www.protectkratom.org
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Submitted URL: https://default.salsalabs.org/Tb403327e-e5dd-4124-a191-3b690b589c37/0adabec9-a49a-496b-aa3b-a4025d3c1a88
Effective URL: https://www.protectkratom.org/donate?eType=EmailBlastContent&eId=7fc81606-f156-4b63-b954-027da171f591
Submission: On June 06 via api from US — Scanned from DE
Effective URL: https://www.protectkratom.org/donate?eType=EmailBlastContent&eId=7fc81606-f156-4b63-b954-027da171f591
Submission: On June 06 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form class="sli-form fv-form fv-form-salsa" data-fv-framework="salsa" novalidate="novalidate" data-ignite-form-id="40487951-f7e5-42da-9397-7a31b9e50d07" id="form_igMcqWGLOBOh">
<div class="sli-step-navigation-wrapper sli-element" id="id_00d90e5c-866d-4755-bb11-d986f99a7993">
<div class="sli-step-navigation-steps sli-flex-container">
<div class="sli-step-navigation-step sli-flex-item sli-vertical-align-top sli-selected" data-ignite-for-step-id="1" tabindex="0"> <a class="sli-step-marker">1</a>
<div class="sli-step-label"> <span class="sli-step-check">✓</span>Amount </div>
</div>
<div class="sli-step-navigation-step sli-flex-item sli-vertical-align-top" data-ignite-for-step-id="2" tabindex="0"> <a class="sli-step-marker">2</a>
<div class="sli-step-label"> <span class="sli-step-check">✓</span>Your Info </div>
</div>
<div class="sli-step-navigation-step sli-flex-item sli-vertical-align-top" data-ignite-for-step-id="3" tabindex="0"> <a class="sli-step-marker">3</a>
<div class="sli-step-label"> <span class="sli-step-check">✓</span>Payment </div>
</div>
<div class="sli-progress-line"></div>
</div>
</div>
<div class="sli-row" id="id_2e1454be-c58d-4dd4-9747-4cf21d070038">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="elementStep" id="id_a155be9b-0ce9-43c2-9b95-5af151da3e00" data-ignite-step-id="1">
<div class="sli-row" id="id_8e96f7f3-2e01-4c38-80d4-7a7891d1c1dd">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_37b9840d-9c1f-4424-9e02-ab5e36b82a19">
<div class="sli-element sli-text" id="id_6c53690b-abf8-47d6-bc08-06d4308b7421">
<div id="id_6c53690b-abf8-47d6-bc08-06d4308b7421_inner">
<h4> <span style="color:#525564">Select an Amount</span> </h4>
</div>
</div>
<div class="sli-selectRecurring sli-element " id="id_3f3feb99-d14d-4941-9d82-150f4601aa2b_KKnCwaSvKO" data-ignite-field-id="MakeRecurring"> <label class="sli-label"
for="id_3f3feb99-d14d-4941-9d82-150f4601aa2b_KKnCwaSvKO_makeRecurring_input"><input class="sli-input" id="id_3f3feb99-d14d-4941-9d82-150f4601aa2b_KKnCwaSvKO_makeRecurring_input" type="checkbox" name="makeRecurring" value="true"
style="margin-right: 5px;" salsa-reference-name="makerecurringcb">Make this donation recurring</label> </div>
<div class="sli-donorPaysFees sli-element " id="id_6c4aea17-ff37-4cb7-8ea2-6a4a8089af7f_PnezdjnVcQ" data-ignite-field-id="DonorPaysFees"> <label class="sli-label"
for="id_6c4aea17-ff37-4cb7-8ea2-6a4a8089af7f_PnezdjnVcQ_donorPaysFees_input"><input class="sli-input" id="id_6c4aea17-ff37-4cb7-8ea2-6a4a8089af7f_PnezdjnVcQ_donorPaysFees_input" type="checkbox" name="donorPaysFees" value="true"
style="margin-right: 5px;" salsa-reference-name="donorpaysfeescb">Increase my donation amount to cover fees</label> </div>
</div>
</div>
<div class="sli-row" id="id_5a680f8e-844f-4b6d-973b-07b8d55cb309">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_0c1616fe-70fe-47c9-9750-dca8501d772e">
<div class="sli-donation-amountblock sli-element" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638" data-ignite-enable-onetime="true" data-ignite-enable-recurring-amounts="true" data-ignite-field-id="DonationAmount">
<div class="sli-donationAmounts">
<div class="sli-oneTimeDonation" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_oneTime" data-ignite-onetime-amount="data-ignite-onetime-amount">
<ul class="sli-oneTimeDonationAmounts sli-style-button" style="justify-content: flex-start;">
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_25" type="radio" data-ignite-amount="25.00" data-fv-onetimeamount="true"
data-sli-widget="_igMcqWGLOBOh" data-fv-row=".sli-oneTimeDonation" data-fv-err-container=".sli-oneTimeDonationError" data-fv-onetimeamount-message="Please select a donation amount, or enter your own amount"
data-fv-field="donationAmtToggle"><label class="sli-oneTimeAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_25_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_25">$25</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_50" type="radio" data-ignite-amount="50.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-oneTimeAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_50_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_50">$50</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_75" type="radio" data-ignite-amount="75.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-oneTimeAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_75_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_75">$75</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_100" type="radio" data-ignite-amount="100.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-oneTimeAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_100_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_100">$100</label></li>
<li><input class="sli-oneTimeAmountRadio" name="donationAmtToggle" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_200" type="radio" data-ignite-amount="200.00" data-fv-field="donationAmtToggle"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-oneTimeAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_200_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_amt_200">$200</label></li>
<li id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_custom" style=" display: block;"><input class="sli-oneTimeAmountRadio sli-oneTimeCustomAmount" name="donationAmtToggleOther"
id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_custom_radio" type="radio" data-ignite-custom-onetime="data-ignite-custom-onetime" aria-label="custom one-time donation amount" data-sli-widget="_igMcqWGLOBOh">
<div class="sli-input-group"> <label class="sli-oneTimeAmountLabel sli-amount-label sli-customAmount sli-input-group-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_custom_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_custom" autocomplete="off">$</label> <input class="sli-oneTimeAmountInput sli-customAmount sli-input sli-input-group-field sli-large" size="5"
id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_onetime_custom" type="text" placeholder="Other" name="customOneTime" data-ignite-custom-onetime-input="donationAmtToggle" data-fv-row=".sli-oneTimeDonation"
data-fv-err-container=".sli-oneTimeDonationError" data-fv-numeric="true" data-fv-numeric-message="Please enter a dollar amount" data-fv-notempty="true" data-fv-notempty-message="An amount is required"
data-fv-greaterthan="true" data-fv-greaterthan-inclusive="false" data-fv-greaterthan-value="0.0" data-fv-greaterthan-message="Please enter a positive amount" autocomplete="off" data-fv-field="customOneTime"> </div>
</li>
</ul>
<div class="sli-oneTimeDonationError sli-field-error"><small class="sli-field-error" data-fv-validator="onetimeAmount" data-fv-for="donationAmtToggle" data-fv-result="NOT_VALIDATED" style="display: none;">Please select a donation
amount, or enter your own amount</small><small class="sli-field-error" data-fv-validator="greaterThan" data-fv-for="customOneTime" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a positive amount</small><small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="customOneTime" data-fv-result="NOT_VALIDATED" style="display: none;">An amount is required</small><small class="sli-field-error" data-fv-validator="numeric"
data-fv-for="customOneTime" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a dollar amount</small></div>
</div>
<div class="sli-recurringDonation" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurring" data-ignite-recurring-amount="data-ignite-recurring-amount" style="display:none;">
<p data-ignite-recurrence-frequency="Monthly" class=" sli-recurringFrequency" style="margin: 0;">Donation will repeat monthly.</p>
<ul class="sli-recurringDonationAmounts sli-style-button" style="justify-content: flex-start;">
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_10" type="radio" data-ignite-amount="10.00" data-fv-recurringamount="true"
data-sli-widget="_igMcqWGLOBOh" data-fv-row=".sli-recurringDonation" data-fv-err-container=".sli-recurringDonationError" data-fv-recurringamount-message="Please select a donation amount, or enter your own amount"
data-fv-field="donationAmtToggle2"><label class="sli-recurringAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_10_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_10">$10</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_25" type="radio" data-ignite-amount="25.00" data-fv-field="donationAmtToggle2"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-recurringAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_25_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_25">$25</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_50" type="radio" data-ignite-amount="50.00" data-fv-field="donationAmtToggle2"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-recurringAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_50_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_50">$50</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_75" type="radio" data-ignite-amount="75.00" data-fv-field="donationAmtToggle2"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-recurringAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_75_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_75">$75</label></li>
<li><input class="sli-recurringAmountRadio" name="donationAmtToggle2" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_100" type="radio" data-ignite-amount="100.00" data-fv-field="donationAmtToggle2"
data-sli-widget="_igMcqWGLOBOh"><label class="sli-recurringAmountLabel sli-amount-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_100_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_100">$100</label></li>
<li id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_custom" style=" display: block;"><input class="sli-recurringAmountRadio sli-recurringCustomAmount" name="donationAmtToggle2Other"
id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_custom_radio" type="radio" aria-label="recurring donation custom amount" data-sli-widget="_igMcqWGLOBOh">
<div class="sli-input-group"> <label class="sli-recurringAmountLabel sli-amount-label sli-customAmount sli-input-group-label sli-large sli-floating" id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_custom_label"
for="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_custom" autocomplete="off">$</label> <input class="sli-recurringAmountInput sli-customAmount sli-input sli-input-group-field sli-large" size="5"
id="id_72004a6b-c269-40a0-9a4a-7135ea9c3638_NmVePrOWoJ_recurringAmt_custom" type="text" placeholder="Other" name="customRecurringAmount" data-fv-row=".sli-recurringDonation" data-fv-err-container=".sli-recurringDonationError"
data-fv-numeric="true" data-fv-numeric-message="Please enter a dollar amount" data-fv-notempty="true" data-fv-notempty-message="An amount is required" data-fv-greaterthan="true" data-fv-greaterthan-inclusive="false"
data-fv-greaterthan-value="0.0" data-fv-greaterthan-message="Please enter a positive amount" autocomplete="off" data-fv-field="customRecurringAmount"> </div>
</li>
</ul>
<div class="sli-recurringDonationError sli-field-error"><small class="sli-field-error" data-fv-validator="recurringAmount" data-fv-for="donationAmtToggle2" data-fv-result="NOT_VALIDATED" style="display: none;">Please select a donation
amount, or enter your own amount</small><small class="sli-field-error" data-fv-validator="greaterThan" data-fv-for="customRecurringAmount" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a positive
amount</small><small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="customRecurringAmount" data-fv-result="NOT_VALIDATED" style="display: none;">An amount is required</small><small class="sli-field-error"
data-fv-validator="numeric" data-fv-for="customRecurringAmount" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a dollar amount</small></div>
</div>
</div>
</div>
</div>
</div>
<div class="sli-row" id="id_faae59dd-2cfc-4c44-87b0-3f6babb5bb5a">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_acf2cc83-f6d1-4b86-815b-c54f6ee13afd">
<div class="sli-element sli-button-element" id="id_c01c531d-9e5d-4dc1-99a3-1017a1bcebf6">
<a class="sli-button sli-floating sli-expand" track="true" data-ignite-button-step="2" data-ignite-skip-validation="false" style="background-color:rgb(182,182,182);" tabindex="0">Next ></a> </div>
</div>
</div>
</div>
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="elementStep" id="id_3a37b270-6314-47b8-aa3f-44ec9c99eb3f" style="display: none;" data-ignite-step-id="2">
<div class="sli-element sli-text" id="id_3b24b64a-f0c7-429b-b304-e0b9f001b7dc">
<div id="id_3b24b64a-f0c7-429b-b304-e0b9f001b7dc_inner">
<h4> <span style="color:#525564">Your Information</span> </h4>
</div>
</div>
<div class="sli-row" id="id_deef6b29-9694-41f5-8bb3-a39bcf736974">
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_37ad9f29-e508-464b-acde-c217d95c15cb">
<div class="sli-field-person-firstname sli-form-field sli-element" data-ignite-field-id="5d5a2165-f19e-4371-851b-183a6b92402b" id="id_b5ee5531-13cc-4380-b5c2-6482b93c7480"> <label class="sli-required-true sli-label"
for="id_b5ee5531-13cc-4380-b5c2-6482b93c7480_input" id="id_b5ee5531-13cc-4380-b5c2-6482b93c7480_label">First Name*</label> <input class="sli-input sli-input-person-firstname" type="text"
data-ignite-field-id="5d5a2165-f19e-4371-851b-183a6b92402b" name="field-person-firstname" maxlength="36" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 36 characters." id="id_b5ee5531-13cc-4380-b5c2-6482b93c7480_input" salsa-reference-name="person-firstname" data-fv-field="field-person-firstname"> <small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-person-firstname" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error"
data-fv-validator="stringLength" data-fv-for="field-person-firstname" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_0b4391aa-aa17-4804-984b-962346cbd256">
<div class="sli-field-person-lastname sli-form-field sli-element" data-ignite-field-id="8d21a878-287a-491f-a362-b8ee2aa71819" id="id_cf28af9d-a933-4b03-91dc-5291e04a7dec"> <label class="sli-required-true sli-label"
for="id_cf28af9d-a933-4b03-91dc-5291e04a7dec_input" id="id_cf28af9d-a933-4b03-91dc-5291e04a7dec_label">Last Name*</label> <input class="sli-input sli-input-person-lastname" type="text"
data-ignite-field-id="8d21a878-287a-491f-a362-b8ee2aa71819" name="field-person-lastname" maxlength="100" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 100 characters." id="id_cf28af9d-a933-4b03-91dc-5291e04a7dec_input" salsa-reference-name="person-lastname" data-fv-field="field-person-lastname"> <small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-person-lastname" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error"
data-fv-validator="stringLength" data-fv-for="field-person-lastname" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
</div>
<div class="sli-row" id="id_2e68fc13-6673-41ee-987b-9943b1a8da32">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_96ddad7b-a6f5-42f3-be39-5823babfea71">
<div class="sli-field-address-line1 sli-form-field sli-element" data-ignite-field-id="f775c79a-df41-43fb-96de-ee2360254689" id="id_96a8b1c3-12a3-4f52-9baa-32e823ca0420"> <label class="sli-required-true sli-label"
for="id_96a8b1c3-12a3-4f52-9baa-32e823ca0420_input" id="id_96a8b1c3-12a3-4f52-9baa-32e823ca0420_label">Address, line 1*</label> <input class="sli-input sli-input-address-line1" type="text"
data-ignite-field-id="f775c79a-df41-43fb-96de-ee2360254689" name="field-address-line1" maxlength="128" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 128 characters." id="id_96a8b1c3-12a3-4f52-9baa-32e823ca0420_input" salsa-reference-name="address-line1" data-fv-field="field-address-line1"> <small class="sli-field-error"
data-fv-validator="notEmpty" data-fv-for="field-address-line1" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="stringLength"
data-fv-for="field-address-line1" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
</div>
<div class="sli-row" id="id_05c643aa-dd1b-4acc-a71a-e22b5f24d225">
<div class="sli-large-4 sli-medium-4 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_76b4335b-3d73-43bf-b139-0f0032170168">
<div class="sli-field-address-city sli-form-field sli-element" data-ignite-field-id="a102d60f-f8ab-47eb-8ee0-864cfa1fc5b2" id="id_2b4f39ac-9e30-4c87-9c71-2b4b2e2c604d"> <label class="sli-required-true sli-label"
for="id_2b4f39ac-9e30-4c87-9c71-2b4b2e2c604d_input" id="id_2b4f39ac-9e30-4c87-9c71-2b4b2e2c604d_label">City*</label> <input class="sli-input sli-input-address-city" type="text" data-ignite-field-id="a102d60f-f8ab-47eb-8ee0-864cfa1fc5b2"
name="field-address-city" maxlength="64" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 64 characters." id="id_2b4f39ac-9e30-4c87-9c71-2b4b2e2c604d_input" salsa-reference-name="address-city" data-fv-field="field-address-city"> <small class="sli-field-error"
data-fv-validator="notEmpty" data-fv-for="field-address-city" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="stringLength"
data-fv-for="field-address-city" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-large-4 sli-medium-4 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_7f7b3178-3f90-4f20-8e39-43aa54cc49a4">
<div class="sli-field-address-state sli-form-field sli-element" data-ignite-field-id="3f8b9098-ff2d-4384-bb95-425f113028c0" id="id_03a3bed0-f93b-4cd7-bcfc-0d87bc58d633"> <label class="sli-required-true sli-label"
for="id_03a3bed0-f93b-4cd7-bcfc-0d87bc58d633_input" id="id_03a3bed0-f93b-4cd7-bcfc-0d87bc58d633_label">State*</label> <select class="sli-select-address-state sli-input" name="field-address-state"
data-ignite-field-id="3f8b9098-ff2d-4384-bb95-425f113028c0" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" id="id_03a3bed0-f93b-4cd7-bcfc-0d87bc58d633_input"
salsa-reference-name="address-state" data-fv-field="field-address-state">
<option value="" selected="selected"> Choose one...</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="AA">Armed Forces America</option>
<option value="AE">Armed Forces Europe</option>
<option value="AP">Armed Forces Pacific</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-address-state" data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small></div>
</div>
<div class="sli-large-4 sli-medium-4 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_fb53c9cf-8ddd-4eb9-854d-23607aae52f1">
<div class="sli-field-address-zip sli-form-field sli-element" data-ignite-field-id="44e5ad15-1fdd-4ba8-bf38-f5cbaad023c2" id="id_31fa5d48-1c4d-4e25-8e1d-4fa0dfe87d4f"> <label class="sli-required-true sli-label"
for="id_31fa5d48-1c4d-4e25-8e1d-4fa0dfe87d4f_input" id="id_31fa5d48-1c4d-4e25-8e1d-4fa0dfe87d4f_label">Zip Code*</label> <input class="sli-input sli-input-address-zip" type="text"
data-ignite-field-id="44e5ad15-1fdd-4ba8-bf38-f5cbaad023c2" name="field-address-zip" maxlength="20" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 20 characters." data-fv-zipcode="true" data-fv-zipcode-priority="1" data-fv-zipcode-country="US" data-fv-zipcode-message="This value is not valid as a %s postal code"
data-fv-regexp="true" data-fv-regexp-priority="2" data-fv-regexp-regexp="^(\d{5}|\d{5}-\d{4})?$" data-fv-regexp-message="Zip Code must be formatted as: "55555" or "55555-5555""
id="id_31fa5d48-1c4d-4e25-8e1d-4fa0dfe87d4f_input" salsa-reference-name="address-zip" data-fv-field="field-address-zip"> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-address-zip"
data-fv-result="NOT_VALIDATED" style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="regexp" data-fv-for="field-address-zip" data-fv-result="NOT_VALIDATED" style="display: none;">Zip
Code must be formatted as: "55555" or "55555-5555"</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="field-address-zip" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not
valid</small><small class="sli-field-error" data-fv-validator="zipCode" data-fv-for="field-address-zip" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid as a %s postal code</small></div>
</div>
</div>
<div class="sli-row" id="id_98cf72a9-d7c0-48e9-a18a-9a4358bbe34b">
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_4bb81f5d-1d31-498d-bb80-3098eb30d4fb">
<div class="sli-field-contact-email sli-form-field sli-element" data-ignite-field-id="2851b463-606f-40c8-bb3d-d31f399e6896" id="id_b77dcab7-d6f1-484b-98d2-cdbc8b8c8e0a"> <label class="sli-required-true sli-label"
for="id_b77dcab7-d6f1-484b-98d2-cdbc8b8c8e0a_input" id="id_b77dcab7-d6f1-484b-98d2-cdbc8b8c8e0a_label">Email Address*</label> <input class="sli-input sli-input-contact-email" type="email"
data-ignite-field-id="2851b463-606f-40c8-bb3d-d31f399e6896" name="field-contact-email" maxlength="128" required="required" data-fv-notempty="true" data-fv-notempty-message="This field requires a value" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 128 characters." data-fv-regexp="true" data-fv-regexp-regexp="^[^@\s]+@([^@\s]+\.)+[^@\s]+$" data-fv-regexp-message="Please enter a valid email address"
id="id_b77dcab7-d6f1-484b-98d2-cdbc8b8c8e0a_input" salsa-reference-name="contact-email" data-fv-field="field-contact-email"> <small class="sli-field-error" data-fv-validator="emailAddress" data-fv-for="field-contact-email"
data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="field-contact-email" data-fv-result="NOT_VALIDATED"
style="display: none;">This field requires a value</small><small class="sli-field-error" data-fv-validator="regexp" data-fv-for="field-contact-email" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a valid email
address</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="field-contact-email" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-large-6 sli-medium-6 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_2c8d9439-39f2-4429-ac08-79d511ae7c86">
<div class="sli-field-person-home_phone sli-form-field sli-element" data-ignite-field-id="6e201e0b-8208-453f-b393-a5f0d9059726" id="id_3c9d26bd-11ce-4c43-8759-38cd29e588de"> <label class="sli-required-false sli-label"
for="id_3c9d26bd-11ce-4c43-8759-38cd29e588de_input" id="id_3c9d26bd-11ce-4c43-8759-38cd29e588de_label">Phone</label> <input class="sli-input sli-input-person-home_phone" type="text"
data-ignite-field-id="6e201e0b-8208-453f-b393-a5f0d9059726" name="field-person-home_phone" placeholder="555-555-5555" maxlength="12" data-fv-stringlength="true"
data-fv-stringlengthmessage="Please limit your input to at most 128 characters." id="id_3c9d26bd-11ce-4c43-8759-38cd29e588de_input" salsa-reference-name="person-home_phone" data-fv-field="field-person-home_phone"> <small
class="sli-field-error" data-fv-validator="stringLength" data-fv-for="field-person-home_phone" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
</div>
<div class="sli-row" id="id_af1685e0-bce6-4d5a-9507-25b82f7f022f">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_cb4dcc23-4e70-4ef2-973a-71066703e3ff">
<div class="sli-contact-types sli-element " id="id_d2232956-9806-417b-a7d6-d5942c85d414" data-ignite-field-id="ContactOptIn"> <label class="sli-label"><input class="sli-input sli-contact-type Email" type="checkbox"
id="id_d2232956-9806-417b-a7d6-d5942c85d414_contact_types_input" checked="checked" name="contactOptIn" value="accepted" style="margin-right: 5px;" data-ignite-contact-value="Email" salsa-reference-name="contactoptincb"> Sign-Up
for Kratom Legislative Updates</label>
<div class="sli-contact-type"></div>
</div>
</div>
</div>
<div class="sli-row" id="id_e554c586-8b7b-4c1d-8e17-7c4d3b53a4eb">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_f9bebcef-d5a1-4c71-a19c-d73bd39c6b1f">
<div class="sli-element sli-button-element" id="id_25852d59-c65c-44e5-9e2a-56b6e4782609">
<a class="sli-button sli-floating sli-expand" track="true" data-ignite-button-step="3" data-ignite-skip-validation="false" style="background-color:rgb(182,182,182);" tabindex="0">Next ></a> </div>
<div class="sli-element sli-button-element" id="id_55077d9f-4dd0-490e-8851-6d8c7f36ce7b">
<a class="sli-button sli-floating sli-small" track="true" data-ignite-button-step="1" data-ignite-skip-validation="true" style="background-color:rgb(102,102,102);" tabindex="0"><< Back</a> </div>
</div>
</div>
</div>
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="elementStep" id="id_11f183db-5f5b-4bd7-974c-5348e2dcf543" style="display: none;" data-ignite-step-id="3">
<div class="sli-row" id="id_7a3282c3-14d9-42a2-91ac-d8a28f5684c9">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_6cc4f7de-cbf0-49b2-bcb8-7e0e3eeafbb5">
<div class="sli-element sli-button-element" id="id_eb6a0acb-d805-4fc9-a957-b38e2f1faef3">
<a class="sli-button sli-floating sli-small" track="true" data-ignite-button-step="2" data-ignite-skip-validation="true" style="background-color:rgb(102,102,102);" tabindex="0"><< Back</a> </div>
<div class="sli-element sli-text" id="id_cd917bbc-8ad0-4c38-b347-1017c14b193d">
<div id="id_cd917bbc-8ad0-4c38-b347-1017c14b193d_inner">
<h4> <span style="color:#525564">Payment Information</span> </h4>
</div>
</div>
<div class="sli-donation-paymentblock sli-element" id="id_be73fa1c-a8f8-4a20-9609-08342c03045f">
<div class="sli-paymentType" id="id_be73fa1c-a8f8-4a20-9609-08342c03045f_paymentType">
<div class="sli-ccType sli-label" for="payment_type"> Payment Type: </div>
<div style="display:inline-block;"> <input name="payment_type" type="radio" value="CREDIT_CARD" checked="checked" id="HCcqaBRacm"> <label class="sli-label" for="HCcqaBRacm">Credit Card</label> </div>
<div style="display:inline-block;"> <input name="payment_type" sli-payment-type="ACH" style="display:none;" type="radio" value="ACH" id="baVIbrDMLR"> <label class="sli-label" style="display:none;" sli-payment-type="ACH"
for="baVIbrDMLR">eCheck</label> </div>
<div style="display:inline-block;"> <input name="payment_type" sli-payment-type="PAYPAL" style="display:none;" type="radio" value="PAYPAL" id="pfmKkviBRb"> <label class="sli-label" style="display:none;" sli-payment-type="PAYPAL"
for="pfmKkviBRb">PayPal</label> </div>
</div>
<div id="id_be73fa1c-a8f8-4a20-9609-08342c03045f_echeck_wepay" data-ignite-echeck-wepay="ignite-echeck-wepay"> <label class="sli-ccLabel sli-label" for="dADlkXwpgY">Bank Account*</label>
<div class="sli-row">
<div class="sli-columns sli-medium-4 sli-large-4 sli-end sli-form-field"></div> <input class="sli-ccInput sli-input" type="text" id="dADlkXwpgY" data-fv-field="wepay_bank" data-fv-notempty-message="Bank Account is required"
readonly="readonly" required="required" name="wepay_bank">
<div class="sli-columns sli-large-8 sli-medium-8"> <input class="sli-button" id="id_be73fa1c-a8f8-4a20-9609-08342c03045f_bankSelect" type="button" value="Select a Bank Account" name="bank-popup"> <small
class="sli-field-error sli-wepay-error" style="display: none;"></small> </div> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="wepay_bank" data-fv-result="NOT_VALIDATED" style="display: none;">Bank Account
is required</small>
</div>
</div>
<div id="id_be73fa1c-a8f8-4a20-9609-08342c03045f_echeck" data-ignite-echeck="ignite-echeck">
<div class="sli-row">
<div class="sli-columns sli-medium-8 sli-large-8 sli-small-12 sli-end sli-form-field"> <label class="sli-ccLabel sli-label" for="YsPfOlJbvz">Name on Account*</label> <input class="sli-ccInput sli-input" type="text" name="holder_name"
id="YsPfOlJbvz" required="required" data-fv-notempty="true" data-fv-notemtpy-message="Please enter the holder name" pattern="^.+\s+.*$" data-fv-regexp-message="Holder name must have at least 2 parts" data-fv-field="holder_name">
<small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="holder_name" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="regexp"
data-fv-for="holder_name" data-fv-result="NOT_VALIDATED" style="display: none;">Holder name must have at least 2 parts</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-8 sli-medium-8 sli-form-field"> <label class="sli-ccLabel sli-label" for="uUWumajVjV">Bank Routing Number*</label> <input class="sli-ccInput sli-input" type="text" name="bank_routing" id="uUWumajVjV"
required="required" maxlength="9" dava-fv-field="bank_routing" data-fv-notempty="true" data-fv-notemtpy-message="Bank Routing Number is required" data-fv-stringlength="true" data-fv-stringlength-min="9"
data-fv-stringlength-max="9" data-fv-stringlength-message="Bank Routing Number must be 9 characters long" data-fv-digits="true" data-fv-digits-message="Please enter only digits" data-fv-field="bank_routing"> <small
class="sli-field-error" data-fv-validator="digits" data-fv-for="bank_routing" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter only digits</small><small class="sli-field-error" data-fv-validator="notEmpty"
data-fv-for="bank_routing" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="bank_routing"
data-fv-result="NOT_VALIDATED" style="display: none;">Bank Routing Number must be 9 characters long</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-8 sli-medium-8 sli-form-field"> <label class="sli-ccLabel sli-label" for="KAWZOOEvQB">Bank Account Number*</label> <input class="sli-bankAccount sli-ccInput sli-input" type="text" name="bank_account"
id="KAWZOOEvQB" required="required" maxlength="17" dava-fv-field="bank_account" data-fv-notempty="true" data-fv-notemtpy-message="Bank Account Number is required" data-fv-stringlength="true" data-fv-stringlength-min="4"
data-fv-stringlength-max="17" data-fv-stringlength-message="Bank Account Number must be from 4 to 17 characters long" data-fv-digits="true" data-fv-digits-message="Please enter only digits" data-fv-field="bank_account"> <small
class="sli-field-error" data-fv-validator="digits" data-fv-for="bank_account" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter only digits</small><small class="sli-field-error" data-fv-validator="notEmpty"
data-fv-for="bank_account" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="bank_account"
data-fv-result="NOT_VALIDATED" style="display: none;">Bank Account Number must be from 4 to 17 characters long</small></div>
</div>
</div>
<div id="id_be73fa1c-a8f8-4a20-9609-08342c03045f_cc" data-ignite-cc="ignite-cc">
<ul class="sli-cards">
<li class="sli-visa off" style=""></li>
<li class="sli-mastercard off" style=""></li>
<li class="sli-discover off" style=""></li>
<li class="sli-amex off" style=""></li>
</ul>
<div class="sli-row">
<div class="sli-columns sli-large-8 sli-medium-8 sli-form-field"> <label class="sli-ccLabel sli-label" for="FEFOneXMkM">Card Number*</label> <input class="sli-ccInput sli-input" name="card_number" id="FEFOneXMkM" type="text"
required="required" data-fv-notempty-message="A credit card number is required" maxlength="16" autocomplete="off" data-fv-creditcard="true" data-fv-creditcard-message="Please enter a valid credit card number"
data-fv-field="card_number"> <small class="sli-field-error" data-fv-validator="creditCard" data-fv-for="card_number" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a valid credit card number</small><small
class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="card_number" data-fv-result="NOT_VALIDATED" style="display: none;">A credit card number is required</small><small class="sli-field-error"
data-fv-validator="stringLength" data-fv-for="card_number" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
<div class="sli-columns sli-large-4 sli-medium-4 sli-end sli-form-field"> <label class="sli-ccExpCcvLabel sli-label" for="UypRgfRapl">Security Code*</label> <input class="sli-ccExpCcvInput sli-input" name="cvv" id="UypRgfRapl"
type="text" required="required" data-fv-notempty-message="CVV/CCV is required" maxlength="4" size="4" autocomplete="off" data-fv-cvv="true" data-fv-cvv_ccfield="card_number" data-dv-cvv-message="Your CVV is invalid"
data-fv-field="cvv"> <small class="sli-field-error" data-fv-validator="cvv" data-fv-for="cvv" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error"
data-fv-validator="notEmpty" data-fv-for="cvv" data-fv-result="NOT_VALIDATED" style="display: none;">CVV/CCV is required</small><small class="sli-field-error" data-fv-validator="stringLength" data-fv-for="cvv"
data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-6 sli-medium-6 sli-form-field"> <label class="sli-ccExpMonthLabel sli-label" for="GConrkpMjP">Expiration Month*</label> <select class="sli-ccInput sli-input" name="expiry_month" id="GConrkpMjP"
required="required" data-fv-notempty-message="Month is required" style="display: block;" data-fv-field="expiry_month">
<option value="" selected="selected">MM</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="expiry_month" data-fv-result="NOT_VALIDATED" style="display: none;">Month is required</small></div>
<div class="sli-columns sli-large-6 sli-medium-6 sli-end sli-form-field"> <label class="sli-ccExpMonthLabel sli-label" for="xydNyZybKr">Expiration Year*</label> <select class="sli-ccInput sli-input" name="expiry_year" id="xydNyZybKr"
required="required" data-fv-notempty-message="Year is required" style="display: block;" data-fv-field="expiry_year">
<option value="" selected="">YYYY</option>
<option value="22">2022</option>
<option value="23">2023</option>
<option value="24">2024</option>
<option value="25">2025</option>
<option value="26">2026</option>
<option value="27">2027</option>
<option value="28">2028</option>
<option value="29">2029</option>
<option value="30">2030</option>
<option value="31">2031</option>
<option value="32">2032</option>
<option value="33">2033</option>
<option value="34">2034</option>
<option value="35">2035</option>
<option value="36">2036</option>
<option value="37">2037</option>
<option value="38">2038</option>
<option value="39">2039</option>
<option value="40">2040</option>
<option value="41">2041</option>
</select> <small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="expiry_year" data-fv-result="NOT_VALIDATED" style="display: none;">Year is required</small></div>
</div>
<div class="sli-row">
<div class="sli-columns sli-large-12 sli-small-12 sli-end sli-form-field"> <label class="sli-ccNameLabel sli-label" for="kOnHzwriRE">Name on Card*</label> <input class="sli-ccNameInput sli-input" name="name_on_card" id="kOnHzwriRE"
type="text" autocomplete="off" required="required" data-fv-callback="true" data-fv-callback-callback="validateCCName" data-fv-field="name_on_card"> <small class="sli-field-error" data-fv-validator="callback"
data-fv-for="name_on_card" data-fv-result="NOT_VALIDATED" style="display: none;">This value is not valid</small><small class="sli-field-error" data-fv-validator="notEmpty" data-fv-for="name_on_card" data-fv-result="NOT_VALIDATED"
style="display: none;">This value is not valid</small></div>
</div>
</div>
</div>
</div>
</div>
<div class="sli-row" id="id_055641d8-c22f-4277-b513-741ce54e7ee0">
<div class="sli-large-12 sli-medium-12 sli-small-12 sli-columns " data-ignite-container-type="DEFAULT" id="id_fd664443-4cdd-493b-a1a0-940c281ff9d0">
<div class="sli-element sli-button-element" id="id_e7ec6341-35a7-41fe-9487-dce31e697d67">
<a class="sli-button sli-floating sli-expand" track="true" data-ignite-submit-button="data-ignite-submit-button" style="background-color:rgb(120, 185, 84);" tabindex="0">Submit</a>
<div class="sli-processing" style="display:none;"></div>
</div>
</div>
</div>
</div>
</div>
</form>Text Content
0 Skip to Content Protect Kratom Donate Home Home About AKA Contact Us Learn More AKA Forum Advocacy Contact Congress Testimonials Take Action Consumer Champions Nevada W.H.O. Comments WV Meeting Join News AKA Programs AKA.ORG Take Action Open Menu Close Menu Protect Kratom Donate Home Home About AKA Contact Us Learn More AKA Forum Advocacy Contact Congress Testimonials Take Action Consumer Champions Nevada W.H.O. Comments WV Meeting Join News AKA Programs AKA.ORG Take Action Open Menu Close Menu Donate Folder: Home Folder: Advocacy Join News AKA Programs AKA.ORG Take Action Back Home About AKA Contact Us Learn More AKA Forum Back Contact Congress Testimonials Take Action Consumer Champions Nevada W.H.O. Comments WV Meeting Loading.... SUPPORT THE FIGHT FOR KRATOM! GIVE TODAY! We need your help! Kratom Consumers Across America Are Under Attack! The American Kratom Association works to protect access to safe kratom through our constant legislative efforts and consumer advocacy. However this vital work could not be done without the generous contributions of supporters like you! TO DONATE BY PAYPAL CLICK ON THIS LINK The American Kratom Association needs your support to ensure we can continue our efforts. Here's how YOU make a difference: * Your donations help the AKA continue our lobbying efforts on Capitol Hill and in state capitals around the country * Your donations help the scientific efforts continue to prove kratom is safe for consumers * Your donations help the AKA ensure consumer kratom is following good manufacturing programs Thank you for your support and contribution! TO DONATE BY CREDIT CARD, GO TO PayPal HERE OR PLEASE FILL OUT THE FORM BELOW AND CLICK "NEXT" 1 ✓Amount 2 ✓Your Info 3 ✓Payment SELECT AN AMOUNT Make this donation recurring Increase my donation amount to cover fees * $25 * $50 * $75 * $100 * $200 * $ Please select a donation amount, or enter your own amountPlease enter a positive amountAn amount is requiredPlease enter a dollar amount Donation will repeat monthly. * $10 * $25 * $50 * $75 * $100 * $ Please select a donation amount, or enter your own amountPlease enter a positive amountAn amount is requiredPlease enter a dollar amount Next > YOUR INFORMATION First Name* This field requires a valueThis value is not valid Last Name* This field requires a valueThis value is not valid Address, line 1* This field requires a valueThis value is not valid City* This field requires a valueThis value is not valid State* Choose one...AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces AmericaArmed Forces EuropeArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUnited States Minor Outlying IslandsUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming This field requires a value Zip Code* This field requires a valueZip Code must be formatted as: "55555" or "55555-5555"This value is not validThis value is not valid as a %s postal code Email Address* This value is not validThis field requires a valuePlease enter a valid email addressThis value is not valid Phone This value is not valid Sign-Up for Kratom Legislative Updates Next > << Back << Back PAYMENT INFORMATION Payment Type: Credit Card eCheck PayPal Bank Account* Bank Account is required Name on Account* This value is not validHolder name must have at least 2 parts Bank Routing Number* Please enter only digitsThis value is not validBank Routing Number must be 9 characters long Bank Account Number* Please enter only digitsThis value is not validBank Account Number must be from 4 to 17 characters long * * * * Card Number* Please enter a valid credit card numberA credit card number is requiredThis value is not valid Security Code* This value is not validCVV/CCV is requiredThis value is not valid Expiration Month* MM010203040506070809101112 Month is required Expiration Year* YYYY20222023202420252026202720282029203020312032203320342035203620372038203920402041 Year is required Name on Card* This value is not validThis value is not valid Submit Please review before submitting your payment. Item Charge Registrations $0.00 Purchases $0.00 Donation $0.00 Fees NONE Total No Charge Follow Us Facebook Twitter Instagram THANK YOU! YOUR DONATION HAS BEEN RECEIVED. We appreciate your generous support. Your donation will be put to work immediately to create lasting change. Contact us! 5501 Merchants View Square | Haymarket, VA 20169 | Support@americankratom.org Follow Us Facebook Twitter Instagram Copyright American Kratom Association 2022 ProtectKratom.org AmericanKratom.org Our Work About Take Action Follow Twitter Facebook