fundraise.pcfa.org.au
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13.238.127.168
Public Scan
URL:
https://fundraise.pcfa.org.au/event/giving-day
Submission: On November 19 via api from AU — Scanned from AU
Submission: On November 19 via api from AU — Scanned from AU
Form analysis 1 forms found in the DOM
POST https://fundraise.pcfa.org.au/processeventdonation
<form action="https://fundraise.pcfa.org.au/processeventdonation" method="post" id="DonationForm_7104" class="lump-donationform form-cards form-slick form-horizontal matchedSidebar form-label-top" novalidate="novalidate">
<input type="hidden" name="page_id" id="page_id" value="11612">
<input type="hidden" name="mandatory" id="mandatory" value="d_fname,d_lname,d_email{email},d_amount{amount},d_receipt" enctype="multipart/form-data">
<input type="hidden" name="d_amount" id="d_amount" autocomplete="new-password" value="116.05">
<input type="hidden" name="d_amount_sel" id="d_amount_sel" autocomplete="new-password" value="110">
<input type="hidden" name="d_fee" id="d_fee" autocomplete="new-password" value="6.05">
<input type="hidden" name="initial_amount" id="initial_amount" autocomplete="new-password" value="110">
<input type="hidden" name="donation_frequency" id="donation_frequency" value="">
<input type="hidden" name="CSRFToken" value="f79dd0494e7b8210dab03ae6733c2d41">
<input type="hidden" name="stripe_key" id="stripe_key_7104" value="pk_live_kPHAmvy3mKyaKlQMQk7k80Ps">
<input type="hidden" name="token" id="token_7104" value="">
<input type="hidden" name="payment_intent_id" id="payment_intent_id_7104">
<input type="hidden" name="card_brand" id="card_brand">
<input type="hidden" name="card_country" id="card_country">
<input type="hidden" name="elements_donation_type" id="elements_donation_type" value="donation">
<input type="hidden" name="elements_refresh" id="elements_refresh" value="">
<input type="hidden" name="event_id" id="event_id" value="526">
<input type="hidden" name="g-recaptcha-response" id="g-recaptcha-response-7104">
<input type="hidden" name="elements_payment_method" id="elements_payment_method" value="card">
<input type="hidden" name="matched_id" id="matched_id" value="7">
<p id="error" class="text-center error" style="display:none">
<b></b>
</p>
<section class="donation-form-top">
<div class="steps-nav text-center steps-icons">
<ul>
<li class="active" id="amountdetailstab">
<i class="material-icons">attach_money</i>
</li>
<li id="personaldetailstab"><i class="material-icons">person</i></li>
<li id="paymentdetailstab"><i class="material-icons">credit_card</i></li>
</ul>
</div>
<div class="donation-form-top-content">
<div class="container">
</div>
</div>
</section>
<div class="donation-steps slick-initialized slick-slider">
<div class="slick-list draggable" style="height: 378.25px;">
<div class="slick-track" style="opacity: 1; width: 1200px;">
<section id="amountdetails" class="section slick-slide slick-current slick-active" data-slick-index="0" style="position: relative; width: 400px; left: 0px; top: 0px; z-index: 999; opacity: 1;" aria-hidden="false">
<div class="handles-container handles-layout-default">
<div class="donationHandlers oneoffdonationHandlers">
<div class="row vertical-align justify-center">
<div class="radio-panel" data-id="1448">
<div class="radio no-image has-text notselected" data-amount="252" role="button" aria-pressed="false" tabindex="0" aria-label="Donate $252" onkeydown="handleBtnKeyDown(event)" data-image="">
<div class="arrow-top border-primary"></div>
<div class="radio-border">
<div class="radio-content">
<div class="radio-amount no-image has-text"> $252 </div>
<div class="radio-text">
<span class="radio-copy">Biomarker research</span>
</div>
</div>
</div>
</div>
</div>
<div class="radio-panel" data-id="1447">
<div class="radio no-image has-text selected" data-amount="110" role="button" aria-pressed="true" tabindex="0" aria-label="Donate $110" onkeydown="handleBtnKeyDown(event)" data-image="">
<div class="arrow-top border-primary"></div>
<div class="radio-border">
<div class="radio-content">
<div class="radio-amount no-image has-text"> $110 </div>
<div class="radio-text">
<span class="radio-copy">Precision medicine tests</span>
</div>
</div>
</div>
</div>
<script>
$(document).ready(function() {
$('#DonationForm_7104 #d_amount,#initial_amount,#DonationForm_7104 #d_amount_sel').val(110).trigger('change');
calculateDonation_7104();
$('#DonationForm_7104 .radio').addClass('notselected');
$('#DonationForm_7104 .radio').removeClass('selected');
$('#DonationForm_7104 .radio[data-amount="110"]').addClass('selected');
$('#DonationForm_7104 .radio[data-amount="110"]').removeClass('notselected');
$('#DonationForm_7104 .donation-steps').removeClass('visibleout');
$('#DonationForm_7104 .donation-steps input').removeAttr('disabled');
if ($(this).find('.radio-copy').html() != "") {
$('#DonationForm_7104 .copy-text').hide().html('<span class="color-primary"></span> Precision medicine tests').fadeIn(300);
}
var matchedamount = 110;
displayMatchedAmount(matchedamount);
});
</script>
</div>
<div class="radio-panel" data-id="1446">
<div class="radio no-image has-text notselected" data-amount="55" role="button" aria-pressed="false" tabindex="0" aria-label="Donate $55" onkeydown="handleBtnKeyDown(event)" data-image="">
<div class="arrow-top border-primary"></div>
<div class="radio-border">
<div class="radio-content">
<div class="radio-amount no-image has-text"> $55 </div>
<div class="radio-text">
<span class="radio-copy">Tumour targeting studies</span>
</div>
</div>
</div>
</div>
</div>
</div><!--row -->
</div>
<div class="container" style="padding:0 30px;">
<h3 class="text-center pb10">Please select a donation amount</h3>
</div>
<div class="container">
<div class="copy-text text-center" style=""><span class="color-primary"></span> Precision medicine tests</div>
</div>
<!-- donationHandlers -->
<div class="container">
<div class="row pb20 other-amount">
<div class="col-xs-12 col-12 error-absolute">
<div class="input-group float-center">
<span class="input-group-addon border-radius-left white color-primary size-125"> $ </span>
<input type="text" class="form-control bl-none size-1em pl10 pr0 height-auto" autocomplete="new-password" name="d_amount_free" id="d_amount_free" value="" placeholder="or nominate a value" aria-label=" Other Amount" tabindex="0">
<script>
$('#DonationForm_7104 #d_amount_free').on('focus', function() {
$('#DonationForm_7104 #d_amount,#initial_amount').val(0);
$('#DonationForm_7104 #d_amount_sel').val('');
$('#DonationForm_7104 .radio').removeClass('selected').removeClass('notselected');
$(this).parent().find('.input-group-addon').addClass('border-primary');
this.placeholder = '';
});
$('#DonationForm_7104 #d_amount_free').on('keypress', function() {
$('#DonationForm_7104 #d_amount,#initial_amount').val(0);
$('#DonationForm_7104 #d_amount_sel').val('');
$('#DonationForm_7104 .radio').removeClass('selected').removeClass('notselected');
$(this).parent().find('.input-group-addon').addClass('border-primary');
this.placeholder = '';
});
$('#DonationForm_7104 #d_amount_free').on('keyup', function() {
RemoveJunk(this, 'nofloat', '');
if ($('#DonationForm_7104 #donation_frequency').val() != '') {
$('#DonationForm_7104 .btn-give').text('Donate $' + $(this).val() + ' ' + $('#DonationForm_7104 #donation_frequency').val());
} else {
$('#DonationForm_7104 .btn-give').text('Donate $' + $(this).val());
}
});
$('#DonationForm_7104 #d_amount_free').on('blur', function() {
freeAmountBlur()
});
function freeAmountBlur() {
if ($('#DonationForm_7104 #d_amount_free').val() > 0) {
doFreeAmount();
calculateDonation_7104();
}
$('#DonationForm_7104 #d_amount_free').parent().find('.input-group-addon').removeClass('border-primary');
$('#DonationForm_7104 #d_amount_free').removeClass('bg-primary');
this.placeholder = ' Other Amount';
}
</script>
</div>
</div>
</div>
<div class="matched-giving text-center active">
<p>With matched giving<br><strong class="matched-name">PCFA</strong> receives</p>
<h2>$220</h2>
</div>
<script>
function displayMatchedAmount(amounttomatch) {
var matchedamount = amounttomatch * (1 + 1);
var myamount = $('#initial_amount').val();
var contribution = matchedamount - myamount;
$('#DonationForm_7104 .matched-giving').addClass('active').html('<p>With matched giving<br/><strong class="matched-name">PCFA</strong> receives</p><h2>$' + matchedamount.toLocaleString() + '</h2>');
}
</script>
<div class="container">
<button type="button" class="btn btn-primary btn-block btn-xl btn-next" rel="amountdetails" tabindex="0">
<span>Donate<span class="donate_amount"></span></span>
</button>
</div>
</div>
</div>
<div dir="ltr" class="resize-sensor" style="pointer-events: none; position: absolute; inset: 0px; overflow: hidden; z-index: -1; visibility: hidden; max-width: 100%;">
<div class="resize-sensor-expand" style="pointer-events: none; position: absolute; inset: 0px; overflow: hidden; z-index: -1; visibility: hidden; max-width: 100%;">
<div style="position: absolute; left: 0px; top: 0px; transition: all; width: 410px; height: 388px;"></div>
</div>
<div class="resize-sensor-shrink" style="pointer-events: none; position: absolute; inset: 0px; overflow: hidden; z-index: -1; visibility: hidden; max-width: 100%;">
<div style="position: absolute; left: 0px; top: 0px; transition: all; width: 200%; height: 200%;"></div>
</div>
</div>
</section>
<section class="section slick-slide" id="personaldetails" data-slick-index="1" aria-hidden="true" style="width: 400px; position: relative; left: -400px; top: 0px; z-index: 998; opacity: 0;" tabindex="-1">
<div class="container" data-gtm-vis-polling-id111291816_42="105">
<script>
function receiptKeydown(event) {
// Check to see if space or enter were pressed
if (event.key === " " || event.key === "Enter" || event.key === "Spacebar") { // "Spacebar" for IE11 support
// Prevent the default action to stop scrolling when space is pressed
event.preventDefault();
$(event.target).trigger('click');
$('#DonationForm_7104 #d_receipt_container .toggle-btn').attr('aria-pressed', 'false');
event.target.setAttribute("aria-pressed", "true");
}
}
</script>
<h3 class="text-center pb10">Your Details</h3>
<div class="row">
<div class="col-xs-12 col-12" id="d_receipt_container">
<div class="form-group">
<div class="col-12 col-xs-12 col-12">
<div class="text-center toggle-switch">
<label class="bg-primary border-primary col-xs-6 col-6 toggle-btn"
onclick="$('#OrganisationInfo').slideUp(300);$('#mandatory').val($('#mandatory').val().replace(',d_organisation',''));$(this).parent().parent().find('label').removeClass('bg-primary border-primary');$(this).addClass('bg-primary border-primary');$('#gift_aid').parent().parent().visibleIn();"
role="button" aria-pressed="true" tabindex="0" onkeydown="receiptKeydown(event)">
<input type="radio" name="d_receipt" value="personal" checked="checked" tabindex="-1"> Individual </label>
<label class="col-xs-6 col-6 toggle-btn"
onclick="$('#OrganisationInfo').slideDown(300);$('#mandatory').val($('#mandatory').val() +',d_organisation');$(this).parent().parent().find('label').removeClass('bg-primary border-primary');$(this).addClass('bg-primary border-primary');$('#gift_aid').attr('checked',false);$('#gift_aid').parent().parent().visibleOut();"
tabindex="0" role="button" aria-pressed="false" onkeydown="handleBtnKeyDown(event)">
<input type="radio" name="d_receipt" value="business" tabindex="-1"> Organisation </label>
</div>
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="col-xs-12 col-12">
<div class="form-group" id="OrganisationInfo" style="display:none;">
<label class="col-xs-12 col-12 " for="d_organisation">Organisation Name *</label>
<div class="col-xs-12 col-12">
<input type="text" class="form-control" name="d_organisation" id="d_organisation" value="" tabindex="-1">
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="col-xs-12 col-12 col-sm-6">
<div class="form-group">
<label class="col-sm-12" for="d_fname"> First Name * </label>
<div class="col-sm-12">
<input type="text" class="form-control " name="d_fname" id="d_fname" value="" autocomplete="given-name" required="" tabindex="-1">
</div>
</div>
</div>
<div class="col-xs-12 col-12 col-sm-6">
<div class="form-group">
<label class="col-sm-12" for="d_lname"> Last Name * </label>
<div class="col-sm-12">
<input type="text" class="form-control " name="d_lname" id="d_lname" value="" autocomplete="family-name" required="" tabindex="-1">
</div>
</div>
</div>
<div class="col-sm-12 col-xs-12 col-12">
<div class="form-group">
<label class="col-sm-12" for="d_email"> Email Address * </label>
<div class="col-sm-12">
<input type="text" class="form-control " name="d_email" id="d_email" value="" autocomplete="email" required="" tabindex="-1">
</div>
</div>
</div>
<div class="col-xs-12 col-12 Mandatory">
<div class="form-group">
<label class="col-xs-12 col-12 ">Mobile </label>
<div class="col-xs-12 col-12 pl0 pr0">
<div class="vertical-align">
<div class="left col-xs-4 col-4 pr0">
<select class="form-control" name="d_phone_mobile_suffix" id="d_phone_mobile_suffix" tabindex="-1">
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</select>
</div>
<div class="col-sm-8 col-xs-8 col-8">
<input type="text" class="form-control phone-group" name="d_phone_mobile" id="d_phone_mobile" value="" tabindex="-1">
</div>
</div>
</div>
</div>
</div>
<div class="clearfix"></div>
<label class="col-sm-12 pt10 pb10">Postal Address <a href="javascript:;" class="expand-address pull-right" tabindex="-1"><small>(enter manually)</small></a></label>
<div class="address-lookup col-sm-12 col-xs-12 col-12">
<div class="form-group ml0 mr0">
<div class="col-sm-12 pl0 pr0 position-relative">
<input type="text" class="form-control" name="d_address" id="d_address" value="" placeholder="Please enter your street address" autocomplete="noprefill" tabindex="-1">
<div class="loqate-marker position-relative"></div>
</div>
<div class="loqate-container" style="width: 100%; position: absolute; display: none;">
<div class="loqate-item loqate-item-template">
<span class="loqate-icon loqate-icon-marker"></span><span class="loqate-item-query"></span>
</div>
</div>
</div>
<script>
$(document).ready(function() {
selectedaddress = false;
addresstimer = false;
$('#d_address').focus(function() {
selectedaddress = false;
});
$('#d_address').blur(function() {
setTimeout(function() {
$('.loqate-container').hide();
}, 300);
});
$('#d_address,#kw_number').keyup(function() {
showloqateresults();
});
});
function showloqateresults(container = '') {
clearTimeout(addresstimer);
if ($('#d_address').val() != '') {
if (selectedaddress) {
$('#kw_postcode_results').html('').addClass('hidden');
} else {
addresstimer = setTimeout(function() {
$('#kw_postcode_results').html('').addClass('hidden');
$('#postcodelookup').html('<i class="fa fa-spinner"></i>');
$.getJSON("/funraisin/searchaddressfromloqate/AU?container=" + container + "&term=" + encodeURI($('#d_address').val()), function(result) {
if (result) {
if (result.status == 'SUCCESS') {
var lookupContainer = $('#d_address').closest('.address-lookup');
lookupContainer.find('.loqate-container .loqate-item-result,.loqate-valid').remove();
for (var i = 0; i < Math.min(result.payload.length, 100); i++) {
var item = lookupContainer.find('.loqate-container .loqate-item-template').clone();
item.removeClass('loqate-item-template');
item.addClass('loqate-item-result');
item.find('.loqate-item-query').html(result.payload[i].fullAddress);
item.attr('data-id', result.payload[i].id);
item.attr('data-type', result.payload[i].type);
item.click(function() {
lookupContainer.find('.loqate-container .loqate-item-result').remove();
lookupContainer.find('.loqate-container').hide();
$('#d_address').val($(this).find('.loqate-item-query').html());
if ($(this).attr('data-type') == 'Postcode' || $(this).attr('data-type') == 'Container') {
showloqateresults($(this).attr('data-id'));
return;
}
$.getJSON("/funraisin/getaddressfromloqate/AU/?id=" + $(this).attr('data-id'), function(result) {
if (result) {
if (result.status == 'SUCCESS') {
$('#d_address_street').val(result.streetNumber + " " + result.street);
$('#d_address_2').val(result.subdwelling);
$('#d_address_suburb').val(result.suburb);
$('#d_address_pcode').val(result.postcode);
$('#d_address_state').val(result.state);
$('select.selectpicker').selectpicker('refresh');
if (typeof result.dpid !== 'undefined') {
$('#d_address_dpid').val(result.dpid);
}
if ($('.address-expand').hasClass('hidden')) {
$('#d_address').after('<span class="loqate-valid"><i class="fa fa-check"></i></span>');
}
}
}
});
});
lookupContainer.find('.loqate-container').prependTo(lookupContainer.find(".loqate-marker"));
lookupContainer.find('.loqate-container').append(item);
lookupContainer.find('.loqate-container').show();
}
}
}
}).fail(function(jqXHR, textStatus, errorThrown) {
console.error("Error:", textStatus, errorThrown); // Log any errors
});
$('#postcodelookup').html('Find');
$(document).on('click', function(event) {
var target = $(event.target);
if (!target.closest('.loqate-marker').length && !target.is('.loqate-marker')) {
$('.loqate-container').hide();
}
});
}, 300);
}
}
}
</script>
</div>
<div class="hidden addressdetails address-expand">
<div class="col-sm-6 col-12 col-xs-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5">Address Line 1 </label>
<div class="col-sm-12">
<input class="form-control g_address_street" type="text" name="d_address_street" id="d_address_street" value="" placeholder="Street address, P.O. box" data-geo="route" data-stripe="address_line1" autocomplete="address-line1"
tabindex="-1">
</div>
</div>
</div>
<div class="col-sm-6 col-12 col-xs-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5">Address Line 2 </label>
<div class="col-sm-12">
<input class="form-control g_address_2" type="text" name="d_address_2" id="d_address_2" value="" placeholder="Apartment, suite, unit, building, floor etc" data-stripe="address_line2" autocomplete="address-line2" tabindex="-1">
</div>
</div>
</div>
<div class="col-sm-6 col-12 col-xs-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="d_address_suburb">Town/Suburb </label>
<div class="col-sm-12">
<input type="text" class="form-control g_address_suburb" name="d_address_suburb" id="d_address_suburb" value="" data-geo="locality" data-stripe="address_city" tabindex="-1">
</div>
</div>
</div>
<div class="col-sm-6 col-12 col-xs-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="d_address_pcode">Postcode </label>
<div class="col-sm-12">
<input type="text" class="form-control g_address_pcode" name="d_address_pcode" id="d_address_pcode" value="" data-geo="postal_code" data-stripe="address_zip" autocomplete="postal-code" tabindex="-1">
</div>
</div>
</div>
<div class="col-sm-6 col-12 col-xs-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="d_address_state">State </label>
<div class="col-sm-12">
<input class="form-control g_address_state ui-autocomplete-input" type="text" name="d_address_state" id="d_address_state" value="" data-geo="administrative_area_level_1_short" data-stripe="address_state" autocomplete="off"
tabindex="-1">
</div>
</div>
</div>
<div class="col-sm-6 col-12 col-xs-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="d_address_country">Country </label>
<div class="col-sm-12">
<div class="btn-group bootstrap-select form-control g_address_country"><button type="button" class="dropdown-toggle form-control" data-toggle="dropdown" role="button" data-id="d_address_country" tabindex="-1"
title="Australia"><span class="filter-option pull-left">Australia</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Australia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">United States</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">United Kingdom</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="3">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">---------------------</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="4">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Afghanistan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="5"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Albania</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="6"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Algeria</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="7">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">American Samoa</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="8"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Andorra</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="9"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Angola</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="10">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Anguilla</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="11">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Antarctica</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="12">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Antigua and Barbuda</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="13">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Argentina</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="14">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Armenia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="15"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Aruba</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="16" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">Australia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="17">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Austria</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="18">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Azerbaijan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="19">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bahamas</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="20">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bahrain</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="21">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bangladesh</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="22">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Barbados</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="23">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Belarus</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="24">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Belgium</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="25"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Belize</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="26"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Benin</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="27">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bermuda</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="28"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bhutan</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="29">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bolivia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="30">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bosnia and Herzegovina</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="31">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Botswana</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="32">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bouvet Island</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="33"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Brazil</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="34">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">British Indian Ocean Territory</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="35">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Brunei Darussalam</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="36">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Bulgaria</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="37">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Burkina Faso</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="38">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Burundi</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="39">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cambodia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="40">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cameroon</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="41"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Canada</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="42">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cape Verde</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="43">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Caribbean Netherlands </span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="44">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cayman Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="45">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Central African Republic</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="46"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Chad</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="47"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Chile</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="48"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">China</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="49">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Christmas Island</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="50">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cocos (Keeling) Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="51">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Colombia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="52">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Comoros</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="53"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Congo</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="54">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Congo, Democratic Republic of</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="55">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cook Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="56">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Costa Rica</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="57">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Côte d'Ivoire</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="58">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Croatia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="59"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cuba</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="60">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Curaçao</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="61"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Cyprus</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="62">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Czech Republic</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="63">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Denmark</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="64">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Djibouti</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="65">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Dominica</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="66">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Dominican Republic</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="67">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ecuador</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="68"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Egypt</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="69">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">El Salvador</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="70">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Equatorial Guinea</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="71">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Eritrea</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="72">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Estonia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="73">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ethiopia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="74">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Falkland Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="75">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Faroe Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="76"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Fiji</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="77">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Finland</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="78"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">France</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="79">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">French Guiana</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="80">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">French Polynesia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="81">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">French Southern Territories</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="82"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Gabon</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="83"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Gambia</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="84">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Georgia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="85">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Germany</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="86"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ghana</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="87">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Gibraltar</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="88"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Greece</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="89">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Greenland</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="90">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Grenada</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="91">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Guadeloupe</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="92"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Guam</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="93">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Guatemala</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="94">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Guernsey</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="95"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Guinea</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="96">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Guinea-Bissau</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="97"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Guyana</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="98"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Haiti</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="99">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Heard and McDonald Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="100">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Honduras</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="101">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Hong Kong</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="102">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Hungary</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="103">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Iceland</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="104"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">India</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="105">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Indonesia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="106"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Iran</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="107"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Iraq</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="108">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ireland</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="109">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Isle of Man</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="110">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Israel</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="111"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Italy</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="112">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Jamaica</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="113"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Japan</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="114">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Jersey</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="115">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Jordan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="116">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Kazakhstan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="117"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Kenya</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="118">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Kiribati</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="119">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Kuwait</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="120">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Kyrgyzstan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="121">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Lao People's Democratic Republic</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="122">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Latvia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="123">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Lebanon</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="124">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Lesotho</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="125">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Liberia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="126"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Libya</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="127">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Liechtenstein</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="128">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Lithuania</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="129">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Luxembourg</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="130"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Macau</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="131">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Macedonia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="132">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Madagascar</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="133">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Malawi</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="134">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Malaysia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="135">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Maldives</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="136"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mali</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="137"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Malta</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="138">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Marshall Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="139">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Martinique</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="140">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mauritania</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="141">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mauritius</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="142">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mayotte</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="143">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mexico</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="144">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Micronesia, Federated States of</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="145">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Moldova</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="146">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Monaco</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="147">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mongolia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="148">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Montenegro</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="149">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Montserrat</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="150">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Morocco</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="151">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mozambique</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="152">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Myanmar</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="153">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Namibia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="154"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Nauru</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="155"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Nepal</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="156">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">New Caledonia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="157">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">New Zealand</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="158">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Nicaragua</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="159"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Niger</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="160">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Nigeria</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="161"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Niue</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="162">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Norfolk Island</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="163">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">North Korea</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="164">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Northern Mariana Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="165">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Norway</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="166"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Oman</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="167">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Pakistan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="168"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Palau</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="169">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Palestine, State of</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="170">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Panama</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="171">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Papua New Guinea</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="172">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Paraguay</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="173"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Peru</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="174">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Philippines</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="175">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Pitcairn</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="176">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Poland</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="177">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Portugal</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="178">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Puerto Rico</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="179"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Qatar</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="180">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Réunion</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="181">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Romania</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="182">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Russian Federation</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="183">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Rwanda</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="184">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Saint Barthélemy</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="185">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Saint Helena</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="186">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Saint Kitts and Nevis</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="187">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Saint Lucia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="188">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Saint Vincent and the Grenadines</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="189">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Saint-Martin (France)</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="190"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Samoa</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="191">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">San Marino</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="192">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sao Tome and Principe</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="193">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Saudi Arabia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="194">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Senegal</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="195">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Serbia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="196">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Seychelles</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="197">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sierra Leone</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="198">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Singapore</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="199">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sint Maarten (Dutch part)</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="200">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Slovakia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="201">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Slovenia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="202">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Solomon Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="203">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Somalia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="204">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">South Africa</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="205">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">South Georgia and the South Sandwich Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="206">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">South Korea</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="207">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">South Sudan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="208"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Spain</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="209">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sri Lanka</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="210">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">St. Pierre and Miquelon</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="211"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sudan</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="212">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Suriname</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="213">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Svalbard and Jan Mayen Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="214">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Swaziland</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="215">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sweden</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="216">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Switzerland</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="217"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Syria</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="218">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Taiwan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="219">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Tajikistan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="220">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Tanzania</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="221">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Thailand</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="222">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">The Netherlands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="223">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Timor-Leste</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="224"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Togo</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="225">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Tokelau</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="226"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Tonga</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="227">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Trinidad and Tobago</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="228">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Tunisia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="229">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Turkey</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="230">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Turkmenistan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="231">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Turks and Caicos Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="232">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Tuvalu</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="233">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Uganda</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="234">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ukraine</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="235">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">United Arab Emirates</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="236">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">United Kingdom</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="237">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">United States</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="238">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">United States Minor Outlying Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="239">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Uruguay</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="240">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Uzbekistan</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="241">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Vanuatu</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="242">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Vatican</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="243">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Venezuela</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="244">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Vietnam</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="245">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Virgin Islands (British)</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="246">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Virgin Islands (U.S.)</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="247">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Wallis and Futuna Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="248">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Western Sahara</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="249"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Yemen</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="250">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Zambia</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="251">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Zimbabwe</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="252">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Åland Islands</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
</ul>
</div><select name="d_address_country" id="d_address_country" class="form-control selectpicker g_address_country" data-stripe="address_country" autocomplete="country" data-size="8" tabindex="-98">
<option value="Australia">Australia</option>
<option value="United States">United States</option>
<option value="United Kingdom">United Kingdom</option>
<option value="">---------------------</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia" selected="selected">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Caribbean Netherlands ">Caribbean Netherlands </option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of">Congo, Democratic Republic of</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard and McDonald Islands">Heard and McDonald Islands</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macau">Macau</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Korea">North Korea</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Réunion">Réunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Saint-Martin (France)">Saint-Martin (France)</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch part)">Sint Maarten (Dutch part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Korea">South Korea</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="St. Pierre and Miquelon">St. Pierre and Miquelon</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="The Netherlands">The Netherlands</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican">Vatican</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands (British)">Virgin Islands (British)</option>
<option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option>
<option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="Åland Islands">Åland Islands</option>
</select>
</div>
</div>
</div>
</div>
</div>
<input type="hidden" name="d_address_dpid" id="d_address_dpid" value="" tabindex="-1">
<script>
$(document).ready(function() {
$('#d_address_state').autocomplete({
source: "/funraisin/getstatesjson/",
minLength: 2,
select: function(event, ui) {
setTimeout(function() {
$("#d_address_state").val(ui.item.state_code);
}, 700);
}
});
});
</script>
<div class="col-xs-12 col-12 sponsor-comments">
<div class="row">
<div class="height-10"></div>
<div class="col-xs-12 col-12">
<div class="form-group d_comment">
<label class="col-xs-12 col-12"> Leave a Message </label>
<div class="col-xs-12 col-12">
<textarea class="form-control" name="d_comments" id="d_comments" rows="4" cols="30" maxlength="350"></textarea>
</div>
</div>
</div>
<div class="col-xs-12 col-12">
<div class="form-group">
<div class="col-xs-12 col-12">
<div class="vertical-align checkbox-wrapper">
<input type="checkbox" name="d_anonymous" value="Y" id="d_anonymous" tabindex="-1">
<span class="checkbox-text">I'd like to remain anonymous</span>
</div>
</div>
</div>
</div>
<script>
$('#DonationForm_7104 #d_anonymous').on('click', function() {
if ($(this).is(":checked")) {
$('#DonationForm_7104 .display_name').addClass('hidden');
} else {
$('#DonationForm_7104 .display_name').removeClass('hidden');
}
});
</script>
<div class="col-xs-12 col-12 display_name">
<div class="form-group d_comment">
<label class="col-xs-12 col-12">Name to appear</label>
<div class="col-xs-12 col-12">
<input class="form-control" type="text" name="d_display_name" id="d_display_name" tabindex="-1">
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row pt10">
<div class="vertical-align width-full buttons-block">
<div class="text-center btn-back-block">
<a class="btn btn-back btn-xl" tabindex="-1"><span class="material-icons">chevron_left</span></a>
</div>
<div class="text-center btn-action-block">
<button type="button" class="btn btn-primary btn-block btn-xl btn-next" rel="personaldetails" tabindex="-1"><span>Payment Options</span></button>
</div>
</div>
</div>
</div>
</section>
<section class="section slick-slide" id="paymentdetails" data-slick-index="2" aria-hidden="true" style="width: 400px; position: relative; left: -800px; top: 0px; z-index: 998; opacity: 0;" tabindex="-1"
data-gtm-vis-polling-id111291816_26="104">
<div class="container">
<div class="row">
<h3 class="text-center col-xs-12 col-12">Payment Details</h3>
<p id="error" class="text-center error" style="display:none">
<b></b>
</p>
<div class="buttons-block col-xs-12">
<a href="javascript:;" data-rel="paypal" class="btn btn-payment-element btn-pay-paypal fadeout" tabindex="-1"></a>
<a href="javascript:void(0);" data-rel="credit card" class="btn btn-payment-element btn-pay-creditcard" id="elements_credit_card" tabindex="-1"><img src="https://d1p2vuwzdwq826.cloudfront.net/cacd2a43ec8cb767ea934456b7916b4f.svg" alt="Credit Card">Credit Card</a>
</div>
<input type="hidden" name="payment_method" id="payment_method" value="credit card" tabindex="-1">
<script>
$('.btn-payment-element').on('click', function() {
$('#payment_method').val($(this).data('rel'));
$('.btn-payment-element').addClass('fadeout');
$(this).removeClass('fadeout');
if ($(this).data('rel') == 'paypal') {
$('.creditcard,.eft').addClass('hidden');
$('.paypal').removeClass('hidden');
} else if ($(this).data('rel') == 'eft') {
$('.creditcard,.paypal').addClass('hidden');
$('.eft').removeClass('hidden');
} else {
$('.creditcard').removeClass('hidden');
$('.paypal,.eft').addClass('hidden');
}
});
</script>
<div class="height-20"></div>
<div class="col-xs-12 col-12 paypal hidden">
<div class="form-group">
<div class="col-xs-12 col-12 pt20 pb20">
</div>
</div>
</div>
<div class="col-xs-12 col-12 creditcard">
<div class="form-group">
<label class="col-sm-12" for="card_name"> Name on Card * </label>
<div class="col-sm-12">
<input type="text" class="form-control " name="card_name" id="card_name" value="" required="" data-stripe="name" x-autocompletetype="cc-name" tabindex="-1">
</div>
</div>
</div>
<div class="col-xs-12 col-12 creditcard">
<div class="form-group">
<label class="col-sm-12" for="card_number"> Card Number * </label>
<div class="col-sm-12">
<input type="text" class="form-control" name="card_number" id="card_number" value="" required="" data-stripe="number" data-eway-encrypt-name="EWAY_CARDNUMBER" data-braintree="number" tabindex="-1">
</div>
</div>
</div>
<div class="clear"></div>
<div class="col-sm-6 col-xs-12 col-12 creditcard">
<div class="form-group">
<label class="col-xs-12 col-12 " for="card_expiry_month">Card Expiry *</label>
<div class="col-sm-6 col-xs-6 col-6">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle bs-placeholder form-control" data-toggle="dropdown" role="button" data-id="card_expiry_month" tabindex="-1" title="MM"><span
class="filter-option pull-left">MM</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">MM</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">01</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">02</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="3"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">03</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="4"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">04</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="5"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">05</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="6"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">06</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="7"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">07</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="8"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">08</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="9"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">09</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="10"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">10</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="11"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">11</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="12"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">12</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
</ul>
</div><select class="form-control selectpicker" id="card_expiry_month" name="card_expiry_month" data-braintree-name="expiration_month" data-stripe="exp_month" tabindex="-98">
<option value="">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>
</div>
</div>
<div class="col-sm-6 col-xs-6 col-6">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle bs-placeholder form-control" data-toggle="dropdown" role="button" data-id="card_expiry_year" tabindex="-1" title="YY"><span
class="filter-option pull-left">YY</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">YY</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2024</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2025</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="3"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2026</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="4"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2027</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="5"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2028</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="6"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2029</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="7"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2030</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="8"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2031</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="9"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2032</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="10"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2033</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="11"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">2034</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
</ul>
</div><select class="form-control selectpicker" id="card_expiry_year" name="card_expiry_year" data-braintree-name="expiration_year" data-stripe="exp_year" aria-label="Expiry year (YY)" tabindex="-98">
<option value="">YY</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>
</select>
</div>
</div>
</div>
</div>
<div class="col-sm-6 col-xs-12 col-12 creditcard">
<div class="form-group">
<label class="col-xs-12 col-12 " for="card_cvv">CVV *</label>
<div class="col-sm-6 col-xs-6 col-6">
<input class="form-control" type="text" size="5" id="card_cvv" name="card_cvv" value="" maxlength="4" data-eway-encrypt-name="EWAY_CARDCVN" data-braintree-name="cvv" data-stripe="cvc" autocomplete="off" tabindex="-1">
</div>
<div class="col-sm-6 col-xs-6 col-6">
<img src="https://4e14afa0f2e33fe0acb7-65ce87aea9ade6f30f5e307f425e6c8a.ssl.cf5.rackcdn.com/cvv.png" style="width:55px;margin-top:-10px;">
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-6 col-xs-12 col-12 donation-amount-display">
<div class="form-group">
<label class="col-xs-12 col-12 pt10 pb0">Donation Amount</label>
<div class="col-sm-4">
<span id="amountdonating">$110</span> <span id="donatingfrequency"></span>
</div>
</div>
</div>
</div>
<style>
.funraisin-fee-bordered .funraisin-fee-box {
border: 1px solid #ff9928;
}
.funraisin-fee-box {
padding: 5px 20px 20px;
border-radius: 5px;
}
.funraisin-fee-box i,
.funraisin-fee-box .hoverlink {
color: #8abce6;
}
.optincheckbox:not(.funraisin-fee-bordered) .funraisin-fee-box {
background: #8abce610;
}
</style>
<input type="hidden" name="optin_fees_rate" id="optin_fees_rate" value="5.5" tabindex="-1">
<input type="hidden" name="d_optin_fees" id="d_optin_fees" value="Y" tabindex="-1">
<div class="row optincheckbox funraisin-fee-default funraisin-no-bg">
<div class="col-xs-12 col-12">
<div class="funraisin-fee-box funraisin-no-bg">
<label class="fee-box-header">Cover platform costs <span class="funraisin-fee-heart"><img class="static" src="https://d1gotx1r5o7hbd.cloudfront.net/e27154d713bcc89ca73cade1b4cd8e33.png"></span></label>
<p class="funraisin-fee-text "><i class="only-default fa fa-heart"></i> I'd like to add a little extra to help cover fees. </p>
<div>
<div class="btn-group bootstrap-select form-control dropup"><button type="button" class="dropdown-toggle form-control" data-toggle="dropdown" role="button" data-id="d_fee_multiple" title="$6.05" tabindex="-1"><span
class="filter-option pull-left">$6.05</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0"><a tabindex="-1" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">$8.80</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="1"><a tabindex="-1" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">$8.25</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="2"><a tabindex="-1" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">$7.15</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="3" class="selected">
<a tabindex="-1" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">$6.05</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="4"><a tabindex="-1" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">$5.50</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="5"><a tabindex="-1" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">$4.95</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="6"><a tabindex="-1" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">$4.40</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="7">
<a tabindex="-1" class="only-default" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Other (or $0)</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="8">
<a tabindex="-1" class="only-bordered" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">I don't wish to help cover costs</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
</ul>
</div><select class="form-control selectpicker dropup" name="d_fee_multiple" id="d_fee_multiple" data-dropup-auto="false" autocomplete="off" tabindex="-1">
<option value="8.80" data-percentage="8" data-amount="">$8.80</option>
<option value="8.25" data-percentage="7.5" data-amount="">$8.25</option>
<option value="7.15" data-percentage="6.5" data-amount="">$7.15</option>
<option value="6.05" data-percentage="5.5" data-amount="" selected="" data-default="true">$6.05</option>
<option value="5.50" data-percentage="5" data-amount="">$5.50</option>
<option value="4.95" data-percentage="4.5" data-amount="">$4.95</option>
<option value="4.40" data-percentage="4" data-amount="">$4.40</option>
<option class="only-default" value="other">Other (or $0)</option>
<option class="only-bordered" value="0">I don't wish to help cover costs</option>
</select>
</div>
</div>
<div class="fee-other hidden">
<p>Your contribution helps cover the costs of fundraising.</p>
<div class="input-group float-center">
<span class="input-group-addon border-radius-left white color-primary size-125"> $ </span>
<input type="number" class="form-control" name="d_fee_other" id="d_fee_other" value="1" min="0" autocomplete="off" tabindex="-1">
</div>
</div>
</div>
</div>
</div>
<script>
var populateFeeDropdown = function(total) {
var amount = total;
var maxamount = parseFloat(amount * (5.5 / 100));
var showpercentage = false;
$("#d_fee_multiple option").each(function() {
if ($(this).attr('value') != 'other' && $(this).attr('value') != '0') {
var percentage = $(this).data('percentage');
var value = (amount * (percentage / 100)).toFixed(2);
if (maxamount > 20 || value > 20) {
value = parseFloat(20 * (percentage / 5.5)).toFixed(2);
showpercentage = false;
if (percentage > 5.5) {
$(this).hide();
value = 20;
} else {
$(this).show();
}
} else {
$(this).show();
}
if (value > 0) {
if (showpercentage) {
$(this).text('$' + value);
} else {
$(this).text('$' + value);
}
} else {
if (percentage > 0) {
$(this).text(percentage + '%');
} else {
$(this).text('$0');
}
}
$(this).val(value);
}
});
$('select#d_fee_multiple').selectpicker('refresh');
}
$('select#d_fee_multiple').on('change', function() {
if ($(this).val() == 'other') {} else {
$('d_fee').val($(this).find(':selected').data('amount'));
}
calculateDonation_7104();
});
$('#d_fee_other').on('input', function() {
$('#d_fee').val($(this).val());
});
$(document).ready(function() {
$('select#d_fee_multiple').on('change', function() {
if ($(this).val() == 'other') {
$('.fee-other').removeClass('hidden');
} else {
$('.fee-other').addClass('hidden');
if ($(this).val() > 0) {
$('.optout-box').addClass('hidden');
} else {
$('.optout-box').removeClass('hidden');
}
}
});
$('#d_fee_other').on('input', function() {
if ($(this).val() > 0) {
$('.optout-box').addClass('hidden');
} else {
$('.optout-box').removeClass('hidden');
}
});
$('select#d_fee_multiple').on('change', function() {
if ($(this).val() == 0) {
$('#d_optin_fees').val('');
} else {
$('#d_optin_fees').val('Y');
}
});
$('#d_fee_other').on('input', function() {
if ($(this).val() == '') {
$('#d_fee_other').val(0);
}
if ($(this).val() == 0) {
$('#d_optin_fees').val('');
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</form>Text Content
* Home * * Giving Day Heroes * Match Partners * Donate Login * Giving Day Heroes * Match Partners * Donate Login GIVE TODAY FOR A STRONGER TOMORROW. Every day, 72 Australian men hear the words no one wants to hear: you have prostate cancer. Donate to PCFA’s Giving Day on Thursday, 21 November to help save their lives. ALL DONATIONS DOUBLED. DONATE NOW YOU CAN HELP FUND LIFE-SAVING RESEARCH At 54, Peter’s prostate cancer diagnosis came to him like a bolt from the blue. “I was shocked. Cancer is something only other people get. You always think to yourself: I’m not going to get cancer. I had a robotic prostatectomy in April and continue to get better every day. “I wouldn’t wish the experience on anybody. If we develop new treatments and ways of managing the disease, we would be spared a lot of pain.” Peter Schweizer Prostate cancer survivor Every 20 minutes an Australian man will be diagnosed with prostate cancer. Research saves lives. MAKE A DONATION MATCHED GIVING $130,397 $130,397 RAISED raised of goal $200,000 $200,000 GOAL $130,397 RAISED raised of goal $200,000 $200,000 GOAL * attach_money * person * credit_card $252 Biomarker research $110 Precision medicine tests $55 Tumour targeting studies PLEASE SELECT A DONATION AMOUNT Precision medicine tests $ With matched giving PCFA receives $220 Donate YOUR DETAILS Individual Organisation Organisation Name * First Name * Last Name * Email Address * Mobile +61 +0 +1 +1242 +1246 +1264 +1268 +1345 +1441 +1473 +1649 +1664 +1670 +1671 +1684 +1758 +1767 +1784 +1787 +1809 +1868 +1869 +1876 +20 +212 +213 +216 +220 +221 +222 +223 +224 +225 +226 +227 +228 +229 +230 +231 +232 +233 +234 +235 +236 +237 +238 +239 +240 +241 +242 +244 +245 +246 +248 +249 +250 +251 +252 +253 +254 +256 +257 +258 +260 +261 +262 +263 +264 +265 +266 +267 +268 +269 +27 +290 +291 +297 +298 +299 +30 +31 +32 +33 +34 +350 +351 +352 +353 +354 +355 +356 +357 +358 +359 +36 +370 +371 +372 +374 +375 +376 +377 +378 +380 +385 +386 +387 +39 +40 +41 +420 +421 +423 +43 +44 +45 +46 +47 +48 +49 +501 +502 +503 +504 +505 +506 +507 +509 +51 +52 +53 +54 +55 +56 +57 +58 +590 +591 +592 +593 +594 +595 +596 +597 +598 +60 +61 +62 +63 +64 +65 +66 +670 +672 +673 +674 +675 +676 +677 +678 +679 +680 +682 +683 +684 +686 +687 +688 +689 +690 +691 +692 +7 +70 +7370 +81 +82 +84 +852 +855 +856 +86 +880 +886 +90 +91 +92 +93 +94 +95 +960 +961 +962 +964 +965 +966 +967 +968 +971 +972 +973 +974 +975 +976 +977 +992 +994 +995 +996 +998 Postal Address (enter manually) Address Line 1 Address Line 2 Town/Suburb Postcode State Country Australia * Australia * United States * United Kingdom * --------------------- * Afghanistan * Albania * Algeria * American Samoa * Andorra * Angola * Anguilla * Antarctica * Antigua and Barbuda * Argentina * Armenia * Aruba * Australia * Austria * Azerbaijan * Bahamas * Bahrain * Bangladesh * Barbados * Belarus * Belgium * Belize * Benin * Bermuda * Bhutan * Bolivia * Bosnia and Herzegovina * Botswana * Bouvet Island * Brazil * British Indian Ocean Territory * Brunei Darussalam * Bulgaria * Burkina Faso * Burundi * Cambodia * Cameroon * Canada * Cape Verde * Caribbean Netherlands * Cayman Islands * Central African Republic * Chad * Chile * China * Christmas Island * Cocos (Keeling) Islands * Colombia * Comoros * Congo * Congo, Democratic Republic of * Cook Islands * Costa Rica * Côte d'Ivoire * Croatia * Cuba * Curaçao * Cyprus * Czech Republic * Denmark * Djibouti * Dominica * Dominican Republic * Ecuador * Egypt * El Salvador * Equatorial Guinea * Eritrea * Estonia * Ethiopia * Falkland Islands * Faroe Islands * Fiji * Finland * France * French Guiana * French Polynesia * French Southern Territories * Gabon * Gambia * Georgia * Germany * Ghana * Gibraltar * Greece * Greenland * Grenada * Guadeloupe * Guam * Guatemala * Guernsey * Guinea * Guinea-Bissau * Guyana * Haiti * Heard and McDonald Islands * Honduras * Hong Kong * Hungary * Iceland * India * Indonesia * Iran * Iraq * Ireland * Isle of Man * Israel * Italy * Jamaica * Japan * Jersey * Jordan * Kazakhstan * Kenya * Kiribati * Kuwait * Kyrgyzstan * Lao People's Democratic Republic * Latvia * Lebanon * Lesotho * Liberia * Libya * Liechtenstein * Lithuania * Luxembourg * Macau * Macedonia * Madagascar * Malawi * Malaysia * Maldives * Mali * Malta * Marshall Islands * Martinique * Mauritania * Mauritius * Mayotte * Mexico * Micronesia, Federated States of * Moldova * Monaco * Mongolia * Montenegro * Montserrat * Morocco * Mozambique * Myanmar * Namibia * Nauru * Nepal * New Caledonia * New Zealand * Nicaragua * Niger * Nigeria * Niue * Norfolk Island * North Korea * Northern Mariana Islands * Norway * Oman * Pakistan * Palau * Palestine, State of * Panama * Papua New Guinea * Paraguay * Peru * Philippines * Pitcairn * Poland * Portugal * Puerto Rico * Qatar * Réunion * Romania * Russian Federation * Rwanda * Saint Barthélemy * Saint Helena * Saint Kitts and Nevis * Saint Lucia * Saint Vincent and the Grenadines * Saint-Martin (France) * Samoa * San Marino * Sao Tome and Principe * Saudi Arabia * Senegal * Serbia * Seychelles * Sierra Leone * Singapore * Sint Maarten (Dutch part) * Slovakia * Slovenia * Solomon Islands * Somalia * South Africa * South Georgia and the South Sandwich Islands * South Korea * South Sudan * Spain * Sri Lanka * St. Pierre and Miquelon * Sudan * Suriname * Svalbard and Jan Mayen Islands * Swaziland * Sweden * Switzerland * Syria * Taiwan * Tajikistan * Tanzania * Thailand * The Netherlands * Timor-Leste * Togo * Tokelau * Tonga * Trinidad and Tobago * Tunisia * Turkey * Turkmenistan * Turks and Caicos Islands * Tuvalu * Uganda * Ukraine * United Arab Emirates * United Kingdom * United States * United States Minor Outlying Islands * Uruguay * Uzbekistan * Vanuatu * Vatican * Venezuela * Vietnam * Virgin Islands (British) * Virgin Islands (U.S.) * Wallis and Futuna Islands * Western Sahara * Yemen * Zambia * Zimbabwe * Åland Islands Australia United States United Kingdom --------------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Åland Islands Leave a Message I'd like to remain anonymous Name to appear chevron_left Payment Options PAYMENT DETAILS Credit Card Name on Card * Card Number * Card Expiry * MM * MM * 01 * 02 * 03 * 04 * 05 * 06 * 07 * 08 * 09 * 10 * 11 * 12 MM 01 02 03 04 05 06 07 08 09 10 11 12 YY * YY * 2024 * 2025 * 2026 * 2027 * 2028 * 2029 * 2030 * 2031 * 2032 * 2033 * 2034 YY 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 CVV * Donation Amount $110 Cover platform costs I'd like to add a little extra to help cover fees. $6.05 * $8.80 * $8.25 * $7.15 * $6.05 * $5.50 * $4.95 * $4.40 * Other (or $0) * I don't wish to help cover costs $8.80 $8.25 $7.15 $6.05 $5.50 $4.95 $4.40 Other (or $0) I don't wish to help cover costs Your contribution helps cover the costs of fundraising. $ Donate Now $130,397 $130,397 RAISED raised of goal $200,000 $200,000 GOAL $130,397 RAISED raised of goal $200,000 $200,000 GOAL YOU CAN HELP FUND A FUTURE FREE OF PROSTATE CANCER Your donation will fund clinical trials to help discover new medicines and treatments for men with prostate cancer. Together, we can end the pain of prostate cancer and protect future generations of Australian men from being taken away from us. Donate now EVERY DONATION WILL BE DOUBLED Thanks to our generous corporate partners, all donations received until midnight 21 November, 2024 will be DOUBLED, helping us go even further in the fight against prostate cancer. Donate now You are our Giving Day Heroes Thank you to all our generous supporters for standing up against prostate cancer. FIND YOUR MESSAGE $1,000 BRIAN WUST $1,000 MATCHED GIFT Matched by our corporate partners $116.05 HAIMONTI $116.05 MATCHED GIFT Matched by our corporate partners $54.12 RONALD CATTLE $54.12 MATCHED GIFT Matched by our corporate partners $110 MATCHED GIFT Matched by our corporate partners $110 GEOFF BLAKE Still struggling myself but have had some better results lately. Can only hope the Chemo is working. $54.12 ANONYMOUS $54.12 MATCHED GIFT Matched by our corporate partners $55 JAMIE & BEV ROBERTS In loving memory of Mark Sheekey, who will be greatly missed. $55 MATCHED GIFT Matched by our corporate partners Next You can also Donate via Direct Deposit: Account Name: Prostate Cancer Foundation of Australia Ltd BSB: 062 000 Account Number: 12668231 Payment reference: Your full name To request your receipt: donations@pcfa.org.au Facebook Post Email Linkedin Donate Top of page CONTACT * fundraising@pcfa.org.au * 1800 22 00 99 * Giving Day Heroes * | * Donate FIND US ON * * * * * Acknowledgment of country * Commitment to diversity Copyright © 2023 Prostate Cancer Foundation of Australia | ABN: 31 521 774 656 | Charity Number: 073 253 924 Privacy Policy | Donations of $2 or more to Prostate Cancer Foundation of Australia are tax-deductible in Australia. You can also Donate via Direct Deposit: Account Name: Prostate Cancer Foundation of Australia Ltd BSB: 062 000 Account Number: 1266 8231 Payment reference: Your full name To request your receipt: donations@pcfa.org.au Donate Top of page Subscribe CONTACT donations@pcfa.org.au 1800 22 00 99 FIND US ON Donate Top of page Subscribe to get the latest news Copyright © 2024 Prostate Cancer Foundation of Australia | ABN: 31 521 774 656 | Charity Number: 073 253 924 | Privacy Policy Donations of $2 or more to Prostate Cancer Foundation of Australia are tax-deductible in Australia. Copyright © 2024 Prostate Cancer Foundation of Australia | ABN: 31 521 774 656 | Charity Number: 073 253 924 | Privacy Policy Donations of $2 or more to Prostate Cancer Foundation of Australia are tax-deductible in Australia. * About * * Events * * Donate * * FAQs * * Register * * prostate.org.au Acknowledgement of Country Commitment to Diversity Copyright © 2024 Prostate Cancer Foundation of Australia | ABN: 31 521 774 656 | Charity Number: 073 253 924 Privacy Policy | Donations of $2 or more to Prostate Cancer Foundation of Australia are tax-deductible in Australia. Copyright © 2024 Prostate Cancer Foundation of Australia ABN: 31 521 774 656 Charity Number: 073 253 924 Privacy Policy | Donations of $2 or more to Prostate Cancer Foundation of Australia are tax-deductible in Australia.