events.helphopelive.org
Open in
urlscan Pro
172.67.73.126
Public Scan
URL:
https://events.helphopelive.org/event/6028/signup/
Submission: On April 08 via manual from GB — Scanned from GB
Submission: On April 08 via manual from GB — Scanned from GB
Form analysis 2 forms found in the DOM
Name: hhl_signup_form — POST
<form id="id_hhl_signup_form" name="hhl_signup_form" method="POST" class="form" enctype="multipart/form-data">
<input id="id_event_item_set-TOTAL_FORMS" name="event_item_set-TOTAL_FORMS" type="hidden" value="14"><input id="id_event_item_set-INITIAL_FORMS" name="event_item_set-INITIAL_FORMS" type="hidden" value="14"><input
id="id_event_item_set-MIN_NUM_FORMS" name="event_item_set-MIN_NUM_FORMS" type="hidden" value="0"><input id="id_event_item_set-MAX_NUM_FORMS" name="event_item_set-MAX_NUM_FORMS" type="hidden" value="1000">
<div id="id_options_div" class="panel" style="margin-top: 10px;">
<h2 class="panel__header"> Registration Options </h2>
<div class="panel__content" style="padding-bottom: 0px;">
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-0-id" name="event_item_set-0-id" type="hidden" value="7203"> Individual Golfer - SAVE $20 Early Bird till May 6th (regularly $165)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-0-price"> $145.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-0-quantity" name="event_item_set-0-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-0-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-0-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-1-id" name="event_item_set-1-id" type="hidden" value="7204"> Foursome Team - SAVE $80 Early BIrd till May 6th (regularly $660)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-1-price"> $580.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-1-quantity" name="event_item_set-1-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-1-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-1-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-2-id" name="event_item_set-2-id" type="hidden" value="7205"> *TOURNAMENT SPONSOR* - As our exemplary Sponsor, enjoy FULL GOLF PACKAGES for 8 people. Your name will be prominently displayed on a solo 6’ banner;
acknowledged with top billing in our program, & have Social Media exposure. ($5,008 is tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-2-price"> $6000.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-2-quantity" name="event_item_set-2-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-2-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-2-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-3-id" name="event_item_set-3-id" type="hidden" value="7206"> *DINNER SPONSOR* - As a valued Top Tier Sponsor, enjoy FULL GOLF PACKAGES for 4 people. Your name will be prominently displayed on a 6’ banner;
acknowledged proudly in our program, & have Social Media exposure. ($3504 tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-3-price"> $4000.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-3-quantity" name="event_item_set-3-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-3-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-3-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-4-id" name="event_item_set-4-id" type="hidden" value="7207"> *19th HOLE SPONSOR* - As a key Top Tier Sponsor, enjoy FULL GOLF PACKAGES for 2 people. Your name will be displayed on a 6’ banner; proudly acknowledged
in our program, & have Social Media exposure. ($1752 tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-4-price"> $2000.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-4-quantity" name="event_item_set-4-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-4-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-4-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-5-id" name="event_item_set-5-id" type="hidden" value="7208"> *PLATINUM SPONSOR* - As one of our Top Tier Sponsors, enjoy 2 Complimentary Dinner Passes including 2 hr open Delux Bar. Your name will be displayed on
a 6’ banner; acknowledged in our program, & have Social Media exposure. ($880 tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-5-price"> $1000.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-5-quantity" name="event_item_set-5-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-5-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-5-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-6-id" name="event_item_set-6-id" type="hidden" value="7209"> Gift Bag Sponsor - A treasured sponsor for our goodie bags given to each golfer. Signage proudly displayed along with personalized labels on each bag.
Acknowledgment in our program & social media exposure. (100% tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-6-price"> $800.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-6-quantity" name="event_item_set-6-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-6-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-6-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-7-id" name="event_item_set-7-id" type="hidden" value="7210"> Prize Sponsor - A winning sponsorship for the winners of our golfer contests! Longest Drive, Closest to the Pin, etc. Signage & Acknowledgement in
our program, (100% tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-7-price"> $600.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-7-quantity" name="event_item_set-7-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-7-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-7-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-8-id" name="event_item_set-8-id" type="hidden" value="7211"> Gold Sponsor - includes representation on signage & recognition in program. (100% tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-8-price"> $500.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-8-quantity" name="event_item_set-8-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-8-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-8-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-9-id" name="event_item_set-9-id" type="hidden" value="7212"> Silver Sponsor - includes representation on signage & recognition in program. (100% tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-9-price"> $400.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-9-quantity" name="event_item_set-9-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-9-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-9-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-10-id" name="event_item_set-10-id" type="hidden" value="7213"> Bronze Sponsor - includes representation on signage & recognition in program. (100% tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-10-price"> $300.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-10-quantity" name="event_item_set-10-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-10-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-10-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-11-id" name="event_item_set-11-id" type="hidden" value="7214"> Hole Sponsor - includes individual full color signage on course hole & recognition in program. (100% tax deductible)
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-11-price"> $200.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-11-quantity" name="event_item_set-11-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-11-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-11-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-12-id" name="event_item_set-12-id" type="hidden" value="7215"> Luncheon Guest - Enjoy a 2 hr open Deluxe bar from 2-4pm, Hors D'oeurves, Appetizers, Sumptuous Buffets
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-12-price"> $60.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-12-quantity" name="event_item_set-12-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-12-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-12-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;">
<input id="id_event_item_set-13-id" name="event_item_set-13-id" type="hidden" value="7216"> Donation in Honor of Lauren Shevchek - enter your desired donation amount, OR enter in INCREASE YOUR MPACT box below
</div>
<div class="row hhl-item-row">
<table>
<tbody>
<tr>
<td class="hhl-list-td" style="width: 40%;">
<h3 style="margin-bottom: 7px;">Price (USD)</h3>
<div id="id_event_item_set-13-price"> $1.00 </div>
</td>
<td class="hhl-list-td" style="width: 60%;">
<h3>Quantity</h3>
<div class="gfield">
<input class="unsigned-integer-only" id="id_event_item_set-13-quantity" name="event_item_set-13-quantity" style="width: 100px; padding-top: 0px; height: 30px;" type="number">
</div>
<div id="id_event_item_set-13-subtot-div" style="display: none;">
<h5 style="margin-bottom: 7px;">Sub-total:</h5> $<span id="id_event_item_set-13-subtot-val"></span>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="row hhl-item-text-bold">
<div id="id_event_item-total-div" style="text-align: left;margin-bottom:5px;"> Order total: $<span id="id_event_item-total-val">0.00</span>
</div>
</div>
</div>
</div>
<div class="panel" style="margin-top: 10px;">
<h2 class="panel__header"> Additional Registration Question </h2>
<div class="panel__content" style="padding-bottom: 0px;">
<div class="row hhl-item-text">
<div class="urlized">To ensure accurate registration, Please list FULL NAMES & EMAILS of each Golfer on your team in registration box below.<br><br>- All sponsors will be contacted via email to secure info for signage.<br><br>- CAN'T
ATTEND, BUT STILL WANT TO HELP? <br> Please make your donation to Lauren below in the "Increase Your Impact" box. <br><br>Enter the amount of your donation where it says: <br> "Include an additional gift to the
campaign." <br><br>All donations listed here are considered "Gifts In Honor of Lauren Shevchek" are 100% tax deductible!<br>
THANK YOU!<br></div>
</div>
<div class="row" style="margin-bottom: 10px;">
<label class="gfield_label"> Please enter Registration Answer </label>
<div class="gfield">
<textarea cols="40" id="id_registration_answer" name="registration_answer" rows="2"></textarea>
</div>
</div>
</div>
</div>
<div class="panel" style="margin-top: 10px;">
<h2 class="panel__header"> Your Information </h2>
<div class="panel__content" style="padding-bottom: 0px;margin-bottom: 10px;">
<div class="row">
<div class="half">
<label class="gfield_label"> First name </label>
<div class="gfield">
<input id="id_first_name" maxlength="255" name="first_name" type="text">
</div>
</div>
<div class="half">
<label class="gfield_label"> Last name </label>
<div class="gfield">
<input id="id_last_name" maxlength="255" name="last_name" type="text">
</div>
</div>
</div>
<div class="row">
<label class="gfield_label"> Address 1 </label>
<div class="gfield">
<input id="id_address_1" maxlength="255" name="address_1" type="text">
</div>
</div>
<div class="row">
<label class="gfield_label"> Address 2 </label>
<div class="gfield">
<input id="id_address_2" maxlength="255" name="address_2" type="text">
</div>
</div>
<div class="row">
<div class="half">
<label class="gfield_label"> City </label>
<div class="gfield">
<input id="id_city" maxlength="255" name="city" type="text">
</div>
</div>
<div class="half">
<label class="gfield_label"> State </label>
<div class="gfield">
<div class="select2-container" id="s2id_id_state">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span class="select2-chosen">Select State/Province</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow"><b></b></span></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen1">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="id_state" name="state" tabindex="-1" class="select2-offscreen">
<option value="" selected="selected">Select State/Province</option>
<optgroup label="United States">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</optgroup>
<optgroup label="Canada">
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NL">Newfoundland</option>
<option value="NT">Northwest Territories</option>
<option value="NS">Nova Scotia</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="QC">Quebec</option>
<option value="SK">Saskatchewan</option>
<option value="YT">Yukon</option>
</optgroup>
<optgroup label="US Territories">
<option value="AS">American Samoa</option>
<option value="FM">Federated States of Micronesia</option>
<option value="GU">Guam</option>
<option value="MH">Marshall Islands</option>
<option value="MP">MP</option>
<option value="PW">Palau</option>
<option value="PR">Puerto Rico</option>
<option value="VI">Virgin Islands</option>
</optgroup>
<optgroup label="US Military">
<option value="AE">Armed Forces</option>
<option value="AA">Armed Forces Americas</option>
<option value="AP">Armed Forces Pacific</option>
</optgroup>
<optgroup label="Other">
<option value="XX">Outside the US or Canada</option>
</optgroup>
</select>
</div>
</div>
</div>
<div class="row">
<div class="half">
<label class="gfield_label"> Zip code </label>
<div class="gfield">
<input id="id_zip_code" maxlength="255" name="zip_code" type="text">
</div>
</div>
<div class="half">
<label class="gfield_label"> Country </label>
<div class="gfield">
<div class="select2-container" id="s2id_id_country">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span class="select2-chosen">United States</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow"><b></b></span></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen2">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="id_country" name="country" tabindex="-1" class="select2-offscreen">
<option value="">Select Country</option>
<option value="United States" selected="selected">United States</option>
<option value="Canada">Canada</option>
<option value="Mexico">Mexico</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">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 Herzegowina">Bosnia and Herzegowina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Terr.">British Indian Ocean Terr.</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="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote d'Ivoire">Cote d'Ivoire</option>
<option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>
<option value="Cuba">Cuba</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="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands/Malvinas">Falkland Islands/Malvinas</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="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 Terr.">French Southern Terr.</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="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard & McDonald Is.">Heard & McDonald Is.</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="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea">Korea</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Dem. Rep.">Lao People's Dem. Rep.</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</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">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Is.">Northern Mariana Is.</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</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="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="S.Georgia & S.Sandwich Is.">S.Georgia & S.Sandwich Is.</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)</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="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="St. Helena">St. Helena</option>
<option value="St. Pierre & Miquelon">St. Pierre & Miquelon</option>
<option value="St. Vincent & Grenadines">St. Vincent & Grenadines</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard & Jan Mayen Is.">Svalbard & Jan Mayen Is.</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</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 & Caicos Islands">Turks & Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="U.S. Minor Outlying Is.">U.S. Minor Outlying Is.</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="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican (Holy See)">Vatican (Holy See)</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands (British)">Virgin Islands (British)</option>
<option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option>
<option value="Wallis & Futuna Is.">Wallis & Futuna Is.</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Yugoslavia">Yugoslavia</option>
<option value="Zaire">Zaire</option>
<option value="Zambia">Zambia</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="half">
<label class="gfield_label"> Email </label>
<div class="gfield">
<input id="id_email" maxlength="255" name="email" type="email">
</div>
</div>
</div>
<div class="row">
<div class="half">
<label class="gfield_label"> Phone </label>
<div class="gfield">
<input id="id_phone" maxlength="255" name="phone" type="text">
</div>
</div>
</div>
<div class="row">
<label class="gfield_label"> Message to organizer </label>
<div class="gfield">
<textarea cols="40" id="id_message_to_organizer" name="message_to_organizer" rows="2"></textarea>
</div>
</div>
</div>
</div>
<div id="additional_donations_div" class="panel" tyle="margin-top: 10px;">
<div class="panel" style="margin-bottom:0px;">
<h2 class="panel__header">Increase Your Impact</h2>
</div>
<div class="panel__content" style="margin-bottom: 5px;padding-bottom:0px;">
<div class="row" style="margin-bottom: 5px;">
<div id="id_additional_ask_div">
<div class="row">
<div style="padding-right:25px;padding-left:25px;">
<!--
<label class="gfield_label">
Include an additional gift to the campaign
</label>
-->
<p style="font-size:16px;">Include an additional gift to the campaign</p>
</div>
<div style="margin-left: 15px;">
<table>
<tbody>
<tr>
<td class="" style="width: 20px;
border: none; padding: 0px; padding-top: 5px;
vertical-align: top; text-align: right;"> $ </td>
<td class="" style="border: none;
padding-top: 0px; padding-left: 5px;
text-align: left;">
<div class="gfield">
<input id="id_additional_campaign_amount" name="additional_campaign_amount" placeholder="0.00" step="0.01" style="width: 150px;" type="number">
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<div class="row">
<p class="gfield_label" style="padding-right:25px;padding-left:25px;font-size:16px">
</p>
<p class="ttcontainer">By adding a tip, you can cover 100% of medical expenses while supporting our nonprofit's continued operations. <span class="tooltip2 bottom"
data-tooltip="Optional tips help cover standard processing fees plus everything Help Hope Live provides, including expert fundraising help, custom campaign tools, and trusted bill pay support. If you skip the tip, a small transaction fee (2.65%) and our admin fee (3%) applies.">Why
Tip?</span></p>
<br>
<label class="gfield_label"> Help Hope Live Tip </label>
<div style="margin-left: 15px;">
<table>
<tbody>
<tr>
<td style="
border: none; padding: 0px; padding-top: 5px;padding-right:10px;
vertical-align: top; text-align: left;left:-10px;width:150px;">
<div class="gfield">
<div class="select2-container" id="s2id_id_cover_fees" style="width: 125px;">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span class="select2-chosen">10%</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow"><b></b></span></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen3">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="id_cover_fees" name="cover_fees" style="width: 125px;" tabindex="-1" class="select2-offscreen">
<option value=".0565">5.65%</option>
<option value=".10" selected="selected">10%</option>
<option value=".15">15%</option>
<option value=".20">20%</option>
<option value="0">No Tip</option>
</select>
</div>
</td>
<td class="" style="width: 20px;
border: none; padding: 0px; padding-top: 15px;
vertical-align: top; text-align: right;"> $ </td>
<td class="" style="border: none;
padding-top: 0px; padding-left: 5px;
text-align: left;disabled:disabled;">
<div class="gfield">
<input id="id_additional_hhl_amount" name="additional_hhl_amount" step="0.01" style="width: 125px;disabled:disabled;pointer-events:none;" type="number">
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<div id="id_amount_div" class="panel" style="margin-top: 10px;">
<h2 class="panel__header"> Amount </h2>
<div class="panel__content" style="padding-bottom: 0px;">
<div id="id_event_sub-total-div" class="row hhl-item-row" style="margin-bottom:5px;color:#7d7d7d;"> Registration Amount: <span style="float:right;"> $<span id="id_event_reg-total-val">0.00</span>
</span>
</div>
<div id="id_additional_campaign_sub-total-div" class="row hhl-item-row" style="margin-bottom:5px;color:#7d7d7d;"> Gift in Honor of Lauren Shevchek: <span style="float:right;">$<span id="id_additional_campaign_sub-total">0.00</span></span>
</div>
<div id="id_hhl_tip_sub-total-div" class="row hhl-item-row" style="margin-bottom:5px;color:#7d7d7d;"> Help Hope Live Tip: <span style="float:right;">$<span id="id_hhl_tip_sub-total">0.00</span></span>
</div>
<div class="row hhl-item-text-bold" style="margin-bottom: 5px;"> Total Amount: <!-- $<span id="id_event_total-val"></span>-->
<!-- +-->
<!-- $<span id="id_event_additional-val"></span>-->
<!-- =-->
<span style="float:right;">$<span id="id_event_final-total-val">0.00</span></span>
</div>
<div class="row">
<p style="color: #01aeb4; font-weight: bold;padding-bottom: 10px;"> Grateful for your support! </p>
</div>
</div>
</div>
<div id="id_payment_div" class="panel" style="margin-top: 10px; display: none;">
<h2 class="panel__header"> Payment Method </h2>
<div class="panel__content" style="padding-bottom: 0px;">
<div class="row" style="margin-bottom: 10px;">
<div class="half">
<label class="gfield_label"> Payment Type </label>
<div class="gfield">
<div class="select2-container" id="s2id_sel-payment-type">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span class="select2-chosen">Select a Payment Type</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow"><b></b></span></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen4">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="sel-payment-type" name="payment_type" onchange="togglePaymentSections();" tabindex="-1" class="select2-offscreen">
<option value="" selected="selected">Select a Payment Type</option>
<option value="ECHECK">Electronic Check</option>
<option value="visa">Visa</option>
<option value="mc">MasterCard</option>
<option value="amex">American Express</option>
<option value="discover">Discover</option>
</select>
</div>
</div>
</div>
<div id="id-cc-fields">
<div class="row" style="margin-bottom: 10px;">
<div class="half">
<label class="gfield_label"> Credit Card Number </label>
<div class="gfield">
<input id="id_card_number" maxlength="50" name="card_number" type="text">
</div>
</div>
</div>
<div class="row" style="margin-bottom: 10px;">
<div class="one-third">
<label class="gfield_label"> Card CVV Value </label>
<div class="gfield">
<input id="id_security_code" maxlength="50" name="security_code" type="text">
</div>
</div>
<div class="one-third">
<label class="gfield_label"> Exp Month </label>
<div class="gfield">
<div class="select2-container" id="s2id_id_exp_month">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span class="select2-chosen">Exp Month</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow"><b></b></span></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen5">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="id_exp_month" name="exp_month" tabindex="-1" class="select2-offscreen">
<option value="" selected="selected">Exp Month</option>
<option value="01">Jan</option>
<option value="02">Feb</option>
<option value="03">Mar</option>
<option value="04">Apr</option>
<option value="05">May</option>
<option value="06">Jun</option>
<option value="07">Jul</option>
<option value="08">Aug</option>
<option value="09">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select>
</div>
</div>
<div class="one-third">
<label class="gfield_label"> Exp Year </label>
<div class="gfield">
<div class="select2-container" id="s2id_id_exp_year">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span class="select2-chosen">Exp Year</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow"><b></b></span></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen6">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="id_exp_year" name="exp_year" tabindex="-1" class="select2-offscreen">
<option value="" selected="selected">Exp Year</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
<option value="2034">2034</option>
</select>
</div>
</div>
</div>
</div>
<div id="id-banking-fields" style="display: none;">
<div class="row" style="margin-bottom: 10px;">
<div class="two-thirds">
<label class="gfield_label"> Bank Account Type </label>
<div class="gfield">
<div class="select2-container" id="s2id_id_bank_account_type">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span class="select2-chosen">Select a Bank Account Type</span><abbr class="select2-search-choice-close"></abbr> <span class="select2-arrow"><b></b></span></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen7">
<div class="select2-drop select2-display-none select2-with-searchbox">
<div class="select2-search"> <input type="text" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="id_bank_account_type" name="bank_account_type" tabindex="-1" class="select2-offscreen">
<option value="" selected="selected">Select a Bank Account Type</option>
<option value="checking">Checking</option>
<option value="savings">Savings</option>
</select>
</div>
</div>
</div>
<div class="row" style="margin-bottom: 10px;">
<img style="max-width: 80%; height: auto;" src="/static/donate/images/check_rev4Web.ac9b76dfb55e.jpg">
</div>
<div class="row" style="margin-bottom: 10px;">
<div class="two-thirds">
<label class="gfield_label"> Bank Routing Number </label>
<div class="gfield">
<input id="id_bank_routing_number" maxlength="9" name="bank_routing_number" type="text">
</div>
</div>
</div>
<div class="row" style="margin-bottom: 10px;">
<div class="two-thirds">
<label class="gfield_label"> Bank Account Number </label>
<div class="gfield">
<input id="id_bank_account_number" maxlength="255" name="bank_account_number" type="text">
</div>
</div>
</div>
<div class="row" style="margin-bottom: 10px;">
<div class="two-thirds">
<label class="gfield_label"> Bank Name </label>
<div class="gfield">
<input id="id_bank_name" maxlength="50" name="bank_name" type="text">
</div>
</div>
</div>
<div class="row" style="margin-bottom: 10px;">
<div class="two-thirds">
<label class="gfield_label"> Name as it appears on the bank account </label>
<div class="gfield">
<input id="id_bank_account_name" maxlength="50" name="bank_account_name" type="text">
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row" style="text-align: center;">
<a id="id-register-event-btn" type="text" class="btn" style="width: 280px;" onclick="document.hhl_signup_form.submit()">Complete Registration</a>
</div>
</form>Name: mc-embedded-subscribe-form — POST //helphopelive.us13.list-manage.com/subscribe/post?u=d09b7ed513b58fdfb881016a6&id=c672f34d9f
<form action="//helphopelive.us13.list-manage.com/subscribe/post?u=d09b7ed513b58fdfb881016a6&id=c672f34d9f" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate="novalidate">
<div id="mc_embed_signup_scroll">
<p class="md-sans modal-form__title"><strong>Subscribe to our mailing list</strong></p>
<div class="indicates-required xxs-sans teal sm-caps"><span class="asterisk">*</span> indicates required</div>
<div class="mc-field-group">
<input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL" placeholder="Email Address *" aria-required="true">
<label for="mce-EMAIL" class="screen-reader-only">Email Address <span class="asterisk">*</span></label>
</div>
<div class="mc-field-group">
<input type="text" value="" name="FNAME" class="required" id="mce-FNAME" placeholder="First Name *" aria-required="true">
<label for="mce-FNAME" class="screen-reader-only">First Name <span class="asterisk">*</span></label>
</div>
<div class="mc-field-group">
<input type="text" value="" name="LNAME" class="required" id="mce-LNAME" placeholder="Last Name *" aria-required="true">
<label for="mce-LNAME" class="screen-reader-only">Last Name <span class="asterisk">*</span></label>
</div>
<div id="mce-responses" class="clear modal-form__response">
<div class="response" id="mce-error-response" style="display:none"></div>
<div class="response" id="mce-success-response" style="display:none">
<button type="button" class="toggle-newsletter">Close</button>
</div>
</div>
<!-- are you reptilian? -->
<div style="position: absolute; left: -5000px;" aria-hidden="true"><input type="text" name="b_d09b7ed513b58fdfb881016a6_c672f34d9f" tabindex="-1" value=""></div>
<div class="clear"><input type="submit" value="Sign Up" name="subscribe" id="mc-embedded-subscribe" class="button btn btn-teal"></div>
</div>
</form>Text Content
* About * Mission & Values * Our Advantage * History * Team * Publications * FAQs * Impact * Latest * Events * Shop * Our Store * Partner Discounts Donate Get Started Login Contact Us When: July 22, 2024 8:00 AM Registration & Breakfast Where: Spring Mill Country Club 80 Jacksonville Road Ivyland, PA 18974 Organizer: Janice Shevchek 215-620-3700 LaurensAngelsTeam@gmail.com JULY 22, 2024; 8:00 AM REGISTRATION & BREAKFAST 10TH ANNUAL GOLF FUNDRAISER TOURNAMENT We are looking forward to celebrating in a BIG WAY at our 10th Annual Golf Fundraiser Tournament. Held once again at Spring Mill's private & pristine Country Club in Ivyland, PA. Please consider joining us for this memorable event. Tax deductible Donations & Sponsorships are greatly appreciated as well. Beyond GRATEFUL for the support of our sponsors, our community & our golfers. WHAT TO EXPECT: Spring Mill's Private Country Club offers an exquisite course with challenging play amidst superbly manicured greens, and long fairways for those who seek a challenge. Lining the fairways are mature trees which provide welcome shade. Spring Mill is located less than 30 minutes from Trenton & Philadelphia. They have sported numerous recent upgrades, including a new driving range, and updated golf carts with GPS navigation. This is a great opportunity to play on a desirable private course while supporting Lauren's battle back from a paralyzing accident. Funds raised also help those in the Mid-Atlantic Catastrophic Injury Fund, of which she is a member. THANK YOU for joining us for this awesome day for an inspiring cause! 8:00 am BAG DROP & REGISTRATION: Enjoy grab‘n’go breakfast sandwiches, fruit, coffee, tea, soda and beer. 9:00 am SCRAMBLE START: While on the course, players enjoy two roving hospitality carts with complimentary snacks, beverages & a refreshing Keg awaits you at the turn. Compete for cash & prizes during play. ~ 2:15 pm LUNCHEON: Join us at the "19th Hole" and enjoy a FREE 2 HR DELUXE BAR. A new chef creates plentiful buffets offering a variety of expertly prepared dishes to satisfy even the most ravenous appetite. The summer buffet is BBQ themed and includes a spice rubbed hearty brisket, rosemary roasted chicken, succulent ribs and more. ** Contests prizes, awards, & silent auction are ongoing during reception ** Tax Deductible SPONSORSHIPS for this event are the driving force behind affording Lauren's uninsured medical expenses which seem to mount each year. Please consider returning as a sponsor or adding a sponsorship or donation this year. Corporate matching also available. Being a sponsor gives you the unique opportunity to support a great cause as well as gain exposure for your business. Sponsorship includes signage associated with your contribution level & acknowledgment in our program. Our TOP TIER SPONSORS* also enjoy complimentary golf packages and/or dinner passes as well as Social Media exposure. Please consider a tax-deductible sponsorship or donation with your registration as this is what truly drives success in reaching our fundraising goals. This year, the top three sponsorship levels will also include a special 10th anniversary gift for each member of your team. It can be personalized with your company's name if desired. Details of sponsorship perks are described on the registration page. As always, sponsorships are tax deductible, to the extent of the law, through our 501c3 non-profit affiliation with Help Hope Live (see brochure for details). THANK YOU for considering attending and or sponsoring this year's fundraiser. Your support inspires MIRACLES!! Register Now Arrow Icon REGISTRATION OPTIONS Individual Golfer - SAVE $20 Early Bird till May 6th (regularly $165) PRICE (USD) $145.00 QUANTITY SUB-TOTAL: $ Foursome Team - SAVE $80 Early BIrd till May 6th (regularly $660) PRICE (USD) $580.00 QUANTITY SUB-TOTAL: $ *TOURNAMENT SPONSOR* - As our exemplary Sponsor, enjoy FULL GOLF PACKAGES for 8 people. Your name will be prominently displayed on a solo 6’ banner; acknowledged with top billing in our program, & have Social Media exposure. ($5,008 is tax deductible) PRICE (USD) $6000.00 QUANTITY SUB-TOTAL: $ *DINNER SPONSOR* - As a valued Top Tier Sponsor, enjoy FULL GOLF PACKAGES for 4 people. Your name will be prominently displayed on a 6’ banner; acknowledged proudly in our program, & have Social Media exposure. ($3504 tax deductible) PRICE (USD) $4000.00 QUANTITY SUB-TOTAL: $ *19th HOLE SPONSOR* - As a key Top Tier Sponsor, enjoy FULL GOLF PACKAGES for 2 people. Your name will be displayed on a 6’ banner; proudly acknowledged in our program, & have Social Media exposure. ($1752 tax deductible) PRICE (USD) $2000.00 QUANTITY SUB-TOTAL: $ *PLATINUM SPONSOR* - As one of our Top Tier Sponsors, enjoy 2 Complimentary Dinner Passes including 2 hr open Delux Bar. Your name will be displayed on a 6’ banner; acknowledged in our program, & have Social Media exposure. ($880 tax deductible) PRICE (USD) $1000.00 QUANTITY SUB-TOTAL: $ Gift Bag Sponsor - A treasured sponsor for our goodie bags given to each golfer. Signage proudly displayed along with personalized labels on each bag. Acknowledgment in our program & social media exposure. (100% tax deductible) PRICE (USD) $800.00 QUANTITY SUB-TOTAL: $ Prize Sponsor - A winning sponsorship for the winners of our golfer contests! Longest Drive, Closest to the Pin, etc. Signage & Acknowledgement in our program, (100% tax deductible) PRICE (USD) $600.00 QUANTITY SUB-TOTAL: $ Gold Sponsor - includes representation on signage & recognition in program. (100% tax deductible) PRICE (USD) $500.00 QUANTITY SUB-TOTAL: $ Silver Sponsor - includes representation on signage & recognition in program. (100% tax deductible) PRICE (USD) $400.00 QUANTITY SUB-TOTAL: $ Bronze Sponsor - includes representation on signage & recognition in program. (100% tax deductible) PRICE (USD) $300.00 QUANTITY SUB-TOTAL: $ Hole Sponsor - includes individual full color signage on course hole & recognition in program. (100% tax deductible) PRICE (USD) $200.00 QUANTITY SUB-TOTAL: $ Luncheon Guest - Enjoy a 2 hr open Deluxe bar from 2-4pm, Hors D'oeurves, Appetizers, Sumptuous Buffets PRICE (USD) $60.00 QUANTITY SUB-TOTAL: $ Donation in Honor of Lauren Shevchek - enter your desired donation amount, OR enter in INCREASE YOUR MPACT box below PRICE (USD) $1.00 QUANTITY SUB-TOTAL: $ Order total: $0.00 ADDITIONAL REGISTRATION QUESTION To ensure accurate registration, Please list FULL NAMES & EMAILS of each Golfer on your team in registration box below. - All sponsors will be contacted via email to secure info for signage. - CAN'T ATTEND, BUT STILL WANT TO HELP? Please make your donation to Lauren below in the "Increase Your Impact" box. Enter the amount of your donation where it says: "Include an additional gift to the campaign." All donations listed here are considered "Gifts In Honor of Lauren Shevchek" are 100% tax deductible! THANK YOU! Please enter Registration Answer YOUR INFORMATION First name Last name Address 1 Address 2 City State Select State/Province Select State/Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon American Samoa Federated States of Micronesia Guam Marshall Islands MP Palau Puerto Rico Virgin Islands Armed Forces Armed Forces Americas Armed Forces Pacific Outside the US or Canada Zip code Country United States Select Country United States Canada Mexico 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 Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Terr. Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands/Malvinas Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Is. Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Lao People's Dem. Rep. Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Is. Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda S.Georgia & S.Sandwich Is. Saint Kitts and Nevis Saint Lucia Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Pierre & Miquelon St. Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Is. Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu U.S. Minor Outlying Is. Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis & Futuna Is. Western Sahara Yemen Yugoslavia Zaire Zambia Email Phone Message to organizer INCREASE YOUR IMPACT Include an additional gift to the campaign $ By adding a tip, you can cover 100% of medical expenses while supporting our nonprofit's continued operations. Why Tip? Help Hope Live Tip 10% 5.65% 10% 15% 20% No Tip $ AMOUNT Registration Amount: $0.00 Gift in Honor of Lauren Shevchek: $0.00 Help Hope Live Tip: $0.00 Total Amount: $0.00 Grateful for your support! PAYMENT METHOD Payment Type Select a Payment Type Select a Payment Type Electronic Check Visa MasterCard American Express Discover Credit Card Number Card CVV Value Exp Month Exp Month Exp Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Exp Year Exp Year Exp Year 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 Bank Account Type Select a Bank Account Type Select a Bank Account Type Checking Savings Bank Routing Number Bank Account Number Bank Name Name as it appears on the bank account Complete Registration Return to Lauren's Page Arrow Right Icon SHARE EVENT PARTNERS IN HOPE OUR SUCCESS AS A FUNDRAISING SITE FOR MEDICAL BILLS WOULDN'T BE POSSIBLE IF IT WEREN'T FOR OUR OUTSTANDING PARTNERS. MOBILITYWORKS Accessibility for all: Helping people connect with who and what matters most VANTAGE MOBILITY INTERNATIONAL Building leading-edge mobility products AMS VANS One of the largest mobility dealers in the U.S. WALGREENS SPECIALTY PHARMACY Consult with specially-trained pharmacists, get your medications for pickup or delivery and more KYW NEWSRADIO 1060 All news, and all that matters to you PRELUDE SOLUTIONS Your first step to optimized communications ABILITIES EXPO The event for the disability community GLOBAL GENES ALLIANCE Born to connect, empower and inspire the rare disease community. UNITED ACCESS A mobility dealer for wheelchair accessible vehicles and adaptive equipment Donate Join Mailing List Donate Help Hope Live 2 Radnor Corporate Center, Suite 100 100 Matsonford Road Radnor, PA 19087 800.642.8399 A 501(c)(3) charitable organization EIN/Charity ID: 52-1322317 MISSION & VALUESOUR ADVANTAGEHISTORYTEAMPUBLICATIONSFAQS IMPACTLATESTGAMINGCONTACT USLOGINPRIVACY POLICY MISSION & VALUESOUR ADVANTAGEHISTORYTEAMPUBLICATIONSFAQS IMPACTLATESTGAMINGCONTACT USLOGINPRIVACY POLICY Help Hope Live 2 Radnor Corporate Center, Suite 100 100 Matsonford Road Radnor, PA 19087 800.642.8399 A 501(c)(3) charitable organization EIN/Charity ID: 52-1322317 Stay Informed Sign up for our eNewsletter to get the latest updates, tips and tricks for running your campaign, and other resources. Sign Up Subscribe to our mailing list * indicates required Email Address * First Name * Last Name * Close