="step-3">Previous</span><span class="step continue submit" data-step-current="step-2" data-step-next="step-3">Next Step</span></div>
</div>
<div class="step-group fieldset-step" id="step-3">
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donor-information">
<legend><span class="fieldset-legend">3. Your Information</span></legend>
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-checkboxes control-group" id="webform-component-donor-information--org-donation">
<div id="edit-submitted-donor-information-org-donation">
<div class="form-item form-type-checkbox form-item-submitted-donor-information-org-donation-1 control-group tooltip--element">
<input type="checkbox" id="edit-submitted-donor-information-org-donation-1" name="submitted[donor_information][org_donation][1]" value="1" class="form-checkbox"> <label class="option"
for="edit-submitted-donor-information-org-donation-1">This gift is from a company, foundation, or organization </label>
<span class="tooltip--wrapper"><span class="tooltip--content" data-name="edit-submitted-donor-information-org-donation-1" data-title="company"> We ask for the name of the company or organization making this gift so we can properly
attribute the donation in our database to the company or organization making this donation.</span></span>
</div>
</div>
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donor-information--organization-name">
<label for="edit-submitted-donor-information-organization-name">Company, foundation, or organization </label>
<input type="text" id="edit-submitted-donor-information-organization-name" name="submitted[donor_information][organization_name]" value="" size="60" maxlength="50" class="form-text">
</div>
<div class="form-item webform-component webform-component-select control-group" id="webform-component-donor-information--title">
<label for="edit-submitted-donor-information-title">Title </label>
<div class="select-wrapper"><select id="edit-submitted-donor-information-title" name="submitted[donor_information][title]" class="form-select" placeholder="">
<option value="" selected="selected"></option>
<option value="Mr.">Mr.</option>
<option value="Ms.">Ms.</option>
<option value="Mrs.">Mrs.</option>
<option value="Dr.">Dr.</option>
<option value="Prof.">Prof.</option>
</select></div>
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donor-information--first-name">
<label for="edit-submitted-donor-information-first-name">First Name <span class="form-required" title="This field is required.">*</span></label>
<input type="text" id="edit-submitted-donor-information-first-name" name="submitted[donor_information][first_name]" value="" size="60" maxlength="64" class="form-text required">
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donor-information--last-name">
<label for="edit-submitted-donor-information-last-name">Last Name <span class="form-required" title="This field is required.">*</span></label>
<input type="text" id="edit-submitted-donor-information-last-name" name="submitted[donor_information][last_name]" value="" size="60" maxlength="64" class="form-text required">
</div>
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donor-information--opt-in">
<div class="fieldset-wrapper"></div>
</fieldset>
<div class="form-item webform-component webform-component-email control-group tooltip--element" id="webform-component-donor-information--mail">
<label for="edit-submitted-donor-information-mail">E-mail address <span class="form-required" title="This field is required.">*</span></label>
<input class="email form-text form-email required" type="email" id="edit-submitted-donor-information-mail" name="submitted[donor_information][mail]" size="60">
<span class="tooltip--wrapper"><span class="tooltip--content" data-name="edit-submitted-donor-information-mail" data-title="email"> We ask for your email address so we can send you a receipt for tax purposes.</span></span>
</div>
<div class="form-item webform-component webform-component-textfield control-group tooltip--element" id="webform-component-donor-information--phone-number">
<label for="edit-submitted-donor-information-phone-number">Phone Number </label>
<input type="text" id="edit-submitted-donor-information-phone-number" name="submitted[donor_information][phone_number]" value="" size="60" maxlength="51" class="form-text" placeholder="##########">
<span class="tooltip--wrapper"><span class="tooltip--content" data-name="edit-submitted-donor-information-phone-number" data-title="phone">We ask for your phone number so we can send you updates from the field.</span></span>
</div>
</div>
</fieldset>
<div class="progress-buttons"><span class="step back" data-step-current="step-3" data-step-next="step-4">Previous</span><span class="step continue submit" data-step-current="step-3" data-step-next="step-4">Next Step</span></div>
</div>
<div class="step-group fieldset-step last-step" id="step-4">
<fieldset class="webform-component-fieldset form-wrapper" id="webform-component-billing-information">
<legend><span class="fieldset-legend">4. Billing</span></legend>
<div class="fieldset-wrapper">
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-billing-information--address">
<label for="edit-submitted-billing-information-address">Billing Address <span class="form-required" title="This field is required.">*</span></label>
<input type="text" id="edit-submitted-billing-information-address" name="submitted[billing_information][address]" value="" size="60" maxlength="100" class="form-text required">
</div>
<div class="form-item webform-component webform-component-textfield control-group" id="webform-component-billing-information--address-line-2">
<label for="edit-submitted-billing-information-address-line-2">Billing Address Line 2 </label>
<input type="text" id="edit-submitted-billing-information-address-line-2" name="submitted[billing_information][address_line_2]" value="" size="60" maxlength="75" class="form-text">
</div>
<div class="form-item webform-component webform-component-select control-group" id="webform-component-billing-information--country">
<label for="edit-submitted-billing-information-country">Country <span class="form-required" title="This field is required.">*</span></label>
<div class="select-wrapper"><select id="edit-submitted-billing-information-country" name="submitted[billing_information][country]" class="form-select required ajax-processed" placeholder="">
<option value="AF">Afghanistan</option>
<option value="AX">Aland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="BQ">Caribbean Netherlands</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo (Brazzaville)</option>
<option value="CD">Congo (Kinshasa)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
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<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
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<option value="GP">Guadeloupe</option>
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<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
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<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
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<option value="IT">Italy</option>
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<option value="KZ">Kazakhstan</option>
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<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Laos</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao S.A.R., China</option>
<option value="MK">Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia</option>
<option value="MD">Moldova</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
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<option value="TV">Tuvalu</option>
<option value="VI">U.S. Virgin Islands</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
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<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican</option>
<option value="VE">Venezuela</option>
<option value="VN">Vietnam</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
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<option value="ZM">Zambia</option>
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<option value="AE">Armed Forces (Europe, Canada, Middle East, Africa)</option>
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Skip to main content HELP SAVE LIVES. DONATE NOW. Doctors Without Borders/Médecins Sans Frontières (MSF) is on the ground in over 70 countries—providing urgently needed humanitarian aid in moments of crisis and conflict. Make a gift today to help us continue providing medical aid where it is needed most. Your 100 percent tax-deductible gift helps MSF respond quickly to emergencies in places like Ukraine, Haiti, Yemen, and beyond. For MSF, the ability to respond quickly to medical humanitarian emergencies is crucial to saving more lives. Unrestricted funds allow us to allocate our resources most efficiently and where the needs are greatest. 1. Amount One-time Monthly Increase the impact of your gift. Make it monthly. Please select your tax-deductible gift amount below $50 $100 $250 $500 $1,000 Other Other $ Minimum payment $5.00. Please select your tax-deductible gift amount below * $10 * $15 * $30 * $60 * $90 * Other * Other $ Minimum payment $10.00. Give in tribute or honor of someone SEND A TRIBUTE GIFT CARD Send a complimentary acknowledgment with your gift to MSF made in honor or in memory of someone dear. Send an Ecard Send a Letter by Mail Don't Send a Notification Select an eCard design 1 2 3 4 5 6 Honoree Details Choose the type of honoree to customize the card’s message. A gift in someone's honor A gift in someone's memory Honoree First Name Honoree Last Name Add another honoree 2nd Honoree First Name 2nd Honoree Last Name Who is this gift coming from? I prefer to be anonymous. Do not include my name on the card. Sender's name(s) Who should we send the card to? Recipient First Name Recipient Last Name Recipient e-mail address Billing Address Billing Address Line 2 Country - None -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe ZIP/Postal Code City State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming When should we send the eCard? eCard Delivery Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Please send me a copy of the eCard when it is delivered to the recipient. 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