www.map.org.uk Open in urlscan Pro
2606:4700::6812:1e49  Public Scan

URL: https://www.map.org.uk/donate/donation-details/484
Submission: On October 19 via manual from CO — Scanned from DE

Form analysis 2 forms found in the DOM

POST

<form action="" method="post" id="map-donation-form" class="donation-form js-enabled">
  <p class="required-fields">*denotes required fields</p>
  <h6 class="donation-options-heading">My Donation</h6>
  <p class="form-field-wrapper form-select currency-select-wrapper">
    <label>Please select your currency</label>
    <select name="donation_currency" id="currency-select">
      <option value="GBP" selected="">UK Pounds (£)</option>
      <option value="USD">US Dollars ($)</option>
      <option value="EUR">Euro (€)</option>
    </select>
  </p>
  <p id="donation-options" class="donation-options">
    <span class="form-select donation-amount-select-mobile" id="donation_amount_select_mobile">
      <label for="donation-amount-select">I would like to give</label>
      <span class="donation-currency-symbol">£</span>
      <select id="donation-amount-select" class="donation-amount-select" name="donation-amount-select">
        <option value="">Select amount</option>
        <option value="20">20</option>
        <option value="50">50</option>
        <option value="75">75</option>
        <option value="100">100</option>
        <option value="250">250</option>
        <option value="500">500</option>
        <option value="1000">1000</option>
        <option value="Other">Other</option>
      </select>
    </span>
    <span class="do-wrapper"><input class="doFirst" type="radio" name="donation_amount" id="donation_amount_20" value="20">
      <label for="donation_amount_20"><span class="donation-currency-symbol">£</span>20</label></span><span class="do-wrapper"><input class="" type="radio" name="donation_amount" id="donation_amount_50" value="50">
      <label for="donation_amount_50"><span class="donation-currency-symbol">£</span>50</label></span><span class="do-wrapper"><input class="" type="radio" name="donation_amount" id="donation_amount_75" value="75">
      <label for="donation_amount_75"><span class="donation-currency-symbol">£</span>75</label></span><span class="do-wrapper"><input class="" type="radio" name="donation_amount" id="donation_amount_100" value="100">
      <label for="donation_amount_100"><span class="donation-currency-symbol">£</span>100</label></span><br><span class="do-wrapper"><input class="" type="radio" name="donation_amount" id="donation_amount_250" value="250">
      <label for="donation_amount_250"><span class="donation-currency-symbol">£</span>250</label></span><span class="do-wrapper"><input class="" type="radio" name="donation_amount" id="donation_amount_500" value="500">
      <label for="donation_amount_500"><span class="donation-currency-symbol">£</span>500</label></span><span class="do-wrapper"><input class="" type="radio" name="donation_amount" id="donation_amount_1000" value="1000">
      <label for="donation_amount_1000"><span class="donation-currency-symbol">£</span>1000</label></span><span class="do-other-wrapper form-text"><input type="radio" name="donation_amount" id="donation_amount_other" class="" value="Other"
        onclick="document.getElementById('donation_amount_other_value').focus()">
      <label for="donation_amount_other">Other</label> <span id="donation-amount-other-value-container" class="donation-amount-other-value-container mobile-hidden" data-currency-symbol="£"><input type="text" name="donation_amount_other_value"
          autocomplete="off" id="donation_amount_other_value" value="" class="donation-amount-other-value" onclick="document.getElementById('donation_amount_other').checked = true;"></span></span>
  </p>
  <h6 class="donation-type-heading">I am giving</h6>
  <p class="donation-type-option form-field-wrapper form-checkbox">
    <input type="radio" name="donation_type" id="donation_type_individual" value="individual">
    <label for="donation_type_individual">As an individual</label>
  </p>
  <p class="donation-type-option form-field-wrapper form-checkbox">
    <input type="radio" name="donation_type" id="donation_type_group" value="group">
    <label for="donation_type_group">As a group</label>
  </p>
  <p class="donation-type-option form-field-wrapper form-checkbox">
    <input type="radio" name="donation_type" id="donation_type_memory" value="memory">
    <label for="donation_type_memory">In tribute</label>
  </p>
  <br>
  <div id="donation-details-group-container" style="display: none;">
    <h6 class="js-hide">If giving as a group:</h6>
    <p class="form-field-wrapper form-select">
      <label for="donation_details_group_type">Organisation type</label>
      <select name="donation_details_group_type" id="donation_details_group_type">
        <option value="">Select</option>
        <option value="Corporate">Company</option>
        <option value="Faith Group - Muslim">Muslim Faith Group</option>
        <option value="Faith Group - Christian">Christian Faith Group</option>
        <option value="Faith Group - Other">All Other Faith Groups</option>
        <option value="Local Group">Organisation</option>
        <option value="Trade Union">Trade Union</option>
        <option value="Trade Union">School</option>
        <option value="Trade Union">College</option>
      </select>
    </p>
    <p class="form-field-wrapper form-text">
      <label for="donation_details_group_name">Name of group / organisation / company*</label>
      <input type="text" name="donation_details_group_name" id="donation_details_group_name" value="" class="input-large ">
    </p>
    <p class="form-field-wrapper form-text">
      <label for="donation_details_group_position">Your position in the group</label>
      <input type="text" name="donation_details_group_position" id="donation_details_group_position" value="" class="input-large ">
    </p>
    <p class="form-field-wrapper form-select">
      <label for="donation_group_country">Group country*</label>
      <select name="donation_group_country" class="" id="donation_group_country">
        <option value="Afghanistan">Afghanistan</option>
        <option value="Åland Islands">Åland 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="Bolivia">Bolivia</option>
        <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
        <option value="Botswana">Botswana</option>
        <option value="Bouvet Island">Bouvet Island</option>
        <option value="Brazil">Brazil</option>
        <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
        <option value="Brunei Darussalam">Brunei Darussalam</option>
        <option value="Bulgaria">Bulgaria</option>
        <option value="Burkina Faso">Burkina Faso</option>
        <option value="Burundi">Burundi</option>
        <option value="Cambodia">Cambodia</option>
        <option value="Cameroon">Cameroon</option>
        <option value="Canada">Canada</option>
        <option value="Cape Verde">Cape Verde</option>
        <option value="Cayman Islands">Cayman Islands</option>
        <option value="Central African Republic">Central African Republic</option>
        <option value="Chad">Chad</option>
        <option value="Chile">Chile</option>
        <option value="China">China</option>
        <option value="Christmas Island">Christmas Island</option>
        <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
        <option value="Colombia">Colombia</option>
        <option value="Comoros">Comoros</option>
        <option value="Congo">Congo</option>
        <option value="Congo, The Democratic Republic of the">Congo, The Democratic Republic of the</option>
        <option value="Cook Islands">Cook Islands</option>
        <option value="Costa Rica">Costa Rica</option>
        <option value="Côte D'Ivoire">Côte D'Ivoire</option>
        <option value="Croatia">Croatia</option>
        <option value="Cuba">Cuba</option>
        <option value="Cyprus">Cyprus</option>
        <option value="Czech Republic">Czech Republic</option>
        <option value="Denmark">Denmark</option>
        <option value="Djibouti">Djibouti</option>
        <option value="Dominica">Dominica</option>
        <option value="Dominican Republic">Dominican Republic</option>
        <option value="Ecuador">Ecuador</option>
        <option value="Egypt">Egypt</option>
        <option value="El Salvador">El Salvador</option>
        <option value="Equatorial Guinea">Equatorial Guinea</option>
        <option value="Eritrea">Eritrea</option>
        <option value="Estonia">Estonia</option>
        <option value="Ethiopia">Ethiopia</option>
        <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
        <option value="Faroe Islands">Faroe Islands</option>
        <option value="Fiji">Fiji</option>
        <option value="Finland">Finland</option>
        <option value="France">France</option>
        <option value="French Guiana">French Guiana</option>
        <option value="French Polynesia">French Polynesia</option>
        <option value="French Southern 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="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="Honduras">Honduras</option>
        <option value="Hong Kong">Hong Kong</option>
        <option value="Hungary">Hungary</option>
        <option value="Iceland">Iceland</option>
        <option value="India">India</option>
        <option value="Indonesia">Indonesia</option>
        <option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
        <option value="Iraq">Iraq</option>
        <option value="Ireland">Ireland</option>
        <option value="Israel">Israel</option>
        <option value="Italy">Italy</option>
        <option value="Jamaica">Jamaica</option>
        <option value="Japan">Japan</option>
        <option value="Jordan">Jordan</option>
        <option value="Kazakhstan">Kazakhstan</option>
        <option value="Kenya">Kenya</option>
        <option value="Kiribati">Kiribati</option>
        <option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
        <option value="Korea, Republic of">Korea, Republic of</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="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</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="Micronesia, Federated States of">Micronesia, Federated States of</option>
        <option value="Moldova, Republic of">Moldova, Republic of</option>
        <option value="Monaco">Monaco</option>
        <option value="Mongolia">Mongolia</option>
        <option value="Montserrat">Montserrat</option>
        <option value="Morocco">Morocco</option>
        <option value="Mozambique">Mozambique</option>
        <option value="Myanmar">Myanmar</option>
        <option value="Namibia">Namibia</option>
        <option value="Nauru">Nauru</option>
        <option value="Nepal">Nepal</option>
        <option value="Netherlands">Netherlands</option>
        <option value="Netherlands Antilles">Netherlands Antilles</option>
        <option value="New Caledonia">New Caledonia</option>
        <option value="New Zealand">New Zealand</option>
        <option value="Nicaragua">Nicaragua</option>
        <option value="Niger">Niger</option>
        <option value="Nigeria">Nigeria</option>
        <option value="Niue">Niue</option>
        <option value="Norfolk Island">Norfolk Island</option>
        <option value="Northern Mariana Islands">Northern Mariana Islands</option>
        <option value="North Macedonia">North Macedonia</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="Poland">Poland</option>
        <option value="Portugal">Portugal</option>
        <option value="Puerto Rico">Puerto Rico</option>
        <option value="Qatar">Qatar</option>
        <option value="Réunion">Réunion</option>
        <option value="Romania">Romania</option>
        <option value="Russian Federation">Russian Federation</option>
        <option value="Rwanda">Rwanda</option>
        <option value="Saint Helena">Saint Helena</option>
        <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
        <option value="Saint Lucia">Saint Lucia</option>
        <option value="Saint 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 and Montenegro">Serbia and Montenegro</option>
        <option value="Seychelles">Seychelles</option>
        <option value="Sierra Leone">Sierra Leone</option>
        <option value="Singapore">Singapore</option>
        <option value="Slovakia">Slovakia</option>
        <option value="Slovenia">Slovenia</option>
        <option value="Solomon Islands">Solomon Islands</option>
        <option value="Somalia">Somalia</option>
        <option value="South Africa">South Africa</option>
        <option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
        <option value="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">Taiwan</option>
        <option value="Tajikistan">Tajikistan</option>
        <option value="Tanzania, United Republic of">Tanzania, United Republic of</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" selected="">United Kingdom</option>
        <option value="United States">United States</option>
        <option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
        <option value="Uruguay">Uruguay</option>
        <option value="Uzbekistan">Uzbekistan</option>
        <option value="Vanuatu">Vanuatu</option>
        <option value="Vatican City State">Vatican City State</option>
        <option value="Venezuela">Venezuela</option>
        <option value="Viet Nam">Viet Nam</option>
        <option value="Virgin Islands, British">Virgin Islands, British</option>
        <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
        <option value="Wallis 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>
    </p>
    <div id="donation-details-group-address-container" class="address-container">
      <p class="form-field-wrapper form-text" style="display: none;">
        <label for="donation_group_address_1">Group address*</label>
        <input type="text" name="donation_group_address_1" id="donation_group_address_1" value="" class="address-1 input-large ">
      </p>
      <p class="form-field-wrapper form-text" style="display: none;">
        <input class="address-2 input-large input-no-label" type="text" name="donation_group_address_2" id="donation_group_address_2" value="">
      </p>
      <p class="form-field-wrapper form-text" style="display: none;">
        <input class="address-3 input-large input-no-label" type="text" name="donation_group_address_3" id="donation_group_address_3" value="">
      </p>
      <p class="form-field-wrapper form-text" style="display: none;">
        <label for="donation_group_town">Group <span data-default-term="town" data-us-term="city">town</span>*</label>
        <input type="text" name="donation_group_town" id="donation_group_town" value="" class="address-town input-medium ">
      </p>
      <p class="form-field-wrapper form-text" style="display: none;">
        <label for="donation_group_county">Group <span data-default-term="county" data-us-term="state">county</span></label>
        <input type="text" name="donation_group_county" id="donation_group_county" value="" class="address-county input-medium ">
      </p>
      <p class="form-field-wrapper form-text address-postcode-container">
        <label for="donation_group_postcode">Group <span data-default-term="postcode" data-us-term="zipcode">postcode</span><span class="form-field-required-star">*</span></label>
        <input type="text" name="donation_group_postcode" id="donation_group_postcode" value="" class="address-postcode input-small "><a href="#" class="address-postcode-search">Find address</a>
      </p>
      <p class="address-manual-toggle-container"><a href="#" class="address-manual-toggle">Enter address manually</a></p>
    </div>
    <br>
  </div>
  <div id="donation-details-memory-container" style="display: none;">
    <h6 class="js-hide">If giving in tribute:</h6>
    <p class="form-field-wrapper form-textarea">
      <label for="donation_details_memory">My gift is given in tribute to </label>
      <textarea class="input-large" name="donation_details_memory" id="donation_details_memory"></textarea>
    </p>
    <br>
  </div>
  <p class="donation-type-option form-field-wrapper form-checkbox" id="donation-details-zakat-container" style="">
    <input type="checkbox" name="donation_zakat" id="donation_zakat" value="1"> <label for="donation_zakat">Please treat donation as a Zakat donation</label>
    <a class="fancyboxcontent" href="#zakat-info" target="_blank" style="margin-left:3px;"><img class="info-icon" src="templates/default/images/info-icon.png" alt="Info"></a>
  </p>
  <div id="zakat-info" class="zakat-info">
    <p>Zakat is one of the five pillars of Islam. It is the obligation for Muslims to give a proportion of their wealth to charity each year.&nbsp;</p>
    <h5>How does Medical Aid for Palestinians use Zakat Donations?</h5>
    <p>Across the occupied Palestinian territory (oPt), Palestinian hospitals are in desperate need of basic, yet essential medicines and medical supplies. Many medical items needed to treat patients are regularly in short supply or have already ran
      out completely. At <strong>Medical Aid for Palestinians (MAP)</strong>, we help by purchasing as many urgently needed medicines, medical supplies and equipment as we can. We can only do this thanks to the financial support we receive from
      supporters like you. You can choose to make your donation to us a 'Zakat donation' by selecting the checkbox in our donation forms.&nbsp;</p>
    <p><strong>MAP uses 100% of all the Zakat donations we receive to respond to the ongoing medicines and medical supply emergency in Gaza and in the West Bank. If you want to make a Zakat donation, please remember to tick the Zakat box on the
        donation page.</strong></p>
    <p>You can make your Zakat Gift have even greater impact by adding Gift Aid to your donation.</p>
    <p>If you would like to discuss your donation further, please contact us on 020 7226 4114 or <a href="mailto:info@map.org.uk.">info@map.org.uk</a></p>
    <p>Thank you for your support.&nbsp;</p>
  </div>
  <hr class="red-line">
  <div class="contact-details">
    <h5 class="contact-details-heading">Contact details</h5>
    <p class="form-field-wrapper form-select">
      <label for="donation_title">Title</label>
      <select name="donation_title" id="donation_title">
        <option value="">Select</option>
        <option value="Dr">Dr</option>
        <option value="Mr">Mr</option>
        <option value="Ms">Ms</option>
        <option value="Mrs">Mrs</option>
        <option value="Miss">Miss</option>
        <option value="Professor">Professor</option>
        <option value="Reverend">Reverend</option>
        <!-- <option value="Other">Other</option> -->
      </select>
    </p>
    <p class="form-field-wrapper form-text" id="other-title-container" style="display: none;">
      <label for="donation_title_other">If other, please specify</label>
      <input type="text" name="donation_title_other" id="donation_title_other" value="" class="input-small ">
    </p>
    <p class="form-field-wrapper form-text">
      <label for="donation_first_name">First name*</label>
      <input type="text" name="donation_first_name" id="donation_first_name" value="" class="input-large ">
    </p>
    <p class="form-field-wrapper form-text">
      <label for="donation_surname">Last name*</label>
      <input type="text" name="donation_surname" id="donation_surname" value="" class="input-large ">
    </p>
    <p class="form-field-wrapper form-text">
      <label for="donation_email">Email*</label>
      <input type="text" name="donation_email" id="donation_email" value="" class="input-large ">
    </p>
    <p class="form-field-wrapper form-text">
      <label for="donation_telephone">Telephone</label>
      <input type="text" name="donation_telephone" id="donation_telephone" value="" class="input-medium ">
    </p>
    <p class="form-field-wrapper form-text">
      <label for="donation_mobile">Mobile</label>
      <input type="text" name="donation_mobile" id="donation_mobile" value="" class="input-medium ">
    </p>
    <br>
    <p>We would like to keep you updated on the latest from our programmes, campaigns, fundraising activities and appeals. Please tick below to tell us how you want to hear from us. You can visit our
      <a href="https://www.map.org.uk/about-map/frequently-asked-questions#payments" target="_blank">FAQs page</a> for more information on donations.</p>
    <div class="table-wrapper">
      <table cellspacing="0" cellpadding="0" border="0">
        <tbody>
          <tr>
            <td></td>
            <td>Yes</td>
            <td>No</td>
          </tr>
          <tr>
            <td><label for="donation_updates_post_y">Post</label></td>
            <td style="text-align: center;"><input type="radio" name="donation_updates_post" id="donation_updates_post_y" value="1"></td>
            <td style="text-align: center;"><input type="radio" name="donation_updates_post" id="donation_updates_post_n" value="0"></td>
          </tr>
          <tr valign="top">
            <td><label for="donation_updates_email_y">Email</label></td>
            <td style="text-align: center;"><input type="radio" name="donation_updates_email" id="donation_updates_email_y" value="1"></td>
            <td style="text-align: center; position: relative;"><input type="radio" name="donation_updates_email" id="donation_updates_email_n" value="0"> <sup style="position:absolute; top: 10px; right: 10px;">†</sup></td>
          </tr>
          <tr>
            <td><label for="donation_updates_telephone_y">Telephone</label></td>
            <td style="text-align: center;"><input type="radio" name="donation_updates_telephone" id="donation_updates_telephone_y" value="1"></td>
            <td style="text-align: center;"><input type="radio" name="donation_updates_telephone" id="donation_updates_telephone_n" value="0"></td>
          </tr>
          <tr>
            <td><label for="donation_updates_text_y">Text</label></td>
            <td style="text-align: center;"><input type="radio" name="donation_updates_text" id="donation_updates_text_y" value="1"></td>
            <td style="text-align: center;"><input type="radio" name="donation_updates_text" id="donation_updates_text_n" value="0"></td>
          </tr>
        </tbody>
      </table>
    </div>
    <p><sup>†</sup> <small><em>If you are currently subscribed to our email list, you can unsubscribe by clicking the link in the footer of the email.</em></small></p>
    <p class="form-field-wrapper form-select">
      <label for="donation_country">Country*</label>
      <select name="donation_country" class="" id="donation_country">
        <option value="Afghanistan">Afghanistan</option>
        <option value="Åland Islands">Åland 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="Bolivia">Bolivia</option>
        <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
        <option value="Botswana">Botswana</option>
        <option value="Bouvet Island">Bouvet Island</option>
        <option value="Brazil">Brazil</option>
        <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
        <option value="Brunei Darussalam">Brunei Darussalam</option>
        <option value="Bulgaria">Bulgaria</option>
        <option value="Burkina Faso">Burkina Faso</option>
        <option value="Burundi">Burundi</option>
        <option value="Cambodia">Cambodia</option>
        <option value="Cameroon">Cameroon</option>
        <option value="Canada">Canada</option>
        <option value="Cape Verde">Cape Verde</option>
        <option value="Cayman Islands">Cayman Islands</option>
        <option value="Central African Republic">Central African Republic</option>
        <option value="Chad">Chad</option>
        <option value="Chile">Chile</option>
        <option value="China">China</option>
        <option value="Christmas Island">Christmas Island</option>
        <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
        <option value="Colombia">Colombia</option>
        <option value="Comoros">Comoros</option>
        <option value="Congo">Congo</option>
        <option value="Congo, The Democratic Republic of the">Congo, The Democratic Republic of the</option>
        <option value="Cook Islands">Cook Islands</option>
        <option value="Costa Rica">Costa Rica</option>
        <option value="Côte D'Ivoire">Côte D'Ivoire</option>
        <option value="Croatia">Croatia</option>
        <option value="Cuba">Cuba</option>
        <option value="Cyprus">Cyprus</option>
        <option value="Czech Republic">Czech Republic</option>
        <option value="Denmark">Denmark</option>
        <option value="Djibouti">Djibouti</option>
        <option value="Dominica">Dominica</option>
        <option value="Dominican Republic">Dominican Republic</option>
        <option value="Ecuador">Ecuador</option>
        <option value="Egypt">Egypt</option>
        <option value="El Salvador">El Salvador</option>
        <option value="Equatorial Guinea">Equatorial Guinea</option>
        <option value="Eritrea">Eritrea</option>
        <option value="Estonia">Estonia</option>
        <option value="Ethiopia">Ethiopia</option>
        <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
        <option value="Faroe Islands">Faroe Islands</option>
        <option value="Fiji">Fiji</option>
        <option value="Finland">Finland</option>
        <option value="France">France</option>
        <option value="French Guiana">French Guiana</option>
        <option value="French Polynesia">French Polynesia</option>
        <option value="French Southern 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="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="Honduras">Honduras</option>
        <option value="Hong Kong">Hong Kong</option>
        <option value="Hungary">Hungary</option>
        <option value="Iceland">Iceland</option>
        <option value="India">India</option>
        <option value="Indonesia">Indonesia</option>
        <option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
        <option value="Iraq">Iraq</option>
        <option value="Ireland">Ireland</option>
        <option value="Israel">Israel</option>
        <option value="Italy">Italy</option>
        <option value="Jamaica">Jamaica</option>
        <option value="Japan">Japan</option>
        <option value="Jordan">Jordan</option>
        <option value="Kazakhstan">Kazakhstan</option>
        <option value="Kenya">Kenya</option>
        <option value="Kiribati">Kiribati</option>
        <option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
        <option value="Korea, Republic of">Korea, Republic of</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="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</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="Micronesia, Federated States of">Micronesia, Federated States of</option>
        <option value="Moldova, Republic of">Moldova, Republic of</option>
        <option value="Monaco">Monaco</option>
        <option value="Mongolia">Mongolia</option>
        <option value="Montserrat">Montserrat</option>
        <option value="Morocco">Morocco</option>
        <option value="Mozambique">Mozambique</option>
        <option value="Myanmar">Myanmar</option>
        <option value="Namibia">Namibia</option>
        <option value="Nauru">Nauru</option>
        <option value="Nepal">Nepal</option>
        <option value="Netherlands">Netherlands</option>
        <option value="Netherlands Antilles">Netherlands Antilles</option>
        <option value="New Caledonia">New Caledonia</option>
        <option value="New Zealand">New Zealand</option>
        <option value="Nicaragua">Nicaragua</option>
        <option value="Niger">Niger</option>
        <option value="Nigeria">Nigeria</option>
        <option value="Niue">Niue</option>
        <option value="Norfolk Island">Norfolk Island</option>
        <option value="Northern Mariana Islands">Northern Mariana Islands</option>
        <option value="North Macedonia">North Macedonia</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="Poland">Poland</option>
        <option value="Portugal">Portugal</option>
        <option value="Puerto Rico">Puerto Rico</option>
        <option value="Qatar">Qatar</option>
        <option value="Réunion">Réunion</option>
        <option value="Romania">Romania</option>
        <option value="Russian Federation">Russian Federation</option>
        <option value="Rwanda">Rwanda</option>
        <option value="Saint Helena">Saint Helena</option>
        <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
        <option value="Saint Lucia">Saint Lucia</option>
        <option value="Saint 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 and Montenegro">Serbia and Montenegro</option>
        <option value="Seychelles">Seychelles</option>
        <option value="Sierra Leone">Sierra Leone</option>
        <option value="Singapore">Singapore</option>
        <option value="Slovakia">Slovakia</option>
        <option value="Slovenia">Slovenia</option>
        <option value="Solomon Islands">Solomon Islands</option>
        <option value="Somalia">Somalia</option>
        <option value="South Africa">South Africa</option>
        <option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
        <option value="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">Taiwan</option>
        <option value="Tajikistan">Tajikistan</option>
        <option value="Tanzania, United Republic of">Tanzania, United Republic of</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" selected="">United Kingdom</option>
        <option value="United States">United States</option>
        <option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
        <option value="Uruguay">Uruguay</option>
        <option value="Uzbekistan">Uzbekistan</option>
        <option value="Vanuatu">Vanuatu</option>
        <option value="Vatican City State">Vatican City State</option>
        <option value="Venezuela">Venezuela</option>
        <option value="Viet Nam">Viet Nam</option>
        <option value="Virgin Islands, British">Virgin Islands, British</option>
        <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
        <option value="Wallis 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>
    </p>
    <div id="donation-address-container" class="address-container">
      <p class="form-field-wrapper form-text" style="display: none;">
        <label for="donation_address_1">Address*</label>
        <input type="text" name="donation_address_1" id="donation_address_1" value="" class="address-1 input-large ">
      </p>
      <p class="form-field-wrapper form-text" style="display: none;">
        <input class="address-2 input-large input-no-label" type="text" name="donation_address_2" id="donation_address_2" value="">
      </p>
      <p class="form-field-wrapper form-text" style="display: none;">
        <input class="address-3 input-large input-no-label" type="text" name="donation_address_3" id="donation_address_3" value="">
      </p>
      <p class="form-field-wrapper form-text" style="display: none;">
        <label for="donation_town"><span data-default-term="Town" data-us-term="City">Town</span>*</label>
        <input type="text" name="donation_town" id="donation_town" value="" class="address-town input-medium ">
      </p>
      <p class="form-field-wrapper form-text" id="donation_county_container" style="display: none;">
        <label for="donation_county">County</label>
        <input type="text" name="donation_county" id="donation_county" value="" class="address-county input-medium ">
      </p>
      <p class="form-field-wrapper form-select" id="donation_state_container" style="display: none;">
        <label for="donation_state">State*</label>
        <select name="donation_state" id="donation_state" value="" class="">
          <option value="">Select</option>
          <option value="Alabama">Alabama</option>
          <option value="Alaska">Alaska</option>
          <option value="Arizona">Arizona</option>
          <option value="Arkansas">Arkansas</option>
          <option value="California">California</option>
          <option value="Colorado">Colorado</option>
          <option value="Connecticut">Connecticut</option>
          <option value="Delaware">Delaware</option>
          <option value="DC">DC</option>
          <option value="Florida">Florida</option>
          <option value="Georgia">Georgia</option>
          <option value="Hawaii">Hawaii</option>
          <option value="Idaho">Idaho</option>
          <option value="Illinois">Illinois</option>
          <option value="Indiana">Indiana</option>
          <option value="Iowa">Iowa</option>
          <option value="Kansas">Kansas</option>
          <option value="Kentucky">Kentucky</option>
          <option value="Louisiana">Louisiana</option>
          <option value="Maine">Maine</option>
          <option value="Maryland">Maryland</option>
          <option value="Massachusetts">Massachusetts</option>
          <option value="Michigan">Michigan</option>
          <option value="Minnesota">Minnesota</option>
          <option value="Mississippi">Mississippi</option>
          <option value="Missouri">Missouri</option>
          <option value="Montana">Montana</option>
          <option value="Nebraska">Nebraska</option>
          <option value="Nevada">Nevada</option>
          <option value="New Hampshire">New Hampshire</option>
          <option value="New Jersey">New Jersey</option>
          <option value="New Mexico">New Mexico</option>
          <option value="New York">New York</option>
          <option value="North Carolina">North Carolina</option>
          <option value="North Dakota">North Dakota</option>
          <option value="Ohio">Ohio</option>
          <option value="Oklahoma">Oklahoma</option>
          <option value="Oregon">Oregon</option>
          <option value="Pennsylvania">Pennsylvania</option>
          <option value="Rhode Island">Rhode Island</option>
          <option value="South Carolina">South Carolina</option>
          <option value="South Dakota">South Dakota</option>
          <option value="Tennessee">Tennessee</option>
          <option value="Texas">Texas</option>
          <option value="Utah">Utah</option>
          <option value="Vermont">Vermont</option>
          <option value="Virginia">Virginia</option>
          <option value="Washington">Washington</option>
          <option value="West Virginia">West Virginia</option>
          <option value="Wisconsin">Wisconsin</option>
          <option value="Wyoming">Wyoming</option>
        </select>
      </p>
      <p class="form-field-wrapper form-text address-postcode-container">
        <label for="donation_postcode"><span data-default-term="Postcode" data-us-term="Zipcode">Postcode</span><span class="form-field-required-star">*</span></label>
        <input type="text" name="donation_postcode" id="donation_postcode" value="" class="address-postcode input-small "><a href="#" class="address-postcode-search">Find address</a>
      </p>
      <p class="address-manual-toggle-container"><a href="#" class="address-manual-toggle">Enter address manually</a></p>
    </div>
  </div>
  <div id="gift-aid-container" style="">
    <hr>
    <img class="img-right gift-aid-logo svg-image" src="templates/default/images/donations/gift-aid.svg" alt="GiftAid it" style="margin-bottom:0;">
    <img class="img-right gift-aid-logo png-fallback" src="templates/default/images/donations/gift-aid.png" alt="GiftAid it" style="margin-bottom:0;">
    <h5 class="gift-aid-heading">I would like to make my donation worth 25%&nbsp;more</h5>
    <p class="gift-aid-text intro"> Donations from UK tax payers qualify for Gift Aid. By ticking the box below, you are allowing Medical Aid for Palestinians to reclaim the tax that you have paid on your donation. </p>
    <p class="gift-aid-confirmation">
      <input type="radio" name="donation_gift_aid" id="donation_gift_aid_yes" value="Yes" class="">
      <label for="donation_gift_aid_yes"> I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to Medical Aid for Palestinians. I am a UK taxpayer and understand that if I pay less Income Tax and/or
        Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference. </label>
    </p>
    <p class="small-text">Please notify us if you want to cancel this declaration, change your name or home address or no longer pay sufficient tax on your income and/or capital gains.</p>
    <p class="gift-aid-confirmation">
      <input type="radio" name="donation_gift_aid" id="donation_gift_aid_no" value="No" class="">
      <label for="donation_gift_aid_no"> MAP should not claim Gift Aid on this donation. </label>
    </p>
  </div>
  <p class="form-field-wrapper">
    <input type="hidden" name="donation_validate" value="1">
    <br>
    <input type="submit" value="Next" class="input-button" id="donation_submit">
  </p>
</form>

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</form>

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EMERGENCY APPEAL



Medical Aid for Palestinians is responding to the current emergency in Gaza,
where hospitals are struggling to cope with an influx of serious injuries.
Please give an urgent donation today. 

MAP's team on the ground is releasing our entire pre-positioned stock of
essential drugs, disposables and essential healthcare supplies from our
warehouses to hospitals treating those injured in Israel's aerial bombardment of
Gaza.

More support will be needed as casualties are expected to continue to rise in
the coming days, and MAP stands ready to respond.

Your support will help ensure that Palestinian health workers have the medical
resources they need. Thank you.

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IF GIVING IN TRIBUTE:

My gift is given in tribute to


Please treat donation as a Zakat donation

Zakat is one of the five pillars of Islam. It is the obligation for Muslims to
give a proportion of their wealth to charity each year. 

HOW DOES MEDICAL AID FOR PALESTINIANS USE ZAKAT DONATIONS?

Across the occupied Palestinian territory (oPt), Palestinian hospitals are in
desperate need of basic, yet essential medicines and medical supplies. Many
medical items needed to treat patients are regularly in short supply or have
already ran out completely. At Medical Aid for Palestinians (MAP), we help by
purchasing as many urgently needed medicines, medical supplies and equipment as
we can. We can only do this thanks to the financial support we receive from
supporters like you. You can choose to make your donation to us a 'Zakat
donation' by selecting the checkbox in our donation forms. 

MAP uses 100% of all the Zakat donations we receive to respond to the ongoing
medicines and medical supply emergency in Gaza and in the West Bank. If you want
to make a Zakat donation, please remember to tick the Zakat box on the donation
page.

You can make your Zakat Gift have even greater impact by adding Gift Aid to your
donation.

If you would like to discuss your donation further, please contact us on 020
7226 4114 or info@map.org.uk

Thank you for your support. 

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fundraising activities and appeals. Please tick below to tell us how you want to
hear from us. You can visit our FAQs page for more information on donations.

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Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia
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I WOULD LIKE TO MAKE MY DONATION WORTH 25% MORE

Donations from UK tax payers qualify for Gift Aid. By ticking the box below, you
are allowing Medical Aid for Palestinians to reclaim the tax that you have paid
on your donation.

I want to Gift Aid my donation and any donations I make in the future or have
made in the past 4 years to Medical Aid for Palestinians. I am a UK taxpayer and
understand that if I pay less Income Tax and/or Capital Gains Tax than the
amount of Gift Aid claimed on all my donations in that tax year it is my
responsibility to pay any difference.

Please notify us if you want to cancel this declaration, change your name or
home address or no longer pay sufficient tax on your income and/or capital
gains.

MAP should not claim Gift Aid on this donation.




THE MAP PROMISE

We don’t share details with other charities.

We promise to use your donation wherever the need is greatest. We won’t pass
your name on or contact you unless you want to hear from us.

DO MORE WITH A REGULAR GIFT

Set up a regular gift and help us do more

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Medical Aid for Palestinians 33a Islington Park Street, London, N1 1QB,
United Kingdom +44 (0)20 7226 4114 info@map.org.uk

MAP is a Charitable Company Limited by Guarantee. Registered Number 3038352
England. Charity Registration No. 1045315.

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