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class="en__field__label en__field__label--item" for="en__field_transaction_donationAmt4">$1,000</label> </div> <div class="en__field__item"> <input type="radio" class="en__field__input en__field__input--radio" value="Other" name="transaction.donationAmt" id="en__field_transaction_donationAmt5" /> <label class="en__field__label en__field__label--item" for="en__field_transaction_donationAmt5">Other</label> </div> <div class="en__field__item en__field__item--other en__field__item--hidden"> <input class="en__field__input en__field__input--other" type="text" name="transaction.donationAmt.other" value="" /> </div> </div> </div> <div class="en__field en__field--select en__field--2017758 en__field--othamt1 en__mandatory"> <label for="en__field_transaction_othamt1" class="en__field__label" style="">My gift will support:</label> <div class="en__field__element en__field__element--select"> <select id="en__field_transaction_othamt1" class="en__field__input en__field__input--select" name="transaction.othamt1" > <option selected="selected" value="National Geographic Society Priorities">National Geographic Society Priorities</option> </select> </div> </div> </div> <div class="en__component en__component--premiumgiftblock"> <div class="en__pgHeader">Select your Thank-You Gift!</div> <div class="en__pgList" data-nogift="Maximize my donation, I would like to decline my thank-you gift." ></div> <input class="en__pgVariantSubmit" type="hidden" name="transaction.selprodvariantid" value="" /> </div> <div class="en__component en__component--formblock" style=""> <input type="hidden" class="en__field__input en__field__input--hidden" name="transaction.othamt4" value="" /> </div> <div class="en__component en__component--copyblock" style=" " > <h2>Payment Information</h2> </div> <div class="en__component en__component--formblock" style=""> <div class="en__field en__field--vgs en__field--459872 en__field--ccnumber en__mandatory"> <label for="en__field_transaction_ccnumber" class="en__field__label" style="">Credit Card Number:</label> <div class="en__field__element en__field__element--vgs"> <input type="hidden" name="transaction.ccnumber" /> <div id="en__field_transaction_ccnumber" class="en__field__input en__field__input--vgs"> </div> </div> </div> <div class="en__field en__field--select en__field--488634 en__field--paymenttype en__mandatory"> <label for="en__field_transaction_paymenttype" class="en__field__label" style="">Payment Type</label> <div class="en__field__element en__field__element--select"> <select id="en__field_transaction_paymenttype" class="en__field__input en__field__input--select" name="transaction.paymenttype" > <option value="VI">Visa</option> <option value="MC">Mastercard</option> <option value="AX">American Express</option> <option value="DI">Discover</option> <option value="Paypal">Paypal</option> </select> </div> </div> <div class="en__field en__field--splitselect en__field--488637 en__field--ccexpire en__mandatory"> <label for="en__field_transaction_ccexpire" class="en__field__label" style="">Credit Card Expiration</label> <div class="en__field__element en__field__element--splitselect"> <input type="hidden" name="transaction.ccexpire.delimiter" value=""> <div class="en__field__item"> <select id="en__field_transaction_ccexpire" class="en__field__input en__field__input--splitselect" name="transaction.ccexpire" > <option value="01">01</option> <option value="02">02</option> <option value="03">03</option> <option value="04">04</option> <option value="05">05</option> <option value="06">06</option> <option value="07">07</option> <option value="08">08</option> <option value="09">09</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> </select> </div> <div class="en__field__item"> <select class="en__field__input en__field__input--splitselect" name="transaction.ccexpire" > <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> </select> </div> </div> </div> <div class="en__field en__field--vgs en__field--459873 en__field--ccvv en__mandatory"> <label for="en__field_transaction_ccvv" class="en__field__label" style="">Credit Card Security Code:</label> <div class="en__field__element en__field__element--vgs"> <input type="hidden" name="transaction.ccvv" /> <div id="en__field_transaction_ccvv" class="en__field__input en__field__input--vgs"> </div> </div> </div> </div> <div class="en__component en__component--copyblock" style=" " > <h2>Billing Information</h2> </div> <div class="en__component en__component--formblock" style=""> <div class="en__field en__field--select en__field--1873625 en__field--title"> <label for="en__field_supporter_title" class="en__field__label" style="">Title</label> <div class="en__field__element en__field__element--select"> <select id="en__field_supporter_title" class="en__field__input en__field__input--select" name="supporter.title" > <option value="">- Select -</option> <option value="Mr.">Mr.</option> <option value="Mrs.">Mrs.</option> <option value="Miss">Miss</option> <option value="Ms.">Ms.</option> <option value="Dr.">Dr.</option> <option value="Drs.">Drs.</option> <option value="Mr. and Mrs.">Mr. and Mrs.</option> <option value="Mr. and Dr.">Mr. and Dr.</option> <option value="Dr. and Mrs.">Dr. and Mrs.</option> <option value="The Honorable">The Honorable</option> <option value="Reverend">Reverend</option> </select> </div> </div> <div class="en__field en__field--text en__field--1873623 en__field--firstName en__mandatory"> <label for="en__field_supporter_firstName" class="en__field__label" style="">First name:</label> <div class="en__field__element en__field__element--text"> <input id="en__field_supporter_firstName" type="text" class="en__field__input en__field__input--text" name="supporter.firstName" value="" /> </div> </div> <div class="en__field en__field--text en__field--1873624 en__field--lastName en__mandatory"> <label for="en__field_supporter_lastName" class="en__field__label" style="">Last name:</label> <div class="en__field__element en__field__element--text"> <input id="en__field_supporter_lastName" type="text" class="en__field__input en__field__input--text" name="supporter.lastName" value="" /> </div> </div> <div class="en__field en__field--email en__field--1873626 en__field--emailAddress en__mandatory"> <label for="en__field_supporter_emailAddress" class="en__field__label" style="">Email:</label> <div class="en__field__element en__field__element--email"> <input id="en__field_supporter_emailAddress" type="email" autocomplete="email" class="en__field__input en__field__input--email" name="supporter.emailAddress" value="" /> </div> </div> <div class="en__field en__field--radio en__field--question en__field--478149 en__field--general-email-sign-up en__mandatory"> <label for="en__field_supporter_questions_478149" class="en__field__label" style="">Yes! Please send me National Geographic Society email updates.</label> <div class="en__field__element en__field__element--radio " > <div class="en__field__item"> <input id="en__field_supporter_questions_4781490" type="radio" class="en__field__input en__field__input--radio" value="Y" name="supporter.questions.478149" /> <label for="en__field_supporter_questions_4781490" class="en__field__label en__field__label--item" >Yes</label> </div> <div class="en__field__item"> <input id="en__field_supporter_questions_4781491" type="radio" class="en__field__input en__field__input--radio" value="N" name="supporter.questions.478149" /> <label for="en__field_supporter_questions_4781491" class="en__field__label en__field__label--item" >No</label> </div> </div> </div> <div class="en__field en__field--text en__field--1873629 en__field--address1 en__mandatory"> <label for="en__field_supporter_address1" class="en__field__label" style="">Address 1:</label> <div class="en__field__element en__field__element--text"> <input id="en__field_supporter_address1" type="text" class="en__field__input en__field__input--text" name="supporter.address1" value="" /> </div> </div> <div class="en__field en__field--text en__field--1873627 en__field--address2"> <label for="en__field_supporter_address2" class="en__field__label" style="">Address 2:</label> <div class="en__field__element en__field__element--text"> <input id="en__field_supporter_address2" type="text" class="en__field__input en__field__input--text" name="supporter.address2" value="" /> </div> </div> <div class="en__field en__field--text en__field--1873628 en__field--city en__mandatory"> <label for="en__field_supporter_city" class="en__field__label" style="">City:</label> <div class="en__field__element en__field__element--text"> <input id="en__field_supporter_city" type="text" class="en__field__input en__field__input--text" name="supporter.city" value="" /> </div> </div> <div class="en__field en__field--select en__field--withOther en__field--1873631 en__field--region en__mandatory"> <label for="en__field_supporter_region" class="en__field__label" style="">State</label> <div class="en__field__element en__field__element--select"> <div class="en__field__item"> <select id="en__field_supporter_region" class="en__field__input en__field__input--select" name="supporter.region" > <option value="">- Select -</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> <option value="Other">Other</option> </select> </div> <div class="en__field__item en__field__item--other en__field__item--hidden"> <input class="en__field__input en__field__input--other" type="text" name="supporter.region.other" value="" /> </div> </div> </div> <div class="en__field en__field--text en__field--1873630 en__field--postcode en__mandatory"> <label for="en__field_supporter_postcode" class="en__field__label" style="">Zip Code:</label> <div class="en__field__element en__field__element--text"> <input id="en__field_supporter_postcode" type="text" class="en__field__input en__field__input--text" name="supporter.postcode" value="" /> </div> </div> <div class="en__field en__field--select en__field--1873635 en__field--country en__mandatory"> <label for="en__field_supporter_country" class="en__field__label" style="">Country or Area</label> <div class="en__field__element en__field__element--select"> <select id="en__field_supporter_country" class="en__field__input en__field__input--select" name="supporter.country" > <option value="US">United States</option> <option value="CA">Canada</option> <option value="GB">United Kingdom</option> <option value="A1">Abkhazia</option> <option value="AF">Afghanistan</option> <option value="DX">Akrotiri and Dhekelia</option> <option value="AL">Albania</option> <option value="DZ">Algeria</option> <option value="AS">American Samoa</option> <option value="AD">Andorra</option> <option value="AO">Angola</option> <option value="AI">Anguilla</option> <option value="AQ">Antarctica</option> <option value="AG">Antigua and Barbuda</option> <option value="AR">Argentina</option> <option value="AL">Armenia</option> <option value="AR">Aruba</option> <option value="AU">Australia</option> <option value="AT">Austria</option> <option value="AZ">Azerbaijan</option> <option value="AC">Azores</option> <option value="BH">Bahrain</option> <option value="BD">Bangladesh</option> <option value="BB">Barbados</option> <option value="BY">Belarus</option> <option value="BE">Belgium</option> <option value="BZ">Belize</option> <option value="BJ">Benin</option> <option value="BM">Bermuda</option> <option value="BT">Bhutan</option> <option value="BO">Bolivia</option> <option value="BO">Bonaire</option> <option value="BA">Bosnia and Herzegovina</option> <option value="BW">Botswana</option> <option value="BR">Brazil</option> <option value="VG">British Virgin Islands</option> <option value="BN">Brunei</option> <option value="BG">Bulgaria</option> <option value="BF">Burkina Faso</option> <option value="BI">Burundi</option> <option value="CV">Cabo Verde</option> <option value="KH">Cambodia</option> <option value="CM">Cameroon</option> <option value="CS">Canary Islands</option> <option value="KY">Cayman Islands</option> <option value="CF">Central African Republic</option> <option value="TD">Chad</option> <option value="CL">Chile</option> <option value="CN">China</option> <option value="CX">Christmas Island</option> <option value="CC">Cocos (Keeling) Islands</option> <option value="CO">Colombia</option> <option value="KM">Comoros</option> <option value="CG">Congo</option> <option value="CK">Cook Islands</option> <option value="CR">Costa Rica</option> <option value="CI">C么te d'Ivoire</option> <option value="HR">Croatia</option> <option value="CU">Cuba</option> <option value="CU">Cura莽ao</option> <option value="CY">Cyprus</option> <option value="CZ">Czechia</option> <option value="CD">Democratic Republic of the Congo</option> <option value="DK">Denmark</option> <option value="DJ">Djibouti</option> <option value="DM">Dominica</option> <option value="DO">Dominican Republic</option> <option value="EC">Ecuador</option> <option value="EG">Egypt</option> <option value="SV">El Salvador</option> <option value="EN">England</option> <option value="GQ">Equatorial Guinea</option> <option value="ER">Eritrea</option> <option value="EE">Estonia</option> <option value="SZ">Eswatini</option> <option value="ET">Ethiopia</option> <option value="FK">Falkland Islands (Islas Malvinas)</option> <option value="FO">Faroe Islands</option> <option value="FM">Federated States of Micronesia</option> <option value="FJ">Fiji</option> <option value="FI">Finland</option> <option value="FR">France</option> <option value="GF">French Guiana</option> <option value="PF">French Polynesia</option> <option value="GA">Gabon</option> <option value="G1">Gaza Strip</option> <option value="GE">Georgia</option> <option value="DE">Germany</option> <option value="GH">Ghana</option> <option value="GI">Gibraltar</option> <option value="GR">Greece</option> <option value="GL">Greenland (Kalaallit Nunaat)</option> <option value="GD">Grenada</option> <option value="GP">Guadeloupe</option> <option value="GU">Guam</option> <option value="GT">Guatemala</option> <option value="GG">Guernsey</option> <option value="GN">Guinea</option> <option value="GW">Guinea-Bissau</option> <option value="GY">Guyana</option> <option value="HT">Haiti</option> <option value="HN">Honduras</option> <option value="HK">Hong Kong S.A.R.</option> <option value="HU">Hungary</option> <option value="IS">Iceland</option> <option value="IN">India</option> <option value="ID">Indonesia</option> <option value="IR">Iran</option> <option value="IQ">Iraq</option> <option value="IE">Ireland</option> <option value="IM">Isle of Man</option> <option value="IL">Israel</option> <option value="IT">Italy</option> <option value="JM">Jamaica</option> <option value="JP">Japan</option> <option value="JE">Jersey</option> <option value="JO">Jordan</option> <option value="KZ">Kazakhstan</option> <option value="KE">Kenya</option> <option value="KI">Kiribati</option> <option value="XK">Kosovo</option> <option value="KW">Kuwait</option> <option value="KG">Kyrgyzstan</option> <option value="LA">Laos</option> <option value="LV">Latvia</option> <option value="LB">Lebanon</option> <option value="LS">Lesotho</option> <option value="LR">Liberia</option> <option value="LY">Libya</option> <option value="LI">Liechtenstein</option> <option value="LT">Lithuania</option> <option value="LU">Luxembourg</option> <option value="MO">Macau S.A.R.</option> <option value="MG">Madagascar</option> <option value="MI">Madeira</option> <option value="MW">Malawi</option> <option value="MY">Malaysia</option> <option value="MV">Maldives</option> <option value="ML">Mali</option> <option value="MT">Malta</option> <option value="MH">Marshall Islands</option> <option value="MQ">Martinique</option> <option value="MR">Mauritania</option> <option value="MU">Mauritius</option> <option value="YT">Mayotte</option> <option value="MX">Mexico</option> <option value="MD">Moldova</option> <option value="MC">Monaco</option> <option value="MN">Mongolia</option> <option value="ME">Montenegro</option> <option value="MS">Montserrat</option> <option value="MA">Morocco</option> <option value="MZ">Mozambique</option> <option value="MM">Myanmar</option> <option value="N1">Nagorno-Karabakh</option> <option value="NA">Namibia</option> <option value="NR">Nauru</option> <option value="NP">Nepal</option> <option value="NL">Netherlands</option> <option value="NC">New Caledonia</option> <option value="NZ">New Zealand</option> <option value="NI">Nicaragua</option> <option value="NE">Niger</option> <option value="NG">Nigeria</option> <option value="NU">Niue</option> <option value="NF">Norfolk Island</option> <option value="KP">North Korea</option> <option value="MK">North Macedonia</option> <option value="N2">Northern Cyprus</option> <option value="ND">Northern Ireland</option> <option value="MP">Northern Mariana Islands</option> <option value="NO">Norway</option> <option value="OM">Oman</option> <option value="PK">Pakistan</option> <option value="PW">Palau</option> <option value="PS">Palestinian Authority</option> <option value="PA">Panama</option> <option value="PG">Papua New Guinea</option> <option value="PY">Paraguay</option> <option value="PE">Peru</option> <option value="PH">Philippines</option> <option value="PN">Pitcairn Islands</option> <option value="PL">Poland</option> <option value="PT">Portugal</option> <option value="PR">Puerto Rico</option> <option value="QA">Qatar</option> <option value="RE">R茅union</option> <option value="RO">Romania</option> <option value="RU">Russia</option> <option value="RW">Rwanda</option> <option value="SF">Saba</option> <option value="BL">Saint Barthelemy</option> <option value="SH">Saint Helena, Ascension, and Tristan da Cunha</option> <option value="KN">Saint Kitts and Nevis</option> <option value="LC">Saint Lucia</option> <option value="MF">Saint Martin</option> <option value="PM">Saint Pierre and Miquelon</option> <option value="VC">Saint Vincent and the Grenadines</option> <option value="WS">Samoa</option> <option value="SM">San Marino</option> <option value="ST">Sao Tome and Principe</option> <option value="SA">Saudi Arabia</option> <option value="SP">Scotland</option> <option value="SN">Senegal</option> <option value="RS">Serbia</option> <option value="SC">Seychelles</option> <option value="SL">Sierra Leone</option> <option value="SG">Singapore</option> <option value="SU">Sint Eustatius</option> <option value="SM">Sint Maarten</option> <option value="SK">Slovakia</option> <option value="SI">Slovenia</option> <option value="SB">Solomon Islands</option> <option value="SO">Somalia</option> <option value="S1">Somaliland</option> <option value="ZA">South Africa</option> <option value="KR">South Korea</option> <option value="S2">South Ossetia</option> <option value="SS">South Sudan</option> <option value="ES">Spain</option> <option value="LK">Sri Lanka</option> <option value="SD">Sudan</option> <option value="SR">Suriname</option> <option value="SQ">Svalbard</option> <option value="SE">Sweden</option> <option value="CH">Switzerland</option> <option value="SY">Syria</option> <option value="TW">Taiwan</option> <option value="TJ">Tajikistan</option> <option value="TZ">Tanzania</option> <option value="TH">Thailand</option> <option value="BS">The Bahamas</option> <option value="GM">The Gambia</option> <option value="TL">Timor-Leste</option> <option value="TG">Togo</option> <option value="TK">Tokelau</option> <option value="TO">Tonga</option> <option value="T1">Transnistria</option> <option value="TT">Trinidad and Tobago</option> <option value="TN">Tunisia</option> <option value="TR">Turkey</option> <option value="TM">Turkmenistan</option> <option value="TC">Turks and Caicos Islands</option> <option value="TV">Tuvalu</option> <option value="UG">Uganda</option> <option value="UA">Ukraine</option> <option value="AE">United Arab Emirates</option> <option value="VI">United States Virgin Islands</option> <option value="UY">Uruguay</option> <option value="UZ">Uzbekistan</option> <option value="VU">Vanuatu</option> <option value="VA">Vatican City</option> <option value="VE">Venezuela</option> <option value="VN">Vietnam</option> <option value="WA">Wales</option> <option value="WF">Wallis and Futuna</option> <option value="W1">West Bank</option> <option value="EH">Western Sahara</option> <option value="YE">Yemen</option> <option value="ZM">Zambia</option> <option value="ZW">Zimbabwe</option> </select> </div> </div> <div class="en__field en__field--text en__field--1873634 en__field--NOT_TAGGED_29"> <label for="en__field_supporter_NOT_TAGGED_29" class="en__field__label" style="">PayPal Billing Agreement</label> <div class="en__field__element en__field__element--text"> <input id="en__field_supporter_NOT_TAGGED_29" type="text" class="en__field__input en__field__input--text" name="supporter.NOT_TAGGED_29" value="By 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