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</div> <script type="text/javascript"> // Putting these functions directly in template for historical reasons. function useAmountOther(mainPriceFieldName) { var currentFocus = CRM.$(':focus'); CRM.$('input[name=' + mainPriceFieldName + ']:radio:unchecked').each( function () { if (CRM.$(this).data('is-null-option') !== undefined) { // Triggering this click here because over in Calculate.tpl // a blur action is attached CRM.$(this).prop('checked', true).trigger('click'); } } ); // Copied from `updatePriceSetHighlight()` below which isn't available here. // @todo - consider adding this to the actions assigned in Calculate.tpl CRM.$('#priceset .price-set-row span').removeClass('highlight'); CRM.$('#priceset .price-set-row input:checked').parent().addClass('highlight'); // Return the focus we blurred earlier. currentFocus.trigger('focus'); } function clearAmountOther(otherPriceFieldName) { cj('#' + otherPriceFieldName).val('').trigger('blur'); } </script> <div class="crm-contribution-page-id-2 crm-block crm-contribution-main-form-block" data-page-id="2" data-page-template="main"> <div id="intro_text" class="crm-public-form-item crm-section intro_text-section"> <p><strong>NorCal CarciNET Community</strong>聽<span>help those with neuroendocrine tumors and carcinoid share challenges and experiences, learn about prognosis and treatments, find information, and improve communications between the medical community, patients and caregivers.聽</span></p> <p><span>Donations to NorCal CarciNET Community support our mission by providing funding for our annual conference, community outreach at our local cancer facilities, meeting space for our bi-monthly meetings and聽honorarium聽for our speakers.聽</span></p> <p><span><strong>NorCal CarciNET Community</strong><span>聽is a 501(c)(3) -聽</span>Contribution<span>聽made to our group are tax deductible.</span></span></p> <p>We are grateful for your generosity.</p> <p>聽</p> <p><strong>NorCal CarciNET Community Members and Board.</strong></p> <hr /> <p>聽If you wish to make re-occurring contribution check the box below. 聽If the box is not select the donation will be for one time only. Thank you.</p> <p>You may also donate appreciated stock by聽<a href="https://stockdonator.com/stock-information/?oid=ccf571f4">clicking here</a>.</p> <hr /> <p>聽</p> </div> <div id="priceset-div"> <div id="priceset" class="crm-section price_set-section"> <div class="crm-section other_amount-section crm-price-field-id-3"> <div class="label"><label for="price_3"> Contribution: <span class="crm-marker" title="This field is required.">*</span> </label></div> <div class="content other_amount-content"> <input price="[3,"1||"]" size="4" name="price_3" type="text" id="price_3" class="four crm-form-text required" /> </div> <div class="clear"></div> </div> <div id="pricesetTotal" class="crm-section section-pricesetTotal"> <div id="pricelabel" class="label "> <span id='amount_sum_label'>Total Amount</span> </div> <div class="content calc-value" id="pricevalue"></div> </div> <script type="text/javascript"> var thousandMarker = ','; var separator = '.'; var symbol = '$'; // moneyFormat is part of a temporary fix. it should // not be expected to be present in future versions // see https://github.com/civicrm/civicrm-core/pull/19151 var moneyFormat = '$ 1,234.56'; var optionSep = '|'; // Recalculate the total fees based on user selection cj("#priceset [price]").each(function () { var elementType = cj(this).attr('type'); if (this.tagName == 'SELECT') { elementType = 'select-one'; } switch(elementType) { case 'checkbox': cj(this).click(function(){ calculateCheckboxLineItemValue(this); display(calculateTotalFee()); }); calculateCheckboxLineItemValue(this); break; case 'radio': cj(this).click( function(){ calculateRadioLineItemValue(this); display(calculateTotalFee()); }); calculateRadioLineItemValue(this); break; case 'text': cj(this).bind( 'keyup', function() { calculateText(this); }).bind( 'blur' , function() { calculateText(this); }); //default calculation of element. calculateText(this); break; case 'select-one': calculateSelectLineItemValue(this); cj(this).change(function() { calculateSelectLineItemValue(this); display(calculateTotalFee()); }); break; } display(calculateTotalFee()); }); /** * Calculate the value of the line item for a radio value. */ function calculateCheckboxLineItemValue(priceElement) { eval( 'var option = ' + cj(priceElement).attr('price') ) ; optionPart = option[1].split(optionSep); price = parseFloat(0); if (cj(priceElement).prop('checked')) { price = parseFloat(optionPart[0]); } cj(priceElement).data('line_raw_total', price); } /** * Calculate the value of the line item for a radio value. */ function calculateRadioLineItemValue(priceElement) { eval( 'var option = ' + cj(priceElement).attr('price') ); optionPart = option[1].split(optionSep); var lineTotal = parseFloat(optionPart[0]); cj(priceElement).data('line_raw_total', lineTotal); var radionGroupName = cj(priceElement).attr("name"); // Reset all unchecked options to having a data value of 0. cj('input[name=' + radionGroupName + ']:radio:unchecked').each( function () { cj(this).data('line_raw_total', 0); } ); } /** * Calculate the value of the line item for a select value. */ function calculateSelectLineItemValue(priceElement) { eval( 'var selectedText = ' + cj(priceElement).attr('price') ); var price = parseFloat('0'); var option = cj(priceElement).val(); if (option) { optionPart = selectedText[option].split(optionSep); price = parseFloat(optionPart[0]); } cj(priceElement).data('line_raw_total', price); } /** * Calculate the value of the line item for a text box. */ function calculateText(priceElement) { //CRM-16034 - comma acts as decimal in price set text pricing //CRM-19937 - dollar sign easy mistake to make by users. var textval = parseFloat(cj(priceElement).val().replace(thousandMarker, '').replace(symbol, '').replace(separator, '.')); if (isNaN(textval)) { textval = parseFloat(0); } eval('var option = '+ cj(priceElement).attr('price')); optionPart = option[1].split(optionSep); addprice = parseFloat(optionPart[0]); var curval = textval * addprice; cj(priceElement).data('line_raw_total', curval); display(calculateTotalFee()); } /** * Calculate the total fee for the visible priceset. */ function calculateTotalFee() { var totalFee = 0; cj("#priceset [price]").each(function () { totalFee = totalFee + cj(this).data('line_raw_total'); }); return totalFee; } /** * Display calculated amount. */ function display(totalfee) { // totalfee is monetary, round it to 2 decimal points so it can // go as a float - CRM-13491 totalfee = Math.round(totalfee*100)/100; // dev/core#1019 Use the moneyFormat assigned to the template as an interim fix // to support forms using a currency other that the site default. Also make sure to // support various currency formatting options, // temporary measure - pending // our preferred fix. // see https://github.com/civicrm/civicrm-core/pull/19151 var totalFormattedFee = CRM.formatMoney(totalfee, false, moneyFormat); cj('#pricevalue').html(totalFormattedFee); cj('#total_amount').val( totalfee ); cj('#pricevalue').data('raw-total', totalfee).trigger('change'); if (totalfee < 0) { cj('table#pricelabel').addClass('disabled'); } else { cj('table#pricelabel').removeClass('disabled'); } if (typeof skipPaymentMethod == 'function') { // Advice to anyone who, like me, feels hatred towards this if construct ... if you remove the if you // get an error on participant 2 of a event that requires approval & permits multiple registrants. skipPaymentMethod(); } } </script> </div> </div> <div class="crm-public-form-item crm-section email-5-section"> <div class="label"><label for="email-5"> Email Address <span class="crm-marker" title="This field is required.">*</span> </label></div> <div class="content"> <input size="30" maxlength="60" class="email crm-form-text required" name="email-5" type="text" id="email-5" /> </div> <div class="clear"></div> </div> <div id='onBehalfOfOrg' class="crm-public-form-item crm-section"> <div class="crm-public-form-item" id="on-behalf-block"> </div> <script type="text/javascript"> CRM.$(function($) { var orgOption = $("input:radio[name=org_option]:checked").attr('id'); var onBehalfRequired = '$onBehalfRequired'; var onbehalfof_id = $('#onbehalfof_id'); var is_for_organization = $('#is_for_organization'); selectCreateOrg(orgOption, false); if (is_for_organization.length) { showHideOnBehalfOfBlock(); is_for_organization.on('change', function() { showHideOnBehalfOfBlock(); }); } function showHideOnBehalfOfBlock() { $('#on-behalf-block').toggle(is_for_organization.is(':checked')); if (is_for_organization.is(':checked')) { $('#onBehalfOfOrg select.crm-select2').removeClass('crm-no-validate'); } else { $('#onBehalfOfOrg select.crm-select2').addClass('crm-no-validate'); } } $("input:radio[name='org_option']").click( function( ) { var orgOption = $(this).attr('id'); selectCreateOrg(orgOption, true); }); onbehalfof_id.change(function() { setLocationDetails($(this).val()); }).change(); if (onbehalfof_id.length) { setLocationDetails(onbehalfof_id.val()); } function resetValues() { // Don't trip chain-select when clearing values $('.crm-chain-select-control', "#select_org div").select2('val', ''); $('input[type=text], select, textarea', "#select_org div").not('.crm-chain-select-control, #onbehalfof_id').val('').change(); $('input[type=radio], input[type=checkbox]', "#select_org div").prop('checked', false).change(); $('#on-behalf-block input').not('input[type=checkbox], input[type=radio], #onbehalfof_id').val(''); // clear checkboxes and radio $('#on-behalf-block') .find('input[type=checkbox], input[type=radio]') .not('input[name=org_option]') .attr('checked', false); } function selectCreateOrg( orgOption, reset ) { if (orgOption == 'CIVICRM_QFID_0_org_option') { $("#onbehalfof_id").show().change(); $("input#onbehalf_organization_name").hide(); } else if (orgOption == 'CIVICRM_QFID_1_org_option') { $("input#onbehalf_organization_name").show(); $("#onbehalfof_id").hide(); reset = true; } if ( reset ) { resetValues(); } } function setLocationDetails(contactID , reset) { resetValues(); var locationUrl = '' + contactID; var submittedOnBehalfInfo = ''; var submittedCID = ""; if (submittedOnBehalfInfo) { submittedOnBehalfInfo = $.parseJSON(submittedOnBehalfInfo); if (submittedCID == contactID) { $.each(submittedOnBehalfInfo, function(key, value) { //handle checkboxes if (typeof value === 'object') { $.each(value, function(k, v) { $('#onbehalf_' + key + '_' + k).prop('checked', v); }); } else if ($('#onbehalf_' + key).length) { $('#onbehalf_' + key ).val(value); } //radio buttons else if ($("input[name='onbehalf[" + key + "]']").length) { $("input[name='onbehalf[" + key + "]']").val([value]); } }); return; } } $.ajax({ url : locationUrl, dataType : "json", success : function(data, status) { for (var ele in data) { if ($("#"+ ele).hasClass('crm-chain-select-target')) { $("#"+ ele).data('newVal', data[ele].value).off('.autofill').on('crmOptionsUpdated.autofill', function() { $(this).off('.autofill').val($(this).data('newVal')).change(); }); } else if ($('#' + ele).data('select2')) { $('#' + ele).select2('val', data[ele].value); } if (data[ele].type == 'Radio') { if (data[ele].value) { var fldName = ele.replace('onbehalf_', ''); $("input[name='onbehalf["+ fldName +"]']").filter("[value='" + data[ele].value + "']").prop('checked', true); } } else if (data[ele].type == 'CheckBox') { for (var selectedOption in data[ele].value) { var fldName = ele.replace('onbehalf_', ''); $("input[name='onbehalf["+ fldName+"]["+ selectedOption +"]']").prop('checked','checked'); } } else if (data[ele].type == 'AdvMulti-Select') { var customFld = ele.replace('onbehalf_', ''); // remove empty value if any $('#onbehalf\\['+ customFld +'\\]-f option[value=""]').remove(); $('#onbehalf\\['+ customFld +'\\]-t option[value=""]').remove(); for (var selectedOption in data[ele].value) { // remove selected values from left and selected values to right $('#onbehalf\\['+ customFld +'\\]-f option[value="' + selectedOption + '"]').remove() .appendTo('#onbehalf\\['+ customFld +'\\]-t'); $('#onbehalf_'+ customFld).val(selectedOption); } } else { // do not set defaults to file type fields if ($('#' + ele).attr('type') != 'file') { $('#' + ele ).val(data[ele].value).change(); } } } }, error : function(XMLHttpRequest, textStatus, errorThrown) { CRM.console('error', "HTTP error status: ", textStatus); } }); } }); </script> </div> <div class="crm-public-form-item crm-section cms_user-section"> </div> <div class="crm-public-form-item crm-section premium_block-section"> </div> <fieldset class="crm-public-form-item crm-group honor_block-group"> <legend>Honoree Information (optional)</legend> <div class="crm-public-form-item crm-section honor_block_text-section"> Please put the name of the person you are honoring </div> <div class="crm-public-form-item crm-section soft_credit_type_id-section"> <div class="content" > <input class="crm-form-radio" value="1" type="radio" id="CIVICRM_QFID_1_soft_credit_type_id" name="soft_credit_type_id" /><label for="CIVICRM_QFID_1_soft_credit_type_id">In Honor of</label> <input class="crm-form-radio" value="2" type="radio" id="CIVICRM_QFID_2_soft_credit_type_id" name="soft_credit_type_id" /><label for="CIVICRM_QFID_2_soft_credit_type_id">In Memory of</label> <a href="#" class="crm-hover-button crm-clear-link" style="visibility:hidden;" title="Clear"><i class="crm-i fa-times" aria-hidden="true"></i></a> <div class="description">Select an option to reveal honoree information fields.</div> </div> </div> <div id="honorType" class="honoree-name-email-section"> <div class="crm-section editrow_prefix_id-section form-item" id="editrow-honor_prefix_id"> <div class="label"> <label for="honor_prefix_id">Individual Prefix</label> </div> <div class="content"> <select class="six crm-select2 crm-form-select" placeholder="" data-option-edit-path="civicrm/admin/options/individual_prefix" data-api-entity="contact" data-api-field="prefix_id" name="honor[prefix_id]" id="honor_prefix_id"> <option value=""></option> <option value="1">Mrs.</option> <option value="2">Ms.</option> <option value="3">Mr.</option> <option value="4">Dr.</option> </select> </div> <div class="clear"></div> </div> <div class="crm-section editrow_first_name-section form-item" id="editrow-honor_first_name"> <div class="label"> <label for="honor_first_name">First Name</label> </div> <div class="content"> <input maxlength="64" size="30" name="honor[first_name]" type="text" id="honor_first_name" class="big crm-form-text" /> </div> <div class="clear"></div> </div> <div class="crm-section editrow_last_name-section form-item" id="editrow-honor_last_name"> <div class="label"> <label for="honor_last_name">Last Name</label> </div> <div class="content"> <input maxlength="64" size="30" name="honor[last_name]" type="text" id="honor_last_name" class="big crm-form-text" /> </div> <div class="clear"></div> </div> <div class="crm-section helprow-note-section helprow-pre" id="helprow-honor_note"> <div class="content description">If there is any additional information you would like us to know about the donation, please enter it below.</div> </div> <div class="crm-section editrow_note-section form-item" id="editrow-honor_note"> <div class="label"> <label for="honor_note">Note</label> </div> <div class="content"> <textarea rows="4" cols="60" name="honor[note]" id="honor_note" class="crm-form-textarea"></textarea> </div> <div class="clear"></div> </div> <div class="crm-section editrow_email-1-section form-item" id="editrow-honor_email-1"> <div class="label"> <label for="honor_email-1">Email Address of Honoree</label> </div> <div class="content"> <input maxlength="254" size="30" name="honor[email-1]" type="text" id="honor_email-1" class="big crm-form-text" /> </div> <div class="clear"></div> </div> <script type="text/javascript"> CRM.$(function($) { $('#selector tr:even').addClass('odd-row'); $('#selector tr:odd ').addClass('even-row'); }); </script> </div> </fieldset> <div class="crm-public-form-item crm-group custom_pre_profile-group"> <fieldset class="crm-profile crm-profile-id-14 crm-profile-name-name_and_address_14"><legend>Contributor Information</legend> <div class="crm-section editrow_first_name-section form-item" id="editrow-first_name"> <div class="label"> <label for="first_name"> First Name <span class="crm-marker" title="This field is required.">*</span> </label> </div> <div class="content"> <input maxlength="64" size="30" name="first_name" type="text" id="first_name" class="big crm-form-text required" /> </div> <div class="clear"></div> </div> <div class="crm-section editrow_last_name-section form-item" id="editrow-last_name"> <div class="label"> <label for="last_name"> Last Name <span class="crm-marker" title="This field is required.">*</span> </label> </div> <div class="content"> <input maxlength="64" size="30" name="last_name" type="text" id="last_name" class="big crm-form-text required" /> </div> <div class="clear"></div> </div> <div class="crm-section editrow_current_employer-section form-item" id="editrow-current_employer"> <div class="label"> <label for="current_employer">Company</label> </div> <div class="content"> <input name="current_employer" type="text" id="current_employer" class="crm-form-text" /> </div> <div class="clear"></div> </div> <div class="crm-section editrow_street_address-1-section form-item" id="editrow-street_address-1"> <div class="label"> <label for="street_address-1"> Address <span class="crm-marker" title="This field is required.">*</span> </label> </div> <div class="content"> <input maxlength="96" size="45" name="street_address-1" type="text" id="street_address-1" class="huge crm-form-text required" /> </div> <div class="clear"></div> </div> <div class="crm-section editrow_city-1-section form-item" id="editrow-city-1"> <div class="label"> <label for="city-1"> City <span class="crm-marker" title="This field is required.">*</span> </label> </div> <div class="content"> <input maxlength="64" size="30" name="city-1" type="text" id="city-1" class="big crm-form-text required" /> </div> <div class="clear"></div> </div> <div class="crm-section editrow_postal_code-1-section form-item" id="editrow-postal_code-1"> <div class="label"> <label for="postal_code-1"> Zip <span class="crm-marker" title="This field is required.">*</span> </label> </div> <div class="content"> <input maxlength="64" size="6" name="postal_code-1" type="text" id="postal_code-1" class="six crm-form-text required" /> </div> <div class="clear"></div> </div> <div class="crm-section editrow_country-1-section form-item" id="editrow-country-1"> <div class="label"> <label for="country-1">Country </label> </div> <div class="content"> <select class="crm-select2 crm-chain-select-control crm-form-select" placeholder="- select Country -" name="country-1" data-target="state_province-1" id="country-1"> <option value="">- select Country -</option> <option value="1228" selected="selected">United States</option> <option value="1001">Afghanistan</option> <option value="1241">脜land Islands</option> <option value="1002">Albania</option> <option value="1003">Algeria</option> <option value="1004">American Samoa</option> <option value="1005">Andorra</option> <option value="1006">Angola</option> <option value="1007">Anguilla</option> <option value="1008">Antarctica</option> <option value="1009">Antigua and Barbuda</option> <option value="1010">Argentina</option> <option value="1011">Armenia</option> <option value="1012">Aruba</option> <option value="1013">Australia</option> <option value="1014">Austria</option> <option value="1015">Azerbaijan</option> <option value="1212">Bahamas</option> <option value="1016">Bahrain</option> <option value="1017">Bangladesh</option> <option value="1018">Barbados</option> <option value="1019">Belarus</option> <option value="1020">Belgium</option> <option value="1021">Belize</option> <option value="1022">Benin</option> <option value="1023">Bermuda</option> <option value="1024">Bhutan</option> <option value="1025">Bolivia</option> <option value="1250">Bonaire, Saint Eustatius and Saba</option> <option value="1026">Bosnia and Herzegovina</option> <option value="1027">Botswana</option> <option value="1028">Bouvet Island</option> <option value="1029">Brazil</option> <option value="1030">British Indian Ocean Territory</option> <option value="1032">Brunei Darussalam</option> <option value="1033">Bulgaria</option> <option value="1034">Burkina Faso</option> <option value="1036">Burundi</option> <option value="1037">Cambodia</option> <option value="1038">Cameroon</option> <option value="1039">Canada</option> <option value="1040">Cape Verde</option> <option value="1041">Cayman Islands</option> <option value="1042">Central African Republic</option> <option value="1043">Chad</option> <option value="1044">Chile</option> <option value="1045">China</option> <option value="1046">Christmas Island</option> <option value="1047">Cocos (Keeling) Islands</option> <option value="1048">Colombia</option> <option value="1049">Comoros</option> <option value="1051">Congo, Republic Of The</option> <option value="1050">Congo, The Democratic Republic of the</option> <option value="1052">Cook Islands</option> <option value="1053">Costa Rica</option> <option value="1054">C么te d鈥橧voire</option> <option value="1055">Croatia</option> <option value="1056">Cuba</option> <option value="1248">Cura莽ao</option> <option value="1057">Cyprus</option> <option value="1058">Czech Republic</option> <option value="1059">Denmark</option> <option value="1060">Djibouti</option> <option value="1061">Dominica</option> <option value="1062">Dominican Republic</option> <option value="1064">Ecuador</option> <option value="1065">Egypt</option> <option value="1066">El Salvador</option> <option value="1067">Equatorial Guinea</option> <option value="1068">Eritrea</option> <option value="1069">Estonia</option> <option value="1203">Eswatini</option> <option value="1070">Ethiopia</option> <option value="1072">Falkland Islands (Malvinas)</option> <option value="1073">Faroe Islands</option> <option value="1074">Fiji</option> <option value="1075">Finland</option> <option value="1076">France</option> <option value="1077">French Guiana</option> <option value="1078">French Polynesia</option> <option value="1079">French Southern Territories</option> <option value="1080">Gabon</option> <option value="1213">Gambia</option> <option value="1081">Georgia</option> <option value="1082">Germany</option> <option value="1083">Ghana</option> <option value="1084">Gibraltar</option> <option value="1085">Greece</option> <option value="1086">Greenland</option> <option value="1087">Grenada</option> <option value="1088">Guadeloupe</option> <option value="1089">Guam</option> <option value="1090">Guatemala</option> <option value="1245">Guernsey</option> <option value="1091">Guinea</option> <option value="1092">Guinea-Bissau</option> <option value="1093">Guyana</option> <option value="1094">Haiti</option> <option value="1095">Heard Island and McDonald Islands</option> <option value="1096">Holy See (Vatican City State)</option> <option value="1097">Honduras</option> <option value="1098">Hong Kong</option> <option value="1099">Hungary</option> <option value="1100">Iceland</option> <option value="1101">India</option> <option value="1102">Indonesia</option> <option value="1103">Iran, Islamic Republic of</option> <option value="1104">Iraq</option> <option value="1105">Ireland</option> <option value="1246">Isle of Man</option> <option value="1106">Israel</option> <option value="1107">Italy</option> <option value="1108">Jamaica</option> <option value="1109">Japan</option> <option value="1244">Jersey</option> <option value="1110">Jordan</option> <option value="1111">Kazakhstan</option> <option value="1112">Kenya</option> <option value="1113">Kiribati</option> <option value="1114">Korea, Democratic People's Republic of</option> <option value="1115">Korea, Republic of</option> <option value="1251">Kosovo</option> <option value="1116">Kuwait</option> <option value="1117">Kyrgyzstan</option> <option value="1118">Lao People's Democratic Republic</option> <option value="1119">Latvia</option> <option value="1120">Lebanon</option> <option value="1121">Lesotho</option> <option value="1122">Liberia</option> <option value="1123">Libya</option> <option value="1124">Liechtenstein</option> <option value="1125">Lithuania</option> <option value="1126">Luxembourg</option> <option value="1127">Macao</option> <option value="1129">Madagascar</option> <option value="1130">Malawi</option> <option value="1131">Malaysia</option> <option value="1132">Maldives</option> <option value="1133">Mali</option> <option value="1134">Malta</option> <option value="1135">Marshall Islands</option> <option value="1136">Martinique</option> <option value="1137">Mauritania</option> <option value="1138">Mauritius</option> <option value="1139">Mayotte</option> <option value="1140">Mexico</option> <option value="1141">Micronesia, Federated States of</option> <option value="1142">Moldova</option> <option value="1143">Monaco</option> <option value="1144">Mongolia</option> <option value="1243">Montenegro</option> <option value="1145">Montserrat</option> <option value="1146">Morocco</option> <option value="1147">Mozambique</option> <option value="1035">Myanmar</option> <option value="1148">Namibia</option> <option value="1149">Nauru</option> <option value="1150">Nepal</option> <option value="1152">Netherlands</option> <option value="1153">New Caledonia</option> <option value="1154">New Zealand</option> <option value="1155">Nicaragua</option> <option value="1156">Niger</option> <option value="1157">Nigeria</option> <option value="1158">Niue</option> <option value="1159">Norfolk Island</option> <option value="1128">North Macedonia</option> <option value="1160">Northern Mariana Islands</option> <option value="1161">Norway</option> <option value="1162">Oman</option> <option value="1163">Pakistan</option> <option value="1164">Palau</option> <option value="1165">Palestine, State of</option> <option value="1166">Panama</option> <option value="1167">Papua New Guinea</option> <option value="1168">Paraguay</option> <option value="1169">Peru</option> <option value="1170">Philippines</option> <option value="1171">Pitcairn</option> <option value="1172">Poland</option> <option value="1173">Portugal</option> <option value="1174">Puerto Rico</option> <option value="1175">Qatar</option> <option value="1179">Reunion</option> <option value="1176">Romania</option> <option value="1177">Russian Federation</option> <option value="1178">Rwanda</option> <option value="1252">Saint Barth茅lemy</option> <option value="1180">Saint Helena</option> <option value="1181">Saint Kitts and Nevis</option> <option value="1182">Saint Lucia</option> <option value="1253">Saint Martin (French part)</option> <option value="1183">Saint Pierre and Miquelon</option> <option value="1184">Saint Vincent and the Grenadines</option> <option value="1185">Samoa</option> <option value="1186">San Marino</option> <option value="1207">Sao Tome and Principe</option> <option value="1187">Saudi Arabia</option> <option value="1188">Senegal</option> <option value="1242">Serbia</option> <option value="1238">Serbia and Montenegro</option> <option value="1189">Seychelles</option> <option value="1190">Sierra Leone</option> <option value="1191">Singapore</option> <option value="1249">Sint Maarten (Dutch Part)</option> <option value="1192">Slovakia</option> <option value="1193">Slovenia</option> <option value="1194">Solomon Islands</option> <option value="1195">Somalia</option> <option value="1196">South Africa</option> <option value="1197">South Georgia and the South Sandwich Islands</option> <option value="1247">South Sudan</option> <option value="1198">Spain</option> <option value="1199">Sri Lanka</option> <option value="1200">Sudan</option> <option value="1201">Suriname</option> <option value="1202">Svalbard and Jan Mayen</option> <option value="1204">Sweden</option> <option value="1205">Switzerland</option> <option value="1206">Syrian Arab Republic</option> <option value="1208">Taiwan</option> <option value="1209">Tajikistan</option> <option value="1210">Tanzania, United Republic of</option> <option value="1211">Thailand</option> <option value="1063">Timor-Leste</option> <option value="1214">Togo</option> <option value="1215">Tokelau</option> <option value="1216">Tonga</option> <option value="1217">Trinidad and Tobago</option> <option value="1218">Tunisia</option> <option value="1219">Turkey</option> <option value="1220">Turkmenistan</option> <option value="1221">Turks and Caicos Islands</option> <option value="1222">Tuvalu</option> <option value="1223">Uganda</option> <option value="1224">Ukraine</option> <option value="1225">United Arab Emirates</option> <option value="1226">United Kingdom</option> <option value="1227">United States Minor Outlying Islands</option> <option value="1229">Uruguay</option> <option value="1230">Uzbekistan</option> <option value="1231">Vanuatu</option> <option value="1232">Venezuela</option> <option value="1233">Viet Nam</option> <option value="1031">Virgin Islands, British</option> <option value="1234">Virgin Islands, U.S.</option> <option value="1235">Wallis and Futuna</option> <option value="1236">Western Sahara</option> <option value="1237">Yemen</option> <option value="1239">Zambia</option> <option value="1240">Zimbabwe</option> </select> </div> <div class="clear"></div> </div> <div class="crm-section editrow_state_province-1-section form-item" id="editrow-state_province-1"> <div class="label"> <label for="state_province-1"> State <span class="crm-marker" title="This field is required.">*</span> </label> </div> <div class="content"> <select data-callback="civicrm/ajax/jqState" data-empty-prompt="Choose country first" data-none-prompt="- N/A -" class="crm-select2 required crm-field-required crm-chain-select-target crm-form-select required" data-select-prompt="- select State/Province -" data-name="state_province-1" name="state_province-1" id="state_province-1"> <option value="">- select State/Province -</option> <option value="1000">Alabama</option> <option value="1001">Alaska</option> <option value="1052">American Samoa</option> <option value="1002">Arizona</option> <option value="1003">Arkansas</option> <option value="1060">Armed Forces Americas</option> <option value="1059">Armed Forces Europe</option> <option value="1061">Armed Forces Pacific</option> <option value="1004" selected="selected">California</option> <option value="1005">Colorado</option> <option value="1006">Connecticut</option> <option value="1007">Delaware</option> <option value="1050">District of Columbia</option> <option value="1008">Florida</option> <option value="1009">Georgia</option> <option value="1053">Guam</option> <option value="1010">Hawaii</option> <option value="1011">Idaho</option> <option value="1012">Illinois</option> <option value="1013">Indiana</option> <option value="1014">Iowa</option> <option value="1015">Kansas</option> <option value="1016">Kentucky</option> <option value="1017">Louisiana</option> <option value="1018">Maine</option> <option value="1019">Maryland</option> <option value="1020">Massachusetts</option> <option value="1021">Michigan</option> <option value="1022">Minnesota</option> <option value="1023">Mississippi</option> <option value="1024">Missouri</option> <option value="1025">Montana</option> <option value="1026">Nebraska</option> <option value="1027">Nevada</option> <option value="1028">New Hampshire</option> <option value="1029">New Jersey</option> <option value="1030">New Mexico</option> <option value="1031">New York</option> <option value="1032">North Carolina</option> <option value="1033">North Dakota</option> <option value="1055">Northern Mariana Islands</option> <option value="1034">Ohio</option> <option value="1035">Oklahoma</option> <option value="1036">Oregon</option> <option value="1037">Pennsylvania</option> <option value="1056">Puerto Rico</option> <option value="1038">Rhode Island</option> <option value="1039">South Carolina</option> <option value="1040">South Dakota</option> <option value="1041">Tennessee</option> <option value="1042">Texas</option> <option value="1058">United States Minor Outlying Islands</option> <option value="1043">Utah</option> <option value="1044">Vermont</option> <option value="1057">Virgin Islands</option> <option value="1045">Virginia</option> <option value="1046">Washington</option> <option value="1047">West Virginia</option> <option value="1048">Wisconsin</option> <option value="1049">Wyoming</option> </select> </div> <div class="clear"></div> </div> <div class="crm-section editrow_phone-Primary-1-section form-item" id="editrow-phone-Primary-1"> <div class="label"> <label for="phone-Primary-1">Phone</label> </div> <div class="content"> <input maxlength="32" size="20" name="phone-Primary-1" type="text" id="phone-Primary-1" class="medium crm-form-text" /> </div> <div class="clear"></div> </div> </fieldset> <script type="text/javascript"> CRM.$(function($) { $('#selector tr:even').addClass('odd-row'); $('#selector tr:odd ').addClass('even-row'); }); </script> </div> <fieldset class="crm-public-form-item crm-group payment_options-group" style="display:none;"> <legend>Payment Options</legend> <div class="crm-public-form-item crm-section payment_processor-section"> <div class="label"><label>Payment Method</label></div> <div class="content"><input class="payment_processor_iats-payments-credit-card crm-form-radio" value="7" type="radio" id="CIVICRM_QFID_7_payment_processor_id" name="payment_processor_id" checked="checked" /><label for="CIVICRM_QFID_7_payment_processor_id">Credit Card (Visa, MC, AMEX)</label> <input class="payment_processor_iats-payments-ach-eft crm-form-radio" value="9" type="radio" id="CIVICRM_QFID_9_payment_processor_id" name="payment_processor_id" /><label for="CIVICRM_QFID_9_payment_processor_id">Pay by Check On Line</label> <input class="payment_processor_paypal-standard crm-form-radio" value="1" type="radio" id="CIVICRM_QFID_1_payment_processor_id" name="payment_processor_id" /><label for="CIVICRM_QFID_1_payment_processor_id">PayPal</label> <input class="payment_processor_paylater crm-form-radio" value="0" type="radio" id="CIVICRM_QFID_0_payment_processor_id" name="payment_processor_id" /><label for="CIVICRM_QFID_0_payment_processor_id">I will send payment by check</label></div> <div class="clear"></div> </div> </fieldset> <div id="billing-payment-block"> <script type="text/javascript"> CRM.config.creditCardTypes = {"Visa":{"label":"Visa","name":"Visa","css_key":"visa","pattern":"4(?:[0-9]{12}|[0-9]{15})"},"MasterCard":{"label":"MasterCard","name":"MasterCard","css_key":"mastercard","pattern":"(5[1-5][0-9]{2}|2[3-6][0-9]{2}|22[3-9][0-9]|222[1-9]|27[0-1][0-9]|2720)[0-9]{12}"},"Amex":{"label":"Amex","name":"Amex","css_key":"amex","pattern":"3[47][0-9]{13}"},"Discover":{"label":"Discover","name":"Discover","css_key":"discover","pattern":"6011[0-9]{12}"}}; </script> <div id="payment_information"> <fieldset class="billing_mode-group credit_card_info-group"> <legend> Credit Card </legend> <div class="crm-section billing_mode-section credit_card_info-section"> <div class="crm-section credit_card_type-section"> <div class="label"><label for="credit_card_type">Card Type</label> </div> <div class="content"> <select name="credit_card_type" id="credit_card_type" class="crm-form-select"> <option value="">- select -</option> <option value="Visa">Visa</option> <option value="MasterCard">MasterCard</option> <option value="Amex">Amex</option> <option value="Discover">Discover</option> </select> <div class="crm-credit_card_type-icons"></div> </div> <div class="clear"></div> </div> <div class="crm-section credit_card_number-section"> <div class="label"><label for="credit_card_number">Card Number</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"> <input size="20" maxlength="20" autocomplete="off" class="creditcard required crm-form-text" name="credit_card_number" type="text" id="credit_card_number" /> </div> <div class="clear"></div> </div> <div class="crm-section cvv2-section"> <div class="label"><label for="cvv2">Security Code</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"> <input size="5" maxlength="10" autocomplete="off" class="required crm-form-text" name="cvv2" type="text" id="cvv2" /> <span class="cvv2-icon" title="Usually the last 3-4 digits in the signature area on the back of the card."> </span> </div> <div class="clear"></div> </div> <div class="crm-section credit_card_exp_date-section"> <div class="label"><label>Expiration Date</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"> <select class="crm-form-select required" id="credit_card_exp_date_M" aria-label="Expiration Date month" name="credit_card_exp_date[M]"> <option value="">-month-</option> <option value="1">Jan</option> <option value="2">Feb</option> <option value="3">Mar</option> <option value="4">Apr</option> <option value="5">May</option> <option value="6">Jun</option> <option value="7">Jul</option> <option value="8">Aug</option> <option value="9">Sep</option> <option value="10">Oct</option> <option value="11">Nov</option> <option value="12">Dec</option> </select> <select class="crm-form-select required" id="credit_card_exp_date_Y" aria-label="Expiration Date year" name="credit_card_exp_date[Y]"> <option value="">-year-</option> <option value="2025">2025</option> <option value="2026">2026</option> <option value="2027">2027</option> <option value="2028">2028</option> <option value="2029">2029</option> <option value="2030">2030</option> <option value="2031">2031</option> <option value="2032">2032</option> <option value="2033">2033</option> <option value="2034">2034</option> <option value="2035">2035</option> </select> </div> <div class="clear"></div> </div> </div> </fieldset> <input type="checkbox" id="billingcheckbox" value="0"> <label for="billingcheckbox">My billing address is the same as above</label> <fieldset class="billing_name_address-group"> <legend>Billing Name and Address</legend> <div class="crm-section billing_name_address-section"> <div class="crm-section billing_first_name-section"> <div class="label"><label for="billing_first_name">Billing First Name</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"><input size="30" maxlength="60" autocomplete="off" class="required crm-form-text" name="billing_first_name" type="text" id="billing_first_name" /></div> <div class="clear"></div> </div> <div class="crm-section billing_middle_name-section"> <div class="label"><label for="billing_middle_name">Billing Middle Name</label> </div> <div class="content"><input size="30" maxlength="60" autocomplete="off" name="billing_middle_name" type="text" id="billing_middle_name" class="big crm-form-text" /></div> <div class="clear"></div> </div> <div class="crm-section billing_last_name-section"> <div class="label"><label for="billing_last_name">Billing Last Name</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"><input size="30" maxlength="60" autocomplete="off" class="required crm-form-text" name="billing_last_name" type="text" id="billing_last_name" /></div> <div class="clear"></div> </div> <div class="crm-section billing_street_address-5-section"> <div class="label"><label for="billing_street_address-5">Street Address</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"><input size="30" maxlength="60" autocomplete="off" class="required crm-form-text" name="billing_street_address-5" type="text" id="billing_street_address-5" /></div> <div class="clear"></div> </div> <div class="crm-section billing_city-5-section"> <div class="label"><label for="billing_city-5">City</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"><input size="30" maxlength="60" autocomplete="off" class="required crm-form-text" name="billing_city-5" type="text" id="billing_city-5" /></div> <div class="clear"></div> </div> <div class="crm-section billing_country_id-5-section"> <div class="label"><label for="billing_country_id-5">Country</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"><select class="big required crm-form-select2 crm-select2 crm-chain-select-control" name="billing_country_id-5" data-target="billing_state_province_id-5" id="billing_country_id-5"> <option value="">- select -</option> <option value="1228" selected="selected">United States</option> <option value="1001">Afghanistan</option> <option value="1241">脜land Islands</option> <option value="1002">Albania</option> <option value="1003">Algeria</option> <option value="1004">American Samoa</option> <option value="1005">Andorra</option> <option value="1006">Angola</option> <option value="1007">Anguilla</option> <option value="1008">Antarctica</option> <option value="1009">Antigua and Barbuda</option> <option value="1010">Argentina</option> <option value="1011">Armenia</option> <option value="1012">Aruba</option> <option value="1013">Australia</option> <option value="1014">Austria</option> <option value="1015">Azerbaijan</option> <option value="1212">Bahamas</option> <option value="1016">Bahrain</option> <option value="1017">Bangladesh</option> <option value="1018">Barbados</option> <option value="1019">Belarus</option> <option value="1020">Belgium</option> <option value="1021">Belize</option> <option value="1022">Benin</option> <option value="1023">Bermuda</option> <option value="1024">Bhutan</option> <option value="1025">Bolivia</option> <option value="1250">Bonaire, Saint Eustatius and Saba</option> <option value="1026">Bosnia and Herzegovina</option> <option value="1027">Botswana</option> <option value="1028">Bouvet Island</option> <option value="1029">Brazil</option> <option value="1030">British Indian Ocean Territory</option> <option value="1032">Brunei Darussalam</option> <option value="1033">Bulgaria</option> <option value="1034">Burkina Faso</option> <option value="1036">Burundi</option> <option value="1037">Cambodia</option> <option value="1038">Cameroon</option> <option value="1039">Canada</option> <option value="1040">Cape Verde</option> <option value="1041">Cayman Islands</option> <option value="1042">Central African Republic</option> <option value="1043">Chad</option> <option value="1044">Chile</option> <option value="1045">China</option> <option value="1046">Christmas Island</option> <option value="1047">Cocos (Keeling) Islands</option> <option value="1048">Colombia</option> <option value="1049">Comoros</option> <option value="1051">Congo, Republic Of The</option> <option value="1050">Congo, The Democratic Republic of the</option> <option value="1052">Cook Islands</option> <option value="1053">Costa Rica</option> <option value="1054">C么te d鈥橧voire</option> <option value="1055">Croatia</option> <option value="1056">Cuba</option> <option value="1248">Cura莽ao</option> <option value="1057">Cyprus</option> <option value="1058">Czech Republic</option> <option value="1059">Denmark</option> <option value="1060">Djibouti</option> <option value="1061">Dominica</option> <option value="1062">Dominican Republic</option> <option value="1064">Ecuador</option> <option value="1065">Egypt</option> <option value="1066">El Salvador</option> <option value="1067">Equatorial Guinea</option> <option value="1068">Eritrea</option> <option value="1069">Estonia</option> <option value="1203">Eswatini</option> <option value="1070">Ethiopia</option> <option value="1072">Falkland Islands (Malvinas)</option> <option value="1073">Faroe Islands</option> <option value="1074">Fiji</option> <option value="1075">Finland</option> <option value="1076">France</option> <option value="1077">French Guiana</option> <option value="1078">French Polynesia</option> <option value="1079">French Southern Territories</option> <option value="1080">Gabon</option> <option value="1213">Gambia</option> <option value="1081">Georgia</option> <option value="1082">Germany</option> <option value="1083">Ghana</option> <option value="1084">Gibraltar</option> <option value="1085">Greece</option> <option value="1086">Greenland</option> <option value="1087">Grenada</option> <option value="1088">Guadeloupe</option> <option value="1089">Guam</option> <option value="1090">Guatemala</option> <option value="1245">Guernsey</option> <option value="1091">Guinea</option> <option value="1092">Guinea-Bissau</option> <option value="1093">Guyana</option> <option value="1094">Haiti</option> <option value="1095">Heard Island and McDonald Islands</option> <option value="1096">Holy See (Vatican City State)</option> <option value="1097">Honduras</option> <option value="1098">Hong Kong</option> <option value="1099">Hungary</option> <option value="1100">Iceland</option> <option value="1101">India</option> <option value="1102">Indonesia</option> <option value="1103">Iran, Islamic Republic of</option> <option value="1104">Iraq</option> <option value="1105">Ireland</option> <option value="1246">Isle of Man</option> <option value="1106">Israel</option> <option value="1107">Italy</option> <option value="1108">Jamaica</option> <option value="1109">Japan</option> <option value="1244">Jersey</option> <option value="1110">Jordan</option> <option value="1111">Kazakhstan</option> <option value="1112">Kenya</option> <option value="1113">Kiribati</option> <option value="1114">Korea, Democratic People's Republic of</option> <option value="1115">Korea, Republic of</option> <option value="1251">Kosovo</option> <option value="1116">Kuwait</option> <option value="1117">Kyrgyzstan</option> <option value="1118">Lao People's Democratic Republic</option> <option value="1119">Latvia</option> <option value="1120">Lebanon</option> <option value="1121">Lesotho</option> <option value="1122">Liberia</option> <option value="1123">Libya</option> <option value="1124">Liechtenstein</option> <option value="1125">Lithuania</option> <option value="1126">Luxembourg</option> <option value="1127">Macao</option> <option value="1129">Madagascar</option> <option value="1130">Malawi</option> <option value="1131">Malaysia</option> <option value="1132">Maldives</option> <option value="1133">Mali</option> <option value="1134">Malta</option> <option value="1135">Marshall Islands</option> <option value="1136">Martinique</option> <option value="1137">Mauritania</option> <option value="1138">Mauritius</option> <option value="1139">Mayotte</option> <option value="1140">Mexico</option> <option value="1141">Micronesia, Federated States of</option> <option value="1142">Moldova</option> <option value="1143">Monaco</option> <option value="1144">Mongolia</option> <option value="1243">Montenegro</option> <option value="1145">Montserrat</option> <option value="1146">Morocco</option> <option value="1147">Mozambique</option> <option value="1035">Myanmar</option> <option value="1148">Namibia</option> <option value="1149">Nauru</option> <option value="1150">Nepal</option> <option value="1152">Netherlands</option> <option value="1153">New Caledonia</option> <option value="1154">New Zealand</option> <option value="1155">Nicaragua</option> <option value="1156">Niger</option> <option value="1157">Nigeria</option> <option value="1158">Niue</option> <option value="1159">Norfolk Island</option> <option value="1128">North Macedonia</option> <option value="1160">Northern Mariana Islands</option> <option value="1161">Norway</option> <option value="1162">Oman</option> <option value="1163">Pakistan</option> <option value="1164">Palau</option> <option value="1165">Palestine, State of</option> <option value="1166">Panama</option> <option value="1167">Papua New Guinea</option> <option value="1168">Paraguay</option> <option value="1169">Peru</option> <option value="1170">Philippines</option> <option value="1171">Pitcairn</option> <option value="1172">Poland</option> <option value="1173">Portugal</option> <option value="1174">Puerto Rico</option> <option value="1175">Qatar</option> <option value="1179">Reunion</option> <option value="1176">Romania</option> <option value="1177">Russian Federation</option> <option value="1178">Rwanda</option> <option value="1252">Saint Barth茅lemy</option> <option value="1180">Saint Helena</option> <option value="1181">Saint Kitts and Nevis</option> <option value="1182">Saint Lucia</option> <option value="1253">Saint Martin (French part)</option> <option value="1183">Saint Pierre and Miquelon</option> <option value="1184">Saint Vincent and the Grenadines</option> <option value="1185">Samoa</option> <option value="1186">San Marino</option> <option value="1207">Sao Tome and Principe</option> <option value="1187">Saudi Arabia</option> <option value="1188">Senegal</option> <option value="1242">Serbia</option> <option value="1238">Serbia and Montenegro</option> <option value="1189">Seychelles</option> <option value="1190">Sierra Leone</option> <option value="1191">Singapore</option> <option value="1249">Sint Maarten (Dutch Part)</option> <option value="1192">Slovakia</option> <option value="1193">Slovenia</option> <option value="1194">Solomon Islands</option> <option value="1195">Somalia</option> <option value="1196">South Africa</option> <option value="1197">South Georgia and the South Sandwich Islands</option> <option value="1247">South Sudan</option> <option value="1198">Spain</option> <option value="1199">Sri Lanka</option> <option value="1200">Sudan</option> <option value="1201">Suriname</option> <option value="1202">Svalbard and Jan Mayen</option> <option value="1204">Sweden</option> <option value="1205">Switzerland</option> <option value="1206">Syrian Arab Republic</option> <option value="1208">Taiwan</option> <option value="1209">Tajikistan</option> <option value="1210">Tanzania, United Republic of</option> <option value="1211">Thailand</option> <option value="1063">Timor-Leste</option> <option value="1214">Togo</option> <option value="1215">Tokelau</option> <option value="1216">Tonga</option> <option value="1217">Trinidad and Tobago</option> <option value="1218">Tunisia</option> <option value="1219">Turkey</option> <option value="1220">Turkmenistan</option> <option value="1221">Turks and Caicos Islands</option> <option value="1222">Tuvalu</option> <option value="1223">Uganda</option> <option value="1224">Ukraine</option> <option value="1225">United Arab Emirates</option> <option value="1226">United Kingdom</option> <option value="1227">United States Minor Outlying Islands</option> <option value="1229">Uruguay</option> <option value="1230">Uzbekistan</option> <option value="1231">Vanuatu</option> <option value="1232">Venezuela</option> <option value="1233">Viet Nam</option> <option value="1031">Virgin Islands, British</option> <option value="1234">Virgin Islands, U.S.</option> <option value="1235">Wallis and Futuna</option> <option value="1236">Western Sahara</option> <option value="1237">Yemen</option> <option value="1239">Zambia</option> <option value="1240">Zimbabwe</option> </select></div> <div class="clear"></div> </div> <div class="crm-section billing_state_province_id-5-section"> <div class="label"><label for="billing_state_province_id-5">State/Province</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"><select data-callback="civicrm/ajax/jqState" data-empty-prompt="Choose country first" data-none-prompt="- N/A -" class="big crm-select2 crm-chain-select-target crm-form-select" data-select-prompt="- select State/Province -" data-name="billing_state_province_id-5" name="billing_state_province_id-5" id="billing_state_province_id-5"> <option value="">- select State/Province -</option> <option value="1000">Alabama</option> <option value="1001">Alaska</option> <option value="1052">American Samoa</option> <option value="1002">Arizona</option> <option value="1003">Arkansas</option> <option value="1060">Armed Forces Americas</option> <option value="1059">Armed Forces Europe</option> <option value="1061">Armed Forces Pacific</option> <option value="1004" selected="selected">California</option> <option value="1005">Colorado</option> <option value="1006">Connecticut</option> <option value="1007">Delaware</option> <option value="1050">District of Columbia</option> <option value="1008">Florida</option> <option value="1009">Georgia</option> <option value="1053">Guam</option> <option value="1010">Hawaii</option> <option value="1011">Idaho</option> <option value="1012">Illinois</option> <option value="1013">Indiana</option> <option value="1014">Iowa</option> <option value="1015">Kansas</option> <option value="1016">Kentucky</option> <option value="1017">Louisiana</option> <option value="1018">Maine</option> <option value="1019">Maryland</option> <option value="1020">Massachusetts</option> <option value="1021">Michigan</option> <option value="1022">Minnesota</option> <option value="1023">Mississippi</option> <option value="1024">Missouri</option> <option value="1025">Montana</option> <option value="1026">Nebraska</option> <option value="1027">Nevada</option> <option value="1028">New Hampshire</option> <option value="1029">New Jersey</option> <option value="1030">New Mexico</option> <option value="1031">New York</option> <option value="1032">North Carolina</option> <option value="1033">North Dakota</option> <option value="1055">Northern Mariana Islands</option> <option value="1034">Ohio</option> <option value="1035">Oklahoma</option> <option value="1036">Oregon</option> <option value="1037">Pennsylvania</option> <option value="1056">Puerto Rico</option> <option value="1038">Rhode Island</option> <option value="1039">South Carolina</option> <option value="1040">South Dakota</option> <option value="1041">Tennessee</option> <option value="1042">Texas</option> <option value="1058">United States Minor Outlying Islands</option> <option value="1043">Utah</option> <option value="1044">Vermont</option> <option value="1057">Virgin Islands</option> <option value="1045">Virginia</option> <option value="1046">Washington</option> <option value="1047">West Virginia</option> <option value="1048">Wisconsin</option> <option value="1049">Wyoming</option> </select></div> <div class="clear"></div> </div> <div class="crm-section billing_postal_code-5-section"> <div class="label"><label for="billing_postal_code-5">Postal Code</label> <span class="crm-marker" title="This field is required.">*</span> </div> <div class="content"><input size="30" maxlength="60" autocomplete="off" class="required crm-form-text" name="billing_postal_code-5" type="text" id="billing_postal_code-5" /></div> <div class="clear"></div> </div> </div> </fieldset> </div> <script type="text/javascript"> CRM.$(function ($) { // build list of ids to track changes on var address_fields = {"street_address":"1","city":"1","postal_code":"1","country":"1","state_province":"1"}; var input_ids = {}; var select_ids = {}; var orig_id, field, field_name; // build input ids $('.billing_name_address-section input').each(function (i) { orig_id = $(this).attr('id'); field = orig_id.split('-'); field_name = field[0].replace('billing_', ''); if (field[1]) { if (address_fields[field_name]) { input_ids['#' + field_name + '-' + address_fields[field_name]] = '#' + orig_id; } } }); if ($('#first_name').length) input_ids['#first_name'] = '#billing_first_name'; if ($('#middle_name').length) input_ids['#middle_name'] = '#billing_middle_name'; if ($('#last_name').length) input_ids['#last_name'] = '#billing_last_name'; // build select ids $('.billing_name_address-section select').each(function (i) { orig_id = $(this).attr('id'); field = orig_id.split('-'); field_name = field[0].replace('billing_', '').replace('_id', ''); if (field[1]) { if (address_fields[field_name]) { select_ids['#' + field_name + '-' + address_fields[field_name]] = '#' + orig_id; } } }); // detect if billing checkbox should default to checked var checked = true; for (var id in input_ids) { orig_id = input_ids[id]; if ($(id).val() != $(orig_id).val()) { checked = false; break; } } for (var id in select_ids) { orig_id = select_ids[id]; if ($(id).val() != $(orig_id).val()) { checked = false; break; } } if (checked) { $('#billingcheckbox').prop('checked', true).data('crm-initial-value', true); if (!CRM.billing || CRM.billing.billingProfileIsHideable) { $('.billing_name_address-group').hide(); } } // onchange handlers for non-billing fields for (var id in input_ids) { orig_id = input_ids[id]; $(id).change(function () { var id = '#' + $(this).attr('id'); var orig_id = input_ids[id]; // if billing checkbox is active, copy other field into billing field if ($('#billingcheckbox').prop('checked')) { $(orig_id).val($(id).val()); } }); } for (var id in select_ids) { orig_id = select_ids[id]; $(id).change(function () { var id = '#' + $(this).attr('id'); var orig_id = select_ids[id]; // if billing checkbox is active, copy other field into billing field if ($('#billingcheckbox').prop('checked')) { $(orig_id + ' option').prop('selected', false); $(orig_id + ' option[value="' + $(id).val() + '"]').prop('selected', true); $(orig_id).change(); } }); } // toggle show/hide var billingCheckboxElement = $('#billingcheckbox'); billingCheckboxElement.click(function() { billingCheckboxChanged(billingCheckboxElement); }); billingCheckboxElement.change(function() { billingCheckboxChanged(billingCheckboxElement); }); function billingCheckboxChanged(billingCheckbox) { if (billingCheckbox.prop('checked')) { if (!CRM.billing || CRM.billing.billingProfileIsHideable) { $('.billing_name_address-group').hide(200); } // copy all values for (var id in input_ids) { orig_id = input_ids[id]; $(orig_id).val($(id).val()); } for (var id in select_ids) { orig_id = select_ids[id]; $(orig_id + ' option').prop('selected', false); $(orig_id + ' option[value="' + $(id).val() + '"]').prop('selected', true); $(orig_id).change(); } } else { $('.billing_name_address-group').show(200); } } // remove spaces, dashes from credit card number $('#credit_card_number').change(function () { var cc = $('#credit_card_number').val() .replace(/ /g, '') .replace(/-/g, ''); $('#credit_card_number').val(cc); }); }); </script> <script type="text/javascript" src="/administrator/components/com_civicrm/civicrm/templates/CRM/Core/BillingBlock.js?r=yVtcOen_US"> </script> </div> <script type="text/javascript"> /** * Show or hide payment options. * * @param bool $isHide * Should the block be hidden. */ function showHidePayment(isHide) { var payment_options = cj(".payment_options-group"); var payment_processor = cj("div.payment_processor-section"); var payment_information = cj("div#payment_information"); // I've added a hide for billing block. But, actually the issue // might be that the unselecting of the processor should cause it // to be hidden (or removed) in which case it can go from this function. var billing_block = cj("div#billing-payment-block"); if (isHide) { payment_options.hide(); payment_processor.hide(); payment_information.hide(); billing_block.hide(); // Ensure that jquery validation doesn't block submission when we don't need to fill in the billing details section cj('#billing-payment-block select.crm-select2').addClass('crm-no-validate'); // also unset selected payment methods cj('input[name="payment_processor_id"]').removeProp('checked'); } else { payment_options.show(); payment_processor.show(); payment_information.show(); billing_block.show(); cj('#billing-payment-block select.crm-select2').removeClass('crm-no-validate'); // also set selected payment methods cj('input[name="payment_processor_id"][checked=checked]').prop('checked', true); } } /** * Hides or shows billing and payment options block depending on whether payment is required. * * In general incomplete orders or $0 orders do not require a payment block. */ function skipPaymentMethod() { var isHide = false; var alwaysShowFlag = (cj("#additional_participants").val()); var alwaysHideFlag = (cj("#bypass_payment").val() == 1); var total_amount_tmp = cj('#pricevalue').data('raw-total'); // Hide billing questions if this is free if (!alwaysShowFlag && total_amount_tmp == 0){ isHide = true; } else { isHide = false; } if (alwaysHideFlag) { isHide = true; } showHidePayment(isHide); } skipPaymentMethod(); CRM.$(function($) { function buildPaymentBlock(type) { var $form = $('#billing-payment-block').closest('form'); var payment_instrument_id = $('#payment_instrument_id').val(); var currency = 'USD'; currency = currency == '' ? $('#currency').val() : currency; var dataUrl = "/index.php?option=com_civicrm&task=civicrm/payment/form&Itemid=490&formName=Main&is_back_office=&pre_profile_id=14"; if (typeof(CRM.vars) != "undefined") { if (typeof(CRM.vars.coreForm) != "undefined") { if (typeof(CRM.vars.coreForm.contact_id) != "undefined") { dataUrl = dataUrl + "&cid=" + CRM.vars.coreForm.contact_id; } if (typeof(CRM.vars.coreForm.checksum) != "undefined" ) { dataUrl = dataUrl + "&cs=" + CRM.vars.coreForm.checksum; } } } dataUrl = dataUrl + "&processor_id=" + type + "&payment_instrument_id=" + payment_instrument_id + "&currency=" + currency; // Processors like pp-express will hide the form submit buttons, so re-show them when switching $('.crm-submit-buttons', $form).show().find('input').prop('disabled', true); CRM.loadPage(dataUrl, {target: '#billing-payment-block'}); } $('[name=payment_processor_id], #currency').on('change.paymentBlock', function() { var payment_processor_id = $('[name=payment_processor_id]:checked').val() == undefined ? $('[name=payment_processor_id]').val() : $('[name=payment_processor_id]:checked').val(); if (payment_processor_id != undefined) { buildPaymentBlock(payment_processor_id); } }); $('#payment_instrument_id').on('change.paymentBlock', function() { buildPaymentBlock(0); }); if ($('#payment_instrument_id').val()) { buildPaymentBlock(0); } $('#billing-payment-block').on('crmLoad', function() { $('.crm-submit-buttons input').prop('disabled', false); }) }); </script> <div class="crm-public-form-item crm-group custom_post_profile-group"> <script type="text/javascript"> CRM.$(function($) { $('#selector tr:even').addClass('odd-row'); $('#selector tr:odd ').addClass('even-row'); }); </script> </div> <div id="crm-submit-buttons" class="crm-submit-buttons"> <button class="crm-form-submit default validate crm-button crm-button-type-upload crm-button_qf_Main_upload" value="1" type="submit" name="_qf_Main_upload" id="_qf_Main_upload-bottom"><i aria-hidden="true" class="crm-i fa-chevron-right"></i> Review your contribution</button> </div> </div> <script type="text/javascript"> cj('input[name="soft_credit_type_id"]').on('change', function() { enableHonorType(); }); function enableHonorType() { var selectedValue = cj('input[name="soft_credit_type_id"]:checked'); if ( selectedValue.val() > 0) { cj('#honorType').show(); } else { cj('#honorType').hide(); } } cj('input[id="is_recur"]').on('change', function() { toggleRecur(); }); function toggleRecur() { var isRecur = cj('input[id="is_recur"]:checked'); var quickConfig = ''; if (cj("#auto_renew").length && quickConfig) { showHideAutoRenew(null); } var frequencyUnit = cj('#frequency_unit'); var frequencyInerval = cj('#frequency_interval'); var installments = cj('#installments'); isDisabled = false; if (isRecur.val() > 0) { cj('#recurHelp').show(); frequencyUnit.prop('disabled', false).addClass('required'); frequencyInerval.prop('disabled', false).addClass('required'); installments.prop('disabled', false); cj('#amount_sum_label').text('Regular Amount'); } else { cj('#recurHelp').hide(); frequencyUnit.prop('disabled', true).removeClass('required'); frequencyInerval.prop('disabled', true).removeClass('required'); installments.prop('disabled', true); cj('#amount_sum_label').text('Total Amount'); } } function pcpAnonymous() { // clear nickname field if anonymous is true if (document.getElementsByName("pcp_is_anonymous")[1].checked) { document.getElementById('pcp_roll_nickname').value = ''; } if (!document.getElementsByName("pcp_display_in_roll")[0].checked) { cj('#nickID').hide(); cj('#nameID').hide(); cj('#personalNoteID').hide(); } else { if (document.getElementsByName("pcp_is_anonymous")[0].checked) { cj('#nameID').show(); cj('#nickID').show(); cj('#personalNoteID').show(); } else { cj('#nameID').show(); cj('#nickID').hide(); cj('#personalNoteID').hide(); } } } CRM.$(function($) { enableHonorType(); toggleRecur(); skipPaymentMethod(); }); CRM.$(function($) { // highlight price sets function updatePriceSetHighlight() { $('#priceset .price-set-row span').removeClass('highlight'); $('#priceset .price-set-row input:checked').parent().addClass('highlight'); } $('#priceset input[type="radio"]').change(updatePriceSetHighlight); updatePriceSetHighlight(); // Update pledge contribution amount when pledge checkboxes change $("input[name^='pledge_amount']").on('change', function() { var total = 0; $("input[name^='pledge_amount']:checked").each(function() { total += Number($(this).attr('amount')); }); $("input[name^='price_']").val(total.toFixed(2)); }); }); </script> <script type="text/javascript"> CRM.$(function($) { $("form.CRM_Contribute_Form_Contribution_Main").crmValidate(); }); </script> </form> <div class="crm-section recaptcha-section" style="display:none"> <table class="form-layout-compressed"> <tr> <td class="recaptcha_label"> </td> <td><div class="g-recaptcha" data-sitekey="6LdPFRITAAAAAHX6RXv9sY1bs3CGhwgV7SQfJyF-"></div> <script type="text/javascript" src="https://www.google.com/recaptcha/api.js"></script> <noscript> <iframe src="https://www.google.com/recaptcha/api.js" height="300" width="500" frameborder="0"></iframe><br/> <div class="g-recaptcha" data-sitekey="6LdPFRITAAAAAHX6RXv9sY1bs3CGhwgV7SQfJyF-"></div> </noscript></td> </tr> </table> </div> <script type="text/javascript"> (function($) { document.addEventListener('DOMContentLoaded', function() { var submitButtons = $('div.crm-submit-buttons').last(); 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