www2.jdrf.org
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74.123.154.222
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Submitted URL: https://click.content.jdrf.org/?qs=d51a493d102fd4a052e31836aec727dc54c6f61fd06b01c701e8889fe90147ae7c5557bfe59f41801b43f6cd8bb3...
Effective URL: https://www2.jdrf.org/site/Donation2?2376.donation=form1&df_id=2376&utm_source=newsletter&utm_medium=email&utm_campaig...
Submission: On July 13 via api from US — Scanned from DE
Effective URL: https://www2.jdrf.org/site/Donation2?2376.donation=form1&df_id=2376&utm_source=newsletter&utm_medium=email&utm_campaig...
Submission: On July 13 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
<form class="ng-pristine ng-valid">
<div class="spirit-form__field-group spirit-form__input spirit-form__input--with-icon" role="combobox" aria-expanded="false" aria-haspopup="listbox" aria-labelledby="downshift-0-label"><label for="jdrf-global-header-search"
class="spirit-form__label spirit-form__label-accessible-text">Search</label>
<div class="spirit-form__input-icon-wrap -left"><svg xmlns="http://www.w3.org/2000/svg" class="spirit-icon spirit-form__input-icon" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke-width="2" stroke-linecap="round"
stroke-linejoin="round">
<circle cx="11" cy="11" r="8"></circle>
<line x1="21" y1="21" x2="16.65" y2="16.65"></line>
</svg></div><input aria-autocomplete="list" aria-labelledby="downshift-0-label" autocomplete="off" class="spirit-form__input-field" id="jdrf-global-header-search" placeholder="Search"> <input type="submit"
class="spirit-form__label-accessible-text" value="Submit">
</div>
</form>Name: donationForm — POST
<form name="donationForm" method="POST" ng-submit="submitDonation()" novalidate="" class="ng-pristine ng-invalid ng-invalid-required ng-valid-email">
<div ng-init="donationFormInfo.donation_form_auth = 'Ycc5g42SfJ4xeYhoY0G5X7LZMuuNXrnddm6J3gCxH7XFGEDrBOEBJwrLoiVUE3iaeN57lDedDY8v9Uo37OuxFBUeoRaG-Wx99rIiRiA'"></div>
<div class="jdrf-don-form-intro">
<div class="spirit-row">
<div class="spirit-col-12">
<div ng-bind-html="donationFormIntro.introText" class="ng-binding">
<h1 class="spirit-h2">Donate Today</h1>
<div class="spirit-body-text-m">
<p><strong>JUVENILE DIABETES RESEARCH FOUNDATION INTERNATIONAL<sup>®</sup> (JDRF)’s</strong> mission is to find a cure for type 1 diabetes (T1D) and its complications through the support of research. Every dollar we direct toward critical
T1D research comes from donors like you. Your generosity propels us toward our goal of a world without T1D.</p>
<p>Your tax-deductible gift today will help us continue our work to bring life-changing treatments and therapies to the millions of people living with T1D until we find a cure.</p>
<p>Thank you for your support.</p>
<p>Looking for other ways to give? Make a <a class="spirit-link" href="Donation2?df_id=2374"><strong>Memorial Donation</strong></a> or a <a class="spirit-link" href="Donation2?df_id=2373"><strong>Tribute Donation</strong></a>.</p>
</div>
</div>
</div>
</div>
</div>
<div class="form__fields js--donation-form-fields" ng-show="donationFormIntro" aria-hidden="false" style="">
<div class="form__error ng-hide" ng-show="donationFormErrors.pageError" aria-hidden="true">
<div class="spirit-form__message spirit-form__message--error">
<div class="spirit-form__message-icon-wrap">
<svg class="spirit-icon spirit-form__message-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
<div class="spirit-form__message-text form-errors-message ng-binding" ng-bind-html="donationFormErrors.pageError"></div>
</div>
</div>
<!--
<div class="spirit-row jdrf-don-form-amounts">
<div class="spirit-col-4" ng-repeat="donationLevel in donationLevels.levels" ng-if="donationLevel.userSpecified != 'true'">
<div class="spirit-button spirit-button--toggle">
<input class="spirit-button__input spirit-button__checkbox" type="radio" id="donationFormInfo-level_id-{{donationLevel.level_id}}" name="level_id" ng-model="donationFormInfo.level_id" value="{{donationLevel.level_id}}" required>
<label for="donationFormInfo-level_id-{{donationLevel.level_id}}" class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.level_id == donationLevel.level_id}" tabindex="0">
<span ng-bind-html="donationLevel.amount.formatted"></span>
</label>
</div>
</div> -->
<section class="form-section">
<h4 class="spirit-h4"> Frequency </h4>
<div class="spirit-row row-radios jdrf-don-form-frequency">
<div class="spirit-col-md-6 form-item-radio one-time-gift-radio">
<div class="spirit-button spirit-button--toggle">
<label class="spirit-button__inner spirit-button__inner--active" ng-class="{'spirit-button__inner--active': donationFormInfo.ng_donation_pattern == 'one-time'}">
<input type="radio" class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-valid ng-not-empty" id="donationFormInfo-ng_donation_pattern" name="ng_donation_pattern" ng-model="donationFormInfo.ng_donation_pattern"
value="one-time" ng-change="changeFreq('one-time')" aria-invalid="false">
<span class="spirit-form__radio-inner">
<!-- <span class="spirit-form__radio-visual"></span> -->
<span class="spirit-form__radio-label"> One Time Gift </span>
</span>
</label>
</div>
</div>
<div class="spirit-col-md-6 form-item-radio">
<div class="spirit-button spirit-button--toggle">
<label class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.ng_donation_pattern == 'monthly'}">
<input type="radio" class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-valid ng-not-empty" id="donationFormInfo-ng_donation_pattern" name="ng_donation_pattern" ng-model="donationFormInfo.ng_donation_pattern"
value="monthly" ng-change="changeFreq('monthly')" aria-invalid="false">
<span class="spirit-form__radio-inner">
<!-- <span class="spirit-form__radio-visual"></span> -->
<span class="spirit-form__radio-label"> Monthly Gift </span>
</span>
</label>
</div>
</div>
</div>
<!-- ngIf: formType == 'monthlyLevels' && donationFormInfo.ng_donation_pattern == 'one-time' -->
<div class="jdrf-don-form-message spirit-form__message spirit-form__message--info ng-scope" ng-if="formType == 'monthlyLevels' && donationFormInfo.ng_donation_pattern == 'one-time'" style="">
<div class="spirit-form__message-icon-wrap">
<svg aria-label="help-circle" class="spirit-icon spirit-form__message-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle">
</use>
</svg>
</div>
<div class="spirit-form__message-text">
<p>Make a bigger impact with a smaller monthly gift! Did you know that giving a small amount each month instead of a one-time gift can help sustain long-term projects and programs that mean more treatments and breakthroughs towards a cure?
</p>
</div>
</div><!-- end ngIf: formType == 'monthlyLevels' && donationFormInfo.ng_donation_pattern == 'one-time' -->
<!-- ngIf: donationFormErrors.donationAmount -->
<div>
<div ng-show="formType != 'monthlyLevels'" aria-hidden="true" class="ng-hide" style="">
<div class="spirit-row jdrf-don-form-amounts">
<!-- ngRepeat: donationLevel in donationLevels.levels -->
<!-- ngRepeat: donationLevel in donationLevels.levels -->
</div>
</div>
<div ng-show="formType == 'monthlyLevels'" aria-hidden="false" class="" style="">
<!-- ngIf: donationFormInfo.ng_donation_pattern == 'one-time' -->
<div class="spirit-row jdrf-don-form-amounts ng-scope" ng-if="donationFormInfo.ng_donation_pattern == 'one-time'">
<!-- ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified != 'true' -->
<div class="spirit-col-4 ng-scope" ng-repeat="donationLevel in onetimeLevels.levels" ng-if="donationLevel.userSpecified != 'true'" style="">
<div class="spirit-button spirit-button--toggle">
<input class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" type="radio" id="donationFormInfo-level_id-66835" name="level_id" ng-model="donationFormInfo.level_id"
value="66835" required="" aria-invalid="true">
<label for="donationFormInfo-level_id-66835" class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.level_id == donationLevel.level_id}" tabindex="0">
<span ng-bind-html="donationLevel.amount.formatted" class="ng-binding">$1,000</span>
</label>
</div>
</div><!-- end ngIf: donationLevel.userSpecified != 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified != 'true' -->
<div class="spirit-col-4 ng-scope ng-enter-prepare" ng-repeat="donationLevel in onetimeLevels.levels" ng-if="donationLevel.userSpecified != 'true'">
<div class="spirit-button spirit-button--toggle">
<input class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" type="radio" id="donationFormInfo-level_id-66836" name="level_id" ng-model="donationFormInfo.level_id"
value="66836" required="" aria-invalid="true">
<label for="donationFormInfo-level_id-66836" class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.level_id == donationLevel.level_id}" tabindex="0">
<span ng-bind-html="donationLevel.amount.formatted" class="ng-binding">$500</span>
</label>
</div>
</div><!-- end ngIf: donationLevel.userSpecified != 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified != 'true' -->
<div class="spirit-col-4 ng-scope ng-enter-prepare" ng-repeat="donationLevel in onetimeLevels.levels" ng-if="donationLevel.userSpecified != 'true'">
<div class="spirit-button spirit-button--toggle">
<input class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" type="radio" id="donationFormInfo-level_id-66837" name="level_id" ng-model="donationFormInfo.level_id"
value="66837" required="" aria-invalid="true">
<label for="donationFormInfo-level_id-66837" class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.level_id == donationLevel.level_id}" tabindex="0">
<span ng-bind-html="donationLevel.amount.formatted" class="ng-binding">$250</span>
</label>
</div>
</div><!-- end ngIf: donationLevel.userSpecified != 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified != 'true' -->
<div class="spirit-col-4 ng-scope ng-enter-prepare" ng-repeat="donationLevel in onetimeLevels.levels" ng-if="donationLevel.userSpecified != 'true'">
<div class="spirit-button spirit-button--toggle">
<input class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" type="radio" id="donationFormInfo-level_id-66838" name="level_id" ng-model="donationFormInfo.level_id"
value="66838" required="" aria-invalid="true">
<label for="donationFormInfo-level_id-66838" class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.level_id == donationLevel.level_id}" tabindex="0">
<span ng-bind-html="donationLevel.amount.formatted" class="ng-binding">$120</span>
</label>
</div>
</div><!-- end ngIf: donationLevel.userSpecified != 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified != 'true' -->
<div class="spirit-col-4 ng-scope ng-enter-prepare" ng-repeat="donationLevel in onetimeLevels.levels" ng-if="donationLevel.userSpecified != 'true'">
<div class="spirit-button spirit-button--toggle">
<input class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" type="radio" id="donationFormInfo-level_id-66839" name="level_id" ng-model="donationFormInfo.level_id"
value="66839" required="" aria-invalid="true">
<label for="donationFormInfo-level_id-66839" class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.level_id == donationLevel.level_id}" tabindex="0">
<span ng-bind-html="donationLevel.amount.formatted" class="ng-binding">$60</span>
</label>
</div>
</div><!-- end ngIf: donationLevel.userSpecified != 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified != 'true' -->
<div class="spirit-col-4 ng-scope ng-enter-prepare" ng-repeat="donationLevel in onetimeLevels.levels" ng-if="donationLevel.userSpecified != 'true'">
<div class="spirit-button spirit-button--toggle">
<input class="spirit-button__input spirit-button__checkbox ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" type="radio" id="donationFormInfo-level_id-66840" name="level_id" ng-model="donationFormInfo.level_id"
value="66840" required="" aria-invalid="true">
<label for="donationFormInfo-level_id-66840" class="spirit-button__inner" ng-class="{'spirit-button__inner--active': donationFormInfo.level_id == donationLevel.level_id}" tabindex="0">
<span ng-bind-html="donationLevel.amount.formatted" class="ng-binding">$30</span>
</label>
</div>
</div><!-- end ngIf: donationLevel.userSpecified != 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified != 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels -->
<!-- ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified == 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified == 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified == 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified == 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified == 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified == 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels --><!-- ngIf: donationLevel.userSpecified == 'true' -->
<div class="spirit-col-12 ng-scope" ng-repeat="donationLevel in onetimeLevels.levels" ng-if="donationLevel.userSpecified == 'true'" style="">
<div class="spirit-form__input input--other-amount">
<input type="radio" id="donationFormInfo-level_id-6315" name="level_id" ng-model="donationFormInfo.level_id" value="6315" required="" class="ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" aria-invalid="true">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-valid ng-empty ng-valid-required" id="donationFormInfo-other_amount" name="other_amount" ng-model="donationFormInfo.other_amount"
placeholder="Other amount" ng-required="donationFormInfo.level_id == donationLevel.level_id" ng-focus="selectOnetimeOtherDonationAmount()" aria-invalid="false">
</div>
</div><!-- end ngIf: donationLevel.userSpecified == 'true' --><!-- end ngRepeat: donationLevel in onetimeLevels.levels -->
</div><!-- end ngIf: donationFormInfo.ng_donation_pattern == 'one-time' -->
<!-- ngIf: donationFormInfo.ng_donation_pattern == 'monthly' -->
</div>
</div>
</section>
<section class="form-section">
<div class="spirit-d-none spirit-form__field-group"><label class="spirit-form__label" for="donation_fee_cover_amount__input" aria-hidden="true">Processing Fee Amount</label>
<div class="spirit-form__input"><input class="js--fill-from-text spirit-form__input-field ng-pristine ng-untouched ng-valid ng-empty" readonly="" name="donation_fee_cover_amount" type="text" id="donation_fee_cover_amount__input"
ng-model="donationFormInfo.donation_fee_cover_amount" aria-hidden="true" aria-invalid="false"></div>
</div>
<div class="spirit-d-none spirit-form__select"><select class="spirit-form__select-input ng-pristine ng-untouched ng-valid ng-empty" name="donation_fee_covered" ng-model="donationFormInfo.donation_fee_covered" aria-hidden="true"
aria-invalid="false">
<option class="spirit-form__select-option" value="" selected="selected"></option>
<option class="spirit-form__select-option" value="true">True</option>
<option class="spirit-form__select-option" value="false">False</option>
</select></div>
<div class="form-row"><label class="spirit-form__checkbox" for="donation-fee-covered"><input type="checkbox" class="spirit-form__checkbox-input checkmark-input ng-pristine ng-untouched ng-valid ng-empty"
ng-model="donationFormInfo.ng_cover_processing_fee" id="donation-fee-covered" aria-invalid="false"> <span class="spirit-form__checkbox-inner"><span class="spirit-form__checkbox-visual"><svg
class="spirit-icon spirit-form__checkbox-checked-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#check"></use>
</svg> </span><span class="spirit-form__checkbox-label">I would like to cover the <!-- ngIf: processingFee --> processing fee for this donation so more can go to our mission of fighting type 1 diabetes.</span></span></label></div>
</section>
<section class="form-section form-section--your-info">
<h4 class="spirit-h4"> Your Information </h4>
<div class="spirit-row">
<div class="spirit-col-md-6">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> First Name <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm['billing.name.first'].$invalid}">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-billing_first_name" name="billing.name.first" ng-model="donationFormInfo['billing.name.first']"
required="" aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm['billing.name.first'].$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['billing.name.first'].$invalid -->
</div>
</div>
<div class="spirit-col-md-6">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Last Name <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm['billing.name.last'].$invalid}">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-billing_last_name" name="billing.name.last" ng-model="donationFormInfo['billing.name.last']"
required="" aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm['billing.name.last'].$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['billing.name.last'].$invalid -->
</div>
</div>
</div>
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Email <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm['donor.email'].$invalid}">
<input type="email" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-valid-email ng-invalid ng-invalid-required" id="donationFormInfo-donor_email" name="donor.email" ng-model="donationFormInfo['donor.email']" required=""
aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm['donor.email'].$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['donor.email'].$invalid -->
</div>
</section>
<section class="form-section form-section--billing">
<h4 class="spirit-h4"> Billing Address </h4>
<div class="spirit-row">
<div class="spirit-col-md-8">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Street Address <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm['billing.address.street1'].$invalid}">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-billing_address_street1" name="billing.address.street1"
ng-model="donationFormInfo['billing.address.street1']" required="" aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm['billing.address.street1'].$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['billing.address.street1'].$invalid -->
</div>
</div>
<div class="spirit-col-md-4">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Line 2 </label>
<div class="spirit-form__input">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-valid ng-empty" id="donationFormInfo-billing_address_street2" name="billing.address.street2" ng-model="donationFormInfo['billing.address.street2']"
placeholder="Optional" aria-invalid="false">
</div>
</div>
</div>
</div>
<div class="spirit-row">
<div class="spirit-col-md-6 form-row">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Country <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__select" ng-class="{'spirit-form__select--invalid': donationForm.$submitted && donationForm['billing.address.country'].$invalid}">
<select name="billing.address.country" class="spirit-form__select-input ng-pristine ng-untouched ng-valid ng-not-empty ng-valid-required" id="donationFormInfo-billing_address_country"
ng-model="donationFormInfo['billing.address.country']" required="" size="1" aria-invalid="false">
<option value=""></option>
<option value="United States" selected="selected">United States</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivarian Republic of Venezuela">Bolivarian Republic of Venezuela</option>
<option value="Bonaire, Sint Eustatios and Saba">Bonaire, Sint Eustatios and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="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">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Democratic People's Republic of Korea">Democratic People's Republic of Korea</option>
<option value="The Democratic Republic of the Congo">The Democratic Republic of the Congo</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Federated States of Micronesia">Federated States of Micronesia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="The Former Yugoslav Republic of Macedonia">The Former Yugoslav Republic of Macedonia</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Islamic Republic of Iran">Islamic Republic of Iran</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Plurinational State of Bolivia">Plurinational State of Bolivia</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republic of Korea">Republic of Korea</option>
<option value="Republic of Moldova">Republic of Moldova</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French)">Saint Martin (French)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="S. Georgia & S. Sandwich Isls.">S. Georgia & S. Sandwich Isls.</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch)">Sint Maarten (Dutch)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United Republic of Tanzania">United Republic of Tanzania</option>
<option value="Uruguay">Uruguay</option>
<option value="USA Minor Outlying Islands">USA Minor Outlying Islands</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands (British)">Virgin Islands (British)</option>
<option value="Virgin Islands (USA)">Virgin Islands (USA)</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing.address.country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing.address.country_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<div class="spirit-form__select-inner"></div>
<span class="spirit-form__select-open-indicator">
<svg class="spirit-icon spirit-form__select-open-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#chevron-down"></use>
</svg>
</span>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['billing.address.country'].$invalid -->
</div>
</div>
<div class="spirit-col-md-6">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> ZIP/Postal Code <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm['billing.address.zip'].$invalid}">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-billing_address_zip" name="billing.address.zip" ng-model="donationFormInfo['billing.address.zip']"
required="" aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm['billing.address.zip'].$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['billing.address.zip'].$invalid -->
</div>
</div>
</div>
<div class="spirit-row">
<div class="spirit-col-md-6 form-row">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> City <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm['billing.address.city'].$invalid}">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-billing_address_city" name="billing.address.city"
ng-model="donationFormInfo['billing.address.city']" required="" aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm['billing.address.city'].$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['billing.address.city'].$invalid -->
</div>
</div>
<div class="spirit-col-md-6 form-row">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> State/Province <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__select" ng-class="{'spirit-form__select--invalid': donationForm.$submitted && donationForm['billing.address.state'].$invalid}">
<select name="billing.address.state" class="spirit-form__select-input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-billing_address_state" ng-model="donationFormInfo['billing.address.state']"
required="" size="1" aria-invalid="true">
<option value="" selected="selected"></option>
<option value="AK">AK - Alaska</option>
<option value="AL">AL - Alabama</option>
<option value="AR">AR - Arkansas</option>
<option value="AZ">AZ - Arizona</option>
<option value="CA">CA - California</option>
<option value="CO">CO - Colorado</option>
<option value="CT">CT - Connecticut</option>
<option value="DC">DC - District of Columbia</option>
<option value="DE">DE - Delaware</option>
<option value="FL">FL - Florida</option>
<option value="GA">GA - Georgia</option>
<option value="HI">HI - Hawaii</option>
<option value="IA">IA - Iowa</option>
<option value="ID">ID - Idaho</option>
<option value="IL">IL - Illinois</option>
<option value="IN">IN - Indiana</option>
<option value="KS">KS - Kansas</option>
<option value="KY">KY - Kentucky</option>
<option value="LA">LA - Louisiana</option>
<option value="MA">MA - Massachusetts</option>
<option value="MD">MD - Maryland</option>
<option value="ME">ME - Maine</option>
<option value="MI">MI - Michigan</option>
<option value="MN">MN - Minnesota</option>
<option value="MO">MO - Missouri</option>
<option value="MS">MS - Mississippi</option>
<option value="MT">MT - Montana</option>
<option value="NC">NC - North Carolina</option>
<option value="ND">ND - North Dakota</option>
<option value="NE">NE - Nebraska</option>
<option value="NH">NH - New Hampshire</option>
<option value="NJ">NJ - New Jersey</option>
<option value="NM">NM - New Mexico</option>
<option value="NV">NV - Nevada</option>
<option value="NY">NY - New York</option>
<option value="OH">OH - Ohio</option>
<option value="OK">OK - Oklahoma</option>
<option value="OR">OR - Oregon</option>
<option value="PA">PA - Pennsylvania</option>
<option value="RI">RI - Rhode Island</option>
<option value="SC">SC - South Carolina</option>
<option value="SD">SD - South Dakota</option>
<option value="TN">TN - Tennessee</option>
<option value="TX">TX - Texas</option>
<option value="UT">UT - Utah</option>
<option value="VA">VA - Virginia</option>
<option value="VT">VT - Vermont</option>
<option value="WA">WA - Washington</option>
<option value="WI">WI - Wisconsin</option>
<option value="WV">WV - West Virginia</option>
<option value="WY">WY - Wyoming</option>
<option value="AS">AS - American Samoa</option>
<option value="FM">FM - Federated States of Micronesia</option>
<option value="GU">GU - Guam</option>
<option value="MH">MH - Marshall Islands</option>
<option value="MP">MP - Northern Mariana Islands</option>
<option value="PR">PR - Puerto Rico</option>
<option value="PW">PW - Palau</option>
<option value="VI">VI - Virgin Islands</option>
<option value="AA">AA - Armed Forces Americas</option>
<option value="AE">AE - Armed Forces</option>
<option value="AP">AP - Armed Forces Pacific</option>
<option value="AB">AB - Alberta</option>
<option value="BC">BC - British Columbia</option>
<option value="MB">MB - Manitoba</option>
<option value="NB">NB - New Brunswick</option>
<option value="NL">NL - Newfoundland and Labrador</option>
<option value="NS">NS - Nova Scotia</option>
<option value="NT">NT - Northwest Territories</option>
<option value="NU">NU - Nunavut</option>
<option value="ON">ON - Ontario</option>
<option value="PE">PE - Prince Edward Island</option>
<option value="QC">QC - Quebec</option>
<option value="SK">SK - Saskatchewan</option>
<option value="YT">YT - Yukon</option>
<option value="None">None</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing.address.state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing.address.state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<div class="spirit-form__select-inner"></div>
<span class="spirit-form__select-open-indicator">
<svg class="spirit-icon spirit-form__select-open-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#chevron-down"></use>
</svg>
</span>
</div>
<!-- ngIf: donationForm.$submitted && donationForm['billing.address.state'].$invalid -->
</div>
</div>
</div>
</section>
<section class="form-section form-section--payment">
<div class="spirit-row">
<div class="spirit-col-12">
<h4 class="spirit-h4"> Payment Information </h4>
</div>
</div>
<!-- ngIf: donationFormErrors.paymentInfo -->
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Payment Type <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__select">
<select class="spirit-form__select-input ng-pristine ng-untouched ng-valid ng-not-empty ng-valid-required" id="donationFormInfo-ng_payment_method" name="ng_payment_method" ng-model="donationFormInfo.ng_payment_method" required=""
aria-invalid="false">
<!-- ngRepeat: donationPaymentMethod in donationPaymentMethods.methods -->
<option class="spirit-form__select-option ng-binding ng-scope" value="credit" ng-repeat="donationPaymentMethod in donationPaymentMethods.methods" selected="selected" style="">Credit Card</option>
<!-- end ngRepeat: donationPaymentMethod in donationPaymentMethods.methods -->
<option class="spirit-form__select-option ng-binding ng-scope" value="ach" ng-repeat="donationPaymentMethod in donationPaymentMethods.methods">Bank Withdrawal</option>
<!-- end ngRepeat: donationPaymentMethod in donationPaymentMethods.methods -->
<option class="spirit-form__select-option ng-binding ng-scope" value="paypal" ng-repeat="donationPaymentMethod in donationPaymentMethods.methods">PayPal</option>
<!-- end ngRepeat: donationPaymentMethod in donationPaymentMethods.methods -->
</select>
<div class="spirit-form__select-inner"></div>
<span class="spirit-form__select-open-indicator">
<svg class="spirit-icon spirit-form__select-open-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#chevron-down"></use>
</svg>
</span>
</div>
</div>
<!-- ngIf: donationFormInfo.ng_payment_method == 'credit' -->
<div class="form-item form-item--payment-option ng-scope" ng-if="donationFormInfo.ng_payment_method == 'credit'">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Card Number <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm.card_number.$invalid}">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo.card_number" name="card_number" ng-model="donationFormInfo.card_number"
ng-required="donationFormInfo.ng_payment_method == 'credit'" required="required" aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm.card_number.$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm.card_number.$invalid -->
</div>
<div class="spirit-row">
<div class="spirit-col-6 spirit-col-md-4">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Exp. Month <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__select" ng-class="{'spirit-form__select--invalid': donationForm.$submitted && donationForm.card_exp_date_month.$invalid}">
<select class="spirit-form__select-input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-card_exp_date_month" name="card_exp_date_month" ng-model="donationFormInfo.card_exp_date_month"
ng-required="donationFormInfo.ng_payment_method == 'credit'" required="required" aria-invalid="true">
<option class="spirit-form__select-option" value="" selected="selected">Month</option>
<option class="spirit-form__select-option" value="01">01</option>
<option class="spirit-form__select-option" value="02">02</option>
<option class="spirit-form__select-option" value="03">03</option>
<option class="spirit-form__select-option" value="04">04</option>
<option class="spirit-form__select-option" value="05">05</option>
<option class="spirit-form__select-option" value="06">06</option>
<option class="spirit-form__select-option" value="07">07</option>
<option class="spirit-form__select-option" value="08">08</option>
<option class="spirit-form__select-option" value="09">09</option>
<option class="spirit-form__select-option" value="10">10</option>
<option class="spirit-form__select-option" value="11">11</option>
<option class="spirit-form__select-option" value="12">12</option>
</select>
<div class="spirit-form__select-inner"></div>
<span class="spirit-form__select-open-indicator">
<svg class="spirit-icon spirit-form__select-open-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#chevron-down"></use>
</svg>
</span>
</div>
<!-- ngIf: donationForm.$submitted && donationForm.card_exp_date_month.$invalid -->
</div>
</div>
<div class="spirit-col-6 spirit-col-md-4">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> Exp. Year <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__select" ng-class="{'spirit-form__select--invalid': donationForm.$submitted && donationForm.card_exp_date_year.$invalid}">
<select class="spirit-form__select-input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-card_exp_date_year" name="card_exp_date_year" ng-model="donationFormInfo.card_exp_date_year"
ng-required="donationFormInfo.ng_payment_method == 'credit'" required="required" aria-invalid="true">
<option class="spirit-form__select-option" value="" selected="selected">Year</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
</select>
<div class="spirit-form__select-inner"></div>
<span class="spirit-form__select-open-indicator">
<svg class="spirit-icon spirit-form__select-open-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#chevron-down"></use>
</svg>
</span>
</div>
<!-- ngIf: donationForm.$submitted && donationForm.card_exp_date_year.$invalid -->
</div>
</div>
<div class="spirit-col-md-4">
<div class="spirit-form__field-group">
<label class="spirit-form__label"> CVV <abbr class="spirit-form__label-required-indicator" title="This field is required." aria-hidden="true">*</abbr>
<span class="spirit-form__label-accessible-text">Required Field.</span>
</label>
<div class="spirit-form__input" ng-class="{'spirit-form__input--with-icon spirit-form__input--invalid': donationForm.$submitted && donationForm.card_cvv.$invalid}">
<input type="text" class="spirit-form__input-field ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="donationFormInfo-card_cvv" name="card_cvv" ng-model="donationFormInfo.card_cvv"
ng-required="donationFormInfo.ng_payment_method == 'credit'" required="required" aria-invalid="true">
<div class="spirit-form__input-icon-wrap ng-hide" ng-show="donationForm.$submitted && donationForm.card_cvv.$invalid" aria-hidden="true">
<svg class="spirit-icon spirit-form__input-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#alert-circle"></use>
</svg>
</div>
</div>
<!-- ngIf: donationForm.$submitted && donationForm.card_cvv.$invalid -->
</div>
</div>
</div>
</div><!-- end ngIf: donationFormInfo.ng_payment_method == 'credit' -->
<!-- ngIf: donationFormInfo.ng_payment_method == 'ach' -->
<!-- ngIf: donationFormInfo.ng_payment_method == 'paypal' -->
</section>
<section class="form-section form-section--opt-in">
<label class="spirit-form__label"> I am interested in learning more about: </label>
<label class="spirit-form__checkbox">
<input type="checkbox" class="spirit-form__checkbox-input checkmark-input ng-pristine ng-untouched ng-valid ng-not-empty" id="donationFormInfo-donor_email_opt_in" name="donor.email_opt_in" ng-model="donationFormInfo['donor.email_opt_in']"
ng-true-value="'true'" aria-invalid="false">
<span class="spirit-form__checkbox-inner">
<span class="spirit-form__checkbox-visual">
<svg class="spirit-icon spirit-form__checkbox-checked-icon" aria-hidden="true">
<use xlink:href="../jdrf-framework/dist/spirit/icons/spirit.svg#check"></use>
</svg>
</span>
<span class="spirit-form__checkbox-label"> General News from JDRF </span>
</span>
</label>
</section>
</div>
<div class="jdrf-don-form-submit" ng-show="donationFormIntro" aria-hidden="false" style="">
<div class="spirit-row">
<div class="spirit-col-12">
<button type="submit" class="spirit-button" ng-disabled="donationForm.ng_loading"> Submit Donation </button>
</div>
</div>
</div>
</form>Text Content
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JUVENILE DIABETES RESEARCH FOUNDATION INTERNATIONAL® (JDRF)’s mission is to find
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like you. Your generosity propels us toward our goal of a world without T1D.
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I am interested in learning more about: General News from JDRF
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