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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="21">2021</option> <option value="22">2022</option> <option value="23">2023</option> <option value="24">2024</option> <option value="25">2025</option> <option value="26">2026</option> <option value="27">2027</option> <option value="28">2028</option> <option value="29">2029</option> <option value="30">2030</option> <option value="31">2031</option> <option value="32">2032</option> <option value="33">2033</option> </select> </div> </div> </div> <div class="en__field en__field--telephone 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--telephone"> <input id="en__field_transaction_ccvv" type="tel" autocomplete="tel" class="en__field__input en__field__input--telephone" name="transaction.ccvv" value=""/> </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--502680 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--459878 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--459876 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--459879 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--459877 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--459880 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--459881 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--488635 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 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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--459883 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 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