Support Whiting School of Engineering | Johns Hopkins Secure eCommerce

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src="/sites/default/files/JH_Whiting_School.png" /></a> </div> </div> </header> <section id="banner_image"> <div class="container"> <div class="region region-banner"> <section id="block-webformheaderimage" class="block block-jhu-ecom-webforms block-jhu-webform-header clearfix"> <div class="imageBorder"> <div class="border1"> </div> <div class="border2"> </div> <div class="border3"> </div> </div><p class="imageTagLine rightTagLine"></p> <img alt="JHU" data-align="center" data-entity-type="file" src="/sites/default/files/header_2_1900_2.jpg" class="bannerImage " /> </section> </div> </div> </section> <section class="user_bar"> <div class="container"> <div class="region region-user-bar"> <nav role="navigation" aria-labelledby="block-darecom-new-account-menu-menu" id="block-darecom-new-account-menu"> <h2 class="sr-only" id="block-darecom-new-account-menu-menu">User account menu</h2> <ul class="menu menu--account nav navbar-nav navbar-right"> <li class="first"> <a href="/user/login" 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js-webform-details-toggle webform-details-toggle webform_submission_webform_480_add_form" data-drupal-selector="webform-submission-webform-480-add-form" action="/form/eng" method="post" id="webform-submission-webform-480-add-form" accept-charset="UTF-8"> <div class="webform-progress"> <ul class="webform-progress-tracker progress-tracker progress-tracker--center" data-webform-progress-steps> <li data-webform-page="webform_start" title="Start" class="progress-step is-active" aria-current="step"> <div class="progress-marker" data-webform-progress-step data-webform-progress-link data-text="1"></div> <div class="progress-text"> <div class="progress-title" data-webform-progress-link> <span class="visually-hidden" data-webform-progress-state>Current</span> Start </div> </div> </li> <li data-webform-page="webform_preview" title="Preview" class="progress-step"> <div class="progress-marker" data-webform-progress-step data-webform-progress-link data-text="2"></div> <div class="progress-text"> <div class="progress-title" data-webform-progress-link> <span class="visually-hidden" data-webform-progress-state></span> Preview </div> </div> </li> <li data-webform-page="webform_confirmation" title="Complete" class="progress-step"> <div class="progress-marker" data-webform-progress-step data-webform-progress-link data-text="3"></div> <div class="progress-text"> <div class="progress-title" data-webform-progress-link> <span class="visually-hidden" data-webform-progress-state></span> Complete </div> </div> </li> </ul> </div> <div class="form-description"></div><div id="jhu_designations_table"><div class="section_designation_information allowSingleDesignation form-item js-form-item form-type-webform-multiple js-form-type-webform-multiple form-item-jhu-designations js-form-item-jhu-designations form-group" id="edit-jhu-designations"> <label class="control-label">JHU Gift Designations</label> <div class="webform-multiple-table webform-multiple-table-responsive"> <div class="table-responsive"> <table data-drupal-selector="edit-jhu-designations-items" class="responsive-enabled table table-hover table-striped" id="edit-jhu-designations-items" data-striping="1"> <thead> <tr> <th colspan="5"><span class="visually-hidden">JHU Gift Designations</span></th> </tr> </thead> <tbody> <tr class="draggable odd" data-drupal-selector="edit-jhu-designations-items-0"> <td class="webform-multiple-table--handle"></td> <td><div data-drupal-selector="edit-jhu-designations-items-0-item-" class="jhu-webform-designation--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-designations-items-0-item---wrapper"><div class="kiosk_amount_container_web_title col-md-12 form-item js-form-item form-type-item js-form-type-item form-item-jhu-designations-items-0--item--kiosk-amount-container-web-title js-form-item-jhu-designations-items-0--item--kiosk-amount-container-web-title form-group" id="edit-jhu-designations-items-0-item-kiosk-amount-container-web-title"> <label class="control-label">Please Select or Enter Gift Amount</label> </div> <div class="kiosk_amount_container_web col-md-12 container_amt_btn_5 form-group js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-designations-items-0-item-kiosk-amount-container-web-1" id="edit-jhu-designations-items-0-item-kiosk-amount-container-web-1"><div class="col-xs-4 col-sm-X2 col-md-X2 amt_btn_5 amount_button amt50 wrap_tag_1" data-amt="50" data-drupal-selector="edit-jhu-designations-items-0-item-btn50">$50</div> <div class="col-xs-4 col-sm-X2 col-md-X2 amt_btn_5 amount_button amt100 wrap_tag_1" data-amt="100" data-drupal-selector="edit-jhu-designations-items-0-item-btn100">$100</div> <div class="col-xs-4 col-sm-X2 col-md-X2 amt_btn_5 amount_button amt250 wrap_tag_1" data-amt="250" data-drupal-selector="edit-jhu-designations-items-0-item-btn250">$250</div> <div class="col-xs-4 col-sm-X2 col-md-X2 amt_btn_5 amount_button amt500 wrap_tag_1" data-amt="500" data-drupal-selector="edit-jhu-designations-items-0-item-btn500">$500</div> <div class="col-xs-4 col-sm-X2 col-md-X2 amt_btn_5 amount_button amtOther wrap_tag_1" data-amt="Other" data-drupal-selector="edit-jhu-designations-items-0-item-btnother">Other</div> </div> <div class="col-xs-12 col-sm-12 col-md-12 designation_dropdown_wrapper col-md-12 floatRight form-item js-form-item form-type-select js-form-type-select form-item-jhu-designations-items-0--item--gift-designation js-form-item-jhu-designations-items-0--item--gift-designation form-group"> <label for="edit-jhu-designations-items-0-item-gift-designation" class="control-label js-form-required form-required">Please Designate My Gift to Support</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-designation--4--gift_designation" validationMessage="Designation cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Designation is required." class="gift_designation_dropdown form-select required form-control" data-drupal-selector="edit-jhu-designations-items-0-item-gift-designation" id="edit-jhu-designations-items-0-item-gift-designation" name="jhu_designations[items][0][_item_][gift_designation]" required="required" aria-required="true"><option value="" selected="selected">- Select your gift designation -</option><option value="3012000000~1200023574">Whiting School Hopkins Fund – Student Experience </option><option value="3012000000~1200023575">Whiting School Hopkins Fund – Student Financial Aid </option><option value="3012000000~1200023576">Whiting School Hopkins Fund – Faculty Support </option><option value="3012000000~1200022046">Whiting School Hopkins Fund – Where the Need is Greatest</option><option value="3012000000~1200022005">Graduate Alumni Annual Fund</option><option value="P000~P000">Pledge payment on existing pledge</option><option value="0000~0000">Other - please specify</option></select></div> </div> <div class="col-xs-12 col-sm-3 col-md-3 giftAmount-wrapper amountLabelWrapper hidden webform-has-field-prefix form-inline form-item js-form-item form-type-number js-form-type-number form-item-jhu-designations-items-0--item--gift-amount js-form-item-jhu-designations-items-0--item--gift-amount form-group"> <label for="edit-jhu-designations-items-0-item-gift-amount" class="control-label js-form-required form-required">Gift Amount</label> <div class="input-group"><span class="input-group-addon"><div class="amountPrefix">$</div></span><input data-webform-composite-id="jhu-webform-designation--4--gift_amount" validationMessage="The Gift Amount must be between $5.00 and $9,999,999.99." validationBlankMessage="Gift Amount is required." class="giftAmount calculateAmount form-number required form-control" CCMAX="9999999.99" ACHMAX="100000.00" inputmode="numeric" data-drupal-selector="edit-jhu-designations-items-0-item-gift-amount" type="number" id="edit-jhu-designations-items-0-item-gift-amount" name="jhu_designations[items][0][_item_][gift_amount]" value="" step="any" min="5" max="9999999.99" placeholder="Gift Amount" size="60" required="required" aria-required="true" /></div> </div> <div class="col-xs-12 col-sm-9 col-md-9 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-designations-items-0--item--gift-pledge-id js-form-item-jhu-designations-items-0--item--gift-pledge-id form-group"> <label for="edit-jhu-designations-items-0-item-gift-pledge-id" class="control-label">Please Enter Pledge ID</label> <input data-webform-composite-id="jhu-webform-designation--4--gift_pledge_id" validationMessage="Pledge ID cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Pledge ID is required." class="form-text form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/ ]+$" data-drupal-selector="edit-jhu-designations-items-0-item-gift-pledge-id" type="text" id="edit-jhu-designations-items-0-item-gift-pledge-id" name="jhu_designations[items][0][_item_][gift_pledge_id]" value="" size="60" maxlength="35" placeholder="Enter Pledge ID" data-drupal-states="{"required":{"[data-webform-composite-id=\u0022jhu-webform-designation--4--gift_designation\u0022]":{"value":"P000~P000"}},"visible":{"[data-webform-composite-id=\u0022jhu-webform-designation--4--gift_designation\u0022]":{"value":"P000~P000"}}}" /> </div> <div class="js-form-wrapper" data-drupal-states="{"visible":{"[data-webform-composite-id=\u0022jhu-webform-designation--4--gift_designation\u0022]":{"value":"P000~P000"}}}"><div class="col-xs-12 col-sm-9 col-md-9 white-space-normal indefinite_desc form-item js-form-item form-type-markup js-form-type-markup form-item- js-form-item- form-no-label form-group" id="edit-jhu-designations-items-0-item-gift-pledge-help-text"> Please enter the pledge ID (example: P-12345678) or other information (such as pledge date or designation) to assist in locating the existing pledge. Recurring and installment options are not available for transactions that include pledge payments. </div> </div><div class="col-xs-12 col-sm-9 col-md-9 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-designations-items-0--item--gift-designation-other js-form-item-jhu-designations-items-0--item--gift-designation-other form-group"> <label for="edit-jhu-designations-items-0-item-gift-designation-other" class="control-label">Please Describe</label> <input data-webform-composite-id="jhu-webform-designation--4--gift_designation_other" validationMessage="Other Designation cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Other Designation is required." class="form-text form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/ ]+$" data-drupal-selector="edit-jhu-designations-items-0-item-gift-designation-other" type="text" id="edit-jhu-designations-items-0-item-gift-designation-other" name="jhu_designations[items][0][_item_][gift_designation_other]" value="" size="60" maxlength="35" placeholder="Please describe" data-drupal-states="{"required":{"[data-webform-composite-id=\u0022jhu-webform-designation--4--gift_designation\u0022]":[{"value":"0000~0000"},{"value":"0000~0000+"}]},"visible":{"[data-webform-composite-id=\u0022jhu-webform-designation--4--gift_designation\u0022]":[{"value":"0000~0000"},{"value":"0000~0000+"}]}}" /> </div> </div> </td> <td class="webform-multiple-table--weight form-inline"><div class="webform-multiple-table--weight form-inline form-item js-form-item form-type-number js-form-type-number form-item-jhu-designations-items-0-weight js-form-item-jhu-designations-items-0-weight form-no-label form-group"> <label for="edit-jhu-designations-items-0-weight" class="control-label sr-only">Item weight</label> <input class="webform-multiple-sort-weight form-number form-control" data-drupal-selector="edit-jhu-designations-items-0-weight" type="number" id="edit-jhu-designations-items-0-weight" name="jhu_designations[items][0][weight]" value="0" step="1" size="10" /> </div> </td> <td class="webform-multiple-table--operations webform-multiple-table--operations-two"><button data-drupal-selector="edit-jhu-designations-items-0-operations-add" formnovalidate="formnovalidate" class="image-button js-form-submit form-submit btn-success btn icon-only" type="image" id="edit-jhu-designations-items-0-operations-add" name="jhu_designations_table_add_0" src="/modules/contrib/webform/images/icons/plus.svg" alt="Add new item after item 1" title="Add new item after item 1"><span class="sr-only">Add</span><span class="icon glyphicon glyphicon-plus-sign" aria-hidden="true"></span></button><button data-drupal-selector="edit-jhu-designations-items-0-operations-remove" formnovalidate="formnovalidate" class="image-button js-form-submit form-submit btn-danger btn icon-only" type="image" id="edit-jhu-designations-items-0-operations-remove" name="jhu_designations_table_remove_0" src="/modules/contrib/webform/images/icons/minus.svg" alt="Remove item 1" title="Remove item 1"><span class="sr-only">Remove</span><span class="icon glyphicon glyphicon-minus-sign" aria-hidden="true"></span></button></td> </tr> </tbody> </table> </div> </div><div class="webform-multiple-add js-webform-multiple-add container-inline"><button data-drupal-selector="edit-jhu-designations-add-submit" formnovalidate="formnovalidate" class="button js-form-submit form-submit btn-success btn" type="submit" id="edit-jhu-designations-add-submit" name="jhu_designations_table_add" value="Add">Add</button><div class="form-inline form-item js-form-item form-type-number js-form-type-number form-item-jhu-designations-add-more-items js-form-item-jhu-designations-add-more-items form-no-label form-group"> <label for="edit-jhu-designations-add-more-items" class="control-label sr-only">Add more items</label> <input data-drupal-selector="edit-jhu-designations-add-more-items" class="form-number form-control" type="number" id="edit-jhu-designations-add-more-items" name="jhu_designations[add][more_items]" value="1" step="1" min="1" max="100" /> more items </div> </div> </div> </div><div data-drupal-selector="edit-jhu-gift-frequency" class="jhu-webform-giftfrequency--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-gift-frequency--wrapper"><fieldset data-webform-composite-id="jhu-webform-giftfrequency--4--gift_frequency" class="radioInSingleLine recurringSustainingRadio singleSelectOnly radioAsButton col-xs-12 col-sm-12 col-md-12 radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-gift-frequency-gift-frequency" id="edit-jhu-gift-frequency-gift-frequency--wrapper"> <legend id="edit-jhu-gift-frequency-gift-frequency--wrapper-legend"> <span class="fieldset-legend">Please select a frequency for this gift</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-gift-frequency-gift-frequency" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-gift-frequency-gift-frequency js-form-item-jhu-gift-frequency-gift-frequency radio"> <label for="edit-jhu-gift-frequency-gift-frequency-0" class="control-label option"><input data-webform-composite-id="jhu-webform-giftfrequency--4--gift_frequency" class="radioInSingleLine recurringSustainingRadio singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-gift-frequency-gift-frequency-0" type="radio" id="edit-jhu-gift-frequency-gift-frequency-0" name="jhu_gift_frequency[gift_frequency]" value="0" />One-time</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-gift-frequency-gift-frequency js-form-item-jhu-gift-frequency-gift-frequency radio"> <label for="edit-jhu-gift-frequency-gift-frequency-1" class="control-label option"><input data-webform-composite-id="jhu-webform-giftfrequency--4--gift_frequency" class="radioInSingleLine recurringSustainingRadio singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-gift-frequency-gift-frequency-1" type="radio" id="edit-jhu-gift-frequency-gift-frequency-1" name="jhu_gift_frequency[gift_frequency]" value="1" />Recurring</label> </div> </div> </div> </fieldset> <fieldset data-webform-composite-id="jhu-webform-giftfrequency--4--payment_frequency" class="payment_frequency radioInSingleLine singleSelectOnly radioAsButton col-xs-12 col-sm-12 col-md-12 radios--wrapper fieldgroup form-composite webform-composite-hidden-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-gift-frequency-payment-frequency" id="edit-jhu-gift-frequency-payment-frequency--wrapper" data-drupal-states="{"required":{"[data-webform-composite-id=\u0022jhu-webform-giftfrequency--4--gift_frequency\u0022]":{"value":"1"}},"visible":{"[data-webform-composite-id=\u0022jhu-webform-giftfrequency--4--gift_frequency\u0022]":{"value":"1"}}}"> <legend id="edit-jhu-gift-frequency-payment-frequency--wrapper-legend"> <span class="visually-hidden fieldset-legend">Payment Frequency</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-gift-frequency-payment-frequency" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-gift-frequency-payment-frequency js-form-item-jhu-gift-frequency-payment-frequency radio"> <label for="edit-jhu-gift-frequency-payment-frequency-mont" class="control-label option"><input data-webform-composite-id="jhu-webform-giftfrequency--4--payment_frequency" class="payment_frequency radioInSingleLine singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-gift-frequency-payment-frequency-mont" type="radio" id="edit-jhu-gift-frequency-payment-frequency-mont" name="jhu_gift_frequency[payment_frequency]" value="MONT" />Monthly</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-gift-frequency-payment-frequency js-form-item-jhu-gift-frequency-payment-frequency radio"> <label for="edit-jhu-gift-frequency-payment-frequency-qter" class="control-label option"><input data-webform-composite-id="jhu-webform-giftfrequency--4--payment_frequency" class="payment_frequency radioInSingleLine singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-gift-frequency-payment-frequency-qter" type="radio" id="edit-jhu-gift-frequency-payment-frequency-qter" name="jhu_gift_frequency[payment_frequency]" value="QTER" />Quarterly</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-gift-frequency-payment-frequency js-form-item-jhu-gift-frequency-payment-frequency radio"> <label for="edit-jhu-gift-frequency-payment-frequency-year" class="control-label option"><input data-webform-composite-id="jhu-webform-giftfrequency--4--payment_frequency" class="payment_frequency radioInSingleLine singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-gift-frequency-payment-frequency-year" type="radio" id="edit-jhu-gift-frequency-payment-frequency-year" name="jhu_gift_frequency[payment_frequency]" value="YEAR" />Annually</label> </div> </div> </div> </fieldset> <div class="col-xs-12 col-sm-12 col-md-12 paymentNumber_wrapper form-item js-form-item form-type-select js-form-type-select form-item-jhu-gift-frequency-payment-number js-form-item-jhu-gift-frequency-payment-number form-group"> <label for="edit-jhu-gift-frequency-payment-number" class="control-label">Select number of additional recurring payments</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-giftfrequency--4--payment_number" class="payment_number form-select form-control" data-drupal-selector="edit-jhu-gift-frequency-payment-number" id="edit-jhu-gift-frequency-payment-number" name="jhu_gift_frequency[payment_number]" data-drupal-states="{"required":{"[data-webform-composite-id=\u0022jhu-webform-giftfrequency--4--gift_frequency\u0022]":{"value":"1"}},"visible":{"[data-webform-composite-id=\u0022jhu-webform-giftfrequency--4--gift_frequency\u0022]":{"value":"1"}}}"><option value="" selected="selected">- Select -</option><option value="0">Indefinite</option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option><option value="32">32</option><option value="33">33</option><option value="34">34</option><option value="35">35</option><option value="36">36</option></select></div> </div> <div class="indefinite_desc form-item js-form-item form-type-item js-form-type-item form-item-jhu-gift-frequency-indefinite-info js-form-item-jhu-gift-frequency-indefinite-info form-no-label form-group" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-giftfrequency--4--payment_number\u0022]":{"value":"0"}}]}" id="edit-jhu-gift-frequency-indefinite-info"> Payments in the amount specified above will be automatically charged to your account as scheduled until you notify The Whiting School of Engineering by phone at <a href="tel:410-516-8723">410-516-8723</a> or email <a href="mailto:engineering@jhu.edu">engineering@jhu.edu</a>. </div> </div> <div data-drupal-selector="edit-jhu-name" class="jhu-webform-name--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-name--wrapper"><div class="section section_your_information isVisitor"><h3 data-webform-composite-id="jhu-webform-name--6--html_tag" data-drupal-selector="edit-jhu-name-html">Donor Information</h3> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-select js-form-type-select form-item-jhu-name-salutation js-form-item-jhu-name-salutation form-group"> <label for="edit-jhu-name-salutation" class="control-label">Salutation</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-name--7--salutation" class="primarySalutation webform-entity-select form-select form-control" data-drupal-selector="edit-jhu-name-salutation" id="edit-jhu-name-salutation" name="jhu_name[salutation]"><option value="" selected="selected">- Salutation -</option><option value="1">Mr.</option><option value="2">Mrs.</option><option value="3">Ms.</option><option value="4">Miss</option><option value="5">Mx.</option><option value="6">Dr.</option><option value="7">Admiral</option><option value="8">Captain</option><option value="9">Colonel</option><option value="10">Commander</option><option value="11">General</option><option value="12">Lady</option><option value="13">Lieutenant</option><option value="14">Lieutenant Colonel</option><option value="15">Major</option><option value="16">Major General</option><option value="17">Professor</option><option value="18">Rabbi</option><option value="19">Sir</option><option value="20">The Honorable</option><option value="21">The Reverend</option></select></div> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-name-first-name js-form-item-jhu-name-first-name form-group"> <label for="edit-jhu-name-first-name" class="control-label js-form-required form-required">First Name</label> <input data-webform-composite-id="jhu-webform-name--7--first_name" validationMessage="First Name cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="First Name is required." class="primaryFirstName form-text required form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/ ]+$" data-drupal-selector="edit-jhu-name-first-name" type="text" id="edit-jhu-name-first-name" name="jhu_name[first_name]" value="" size="60" maxlength="15" placeholder="First Name" required="required" aria-required="true" /> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-name-middle-name js-form-item-jhu-name-middle-name form-group"> <label for="edit-jhu-name-middle-name" class="control-label">Middle Initial</label> <input data-webform-composite-id="jhu-webform-name--7--middle_name" validationMessage="Middle Initial cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" class="primaryMiddleName form-text form-control" pattern="^[a-zA-Z']+$" data-drupal-selector="edit-jhu-name-middle-name" type="text" id="edit-jhu-name-middle-name" name="jhu_name[middle_name]" value="" size="60" maxlength="1" placeholder="Middle Initial" /> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-name-last-name js-form-item-jhu-name-last-name form-group"> <label for="edit-jhu-name-last-name" class="control-label js-form-required form-required">Last Name</label> <input data-webform-composite-id="jhu-webform-name--7--last_name" validationMessage="Last Name cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Last Name is required." class="primaryLastName form-text required form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/ ]+$" data-drupal-selector="edit-jhu-name-last-name" type="text" id="edit-jhu-name-last-name" name="jhu_name[last_name]" value="" size="60" maxlength="30" placeholder="Last Name" required="required" aria-required="true" /> </div> </div><input data-webform-composite-id="jhu-webform-name--7--cons_id" data-drupal-selector="edit-jhu-name-cons-id" type="hidden" name="jhu_name[cons_id]" value="" /><input data-webform-composite-id="jhu-webform-name--7--jhed_id" data-drupal-selector="edit-jhu-name-jhed-id" type="hidden" name="jhu_name[jhed_id]" value="" /></div> <div data-drupal-selector="edit-jhu-address" class="jhu-webform-address--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-address--wrapper"><div class="section section_address_information isVisitor"><div class="addressLineBlock"><div class="col-xs-12 col-sm-6 col-md-6 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-address-main-address-line-1 js-form-item-jhu-address-main-address-line-1 form-group"> <label for="edit-jhu-address-main-address-line-1" class="control-label js-form-required form-required">Address Line 1</label> <input data-webform-composite-id="jhu-webform-address--4--main_address_line_1" validationMessage="Address cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Address is required." class="main-AddressLine1 form-text required form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/!%?@+,=> ]+$" data-drupal-selector="edit-jhu-address-main-address-line-1" type="text" id="edit-jhu-address-main-address-line-1" name="jhu_address[main_address_line_1]" value="" size="60" maxlength="35" placeholder="Address Line 1" required="required" aria-required="true" /> </div> <div class="col-xs-12 col-sm-6 col-md-6 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-address-main-address-line-2 js-form-item-jhu-address-main-address-line-2 form-group"> <label for="edit-jhu-address-main-address-line-2" class="control-label">Address Line 2</label> <input data-webform-composite-id="jhu-webform-address--4--main_address_line_2" validationMessage="Address cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" class="main-AddressLine2 form-text form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/!%?@+,=> ]+$" data-drupal-selector="edit-jhu-address-main-address-line-2" type="text" id="edit-jhu-address-main-address-line-2" name="jhu_address[main_address_line_2]" value="" size="60" maxlength="35" placeholder="Address Line 2" /> </div> </div><div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-address-main-address-city js-form-item-jhu-address-main-address-city form-group"> <label for="edit-jhu-address-main-address-city" class="control-label js-form-required form-required">City</label> <input data-webform-composite-id="jhu-webform-address--4--main_address_city" validationMessage="City cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="City is required." class="main-AddressCity form-text required form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'\- ]+$" data-drupal-selector="edit-jhu-address-main-address-city" type="text" id="edit-jhu-address-main-address-city" name="jhu_address[main_address_city]" value="" size="60" maxlength="35" placeholder="City" required="required" aria-required="true" /> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-select js-form-type-select form-item-jhu-address-main-address-state js-form-item-jhu-address-main-address-state form-group"> <label for="edit-jhu-address-main-address-state" class="control-label js-form-required form-required">State</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-address--4--main_address_state" validationMessage="" validationBlankMessage="State is required." class="main-AddressState webform-entity-select form-select required form-control" data-drupal-selector="edit-jhu-address-main-address-state" id="edit-jhu-address-main-address-state" name="jhu_address[main_address_state]" required="required" aria-required="true"><option value="" selected="selected">- State -</option><option value="243">Non-U.S. Address</option><option value="244">Alabama</option><option value="245">Alaska</option><option value="246">Arizona</option><option value="247">Arkansas</option><option value="248">Armed Forces (other)</option><option value="249">Armed Forces Pacific</option><option value="250">Armed Forces US</option><option value="251">California</option><option value="252">Colorado</option><option value="253">Connecticut</option><option value="254">Delaware</option><option value="255">Florida</option><option value="256">Georgia</option><option value="257">Guam</option><option value="258">Hawaii</option><option value="259">Idaho</option><option value="260">Illinois</option><option value="261">Indiana</option><option value="262">Iowa</option><option value="263">Kansas</option><option value="264">Kentucky</option><option value="265">Louisiana</option><option value="266">Maine</option><option value="267">Marshall Islands</option><option value="268">Maryland</option><option value="269">Massachusetts</option><option value="270">Michigan</option><option value="271">Minnesota</option><option value="272">Mississippi</option><option value="273">Missouri</option><option value="274">Montana</option><option value="275">Nebraska</option><option value="276">Nevada</option><option value="277">New Hampshire</option><option value="278">New Jersey</option><option value="279">New Mexico</option><option value="280">New York</option><option value="281">North Carolina</option><option value="282">North Dakota</option><option value="283">Northern Mariana Islands</option><option value="284">Ohio</option><option value="285">Oklahoma</option><option value="286">Oregon</option><option value="287">Pennsylvania</option><option value="288">Puerto Rico</option><option value="289">Rhode Island</option><option value="290">South Carolina</option><option value="291">South Dakota</option><option value="292">Tennessee</option><option value="293">Texas</option><option value="294">Utah</option><option value="295">Vermont</option><option value="296">Virgin Islands</option><option value="297">Virginia</option><option value="298">Washington</option><option value="299">Washington D.C.</option><option value="300">West Virginia</option><option value="301">Wisconsin</option><option value="302">Wyoming</option></select></div> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-address-main-address-zip js-form-item-jhu-address-main-address-zip form-group"> <label for="edit-jhu-address-main-address-zip" class="control-label js-form-required form-required">Zip Code</label> <input data-webform-composite-id="jhu-webform-address--4--main_address_zip" validationMessage="Zip Code must be 5 digits." validationBlankMessage="Zip Code is required." class="main-AddressZip js-webform-input-mask form-text required form-control" data-inputmask-mask="99999" pattern="^[0-9- ]+$" data-drupal-selector="edit-jhu-address-main-address-zip" type="text" id="edit-jhu-address-main-address-zip" name="jhu_address[main_address_zip]" value="" size="60" maxlength="10" placeholder="Zip Code" required="required" aria-required="true" /> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-select js-form-type-select form-item-jhu-address-main-address-country js-form-item-jhu-address-main-address-country form-group"> <label for="edit-jhu-address-main-address-country" class="control-label js-form-required form-required">Country</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-address--4--main_address_country" validationMessage="" validationBlankMessage="Country is required." class="main-AddressCountry webform-entity-select form-select required form-control" data-drupal-selector="edit-jhu-address-main-address-country" id="edit-jhu-address-main-address-country" name="jhu_address[main_address_country]" required="required" aria-required="true"><option value="" selected="selected">- Country -</option><option value="46">United States of America</option><option value="233">Afghanistan</option><option value="194">Albania</option><option value="27">Algeria</option><option value="195">Andorra</option><option value="28">Angola</option><option value="25">Anguilla</option><option value="196">Antarctica</option><option value="188">Antigua and Barbuda</option><option value="30">Argentina</option><option value="193">Armenia</option><option value="31">Aruba</option><option value="32">Australia</option><option value="33">Austria</option><option value="145">Azerbaijan</option><option value="34">Azores</option><option value="35">Bahamas</option><option value="36">Bahrain</option><option value="37">Bangladesh</option><option value="38">Barbados</option><option value="47">Belarus</option><option value="40">Belgium</option><option value="190">Belize</option><option value="226">Belorussia</option><option value="182">Benin</option><option value="41">Bermuda</option><option value="42">Bhutan</option><option value="43">Bolivia</option><option value="67">Bosnia-Herzegovina</option><option value="44">Botswana</option><option value="45">Brazil</option><option value="186">British Virgin Islands</option><option value="48">Brunei</option><option value="197">Bulgaria</option><option value="170">Burkina Faso</option><option value="50">Burundi</option><option value="51">Cambodia</option><option value="52">Cameroon</option><option value="53">Canada</option><option value="55">Cape Verde Islands</option><option value="108">Cayman Islands</option><option value="57">Central Africa Republic</option><option value="234">Chad</option><option value="59">Chile</option><option value="61">Colombia</option><option value="62">Comoros Islands</option><option value="63">Congo</option><option value="64">Costa Rica</option><option value="70">Croatia</option><option value="65">Cuba</option><option value="66">Cyprus</option><option value="58">Czech Republic</option><option value="68">Denmark</option><option value="198">Djibouti</option><option value="199">Dominica</option><option value="69">Dominican Republic</option><option value="228">East Timor</option><option value="72">Ecuador</option><option value="73">Egypt</option><option value="74">El Salvador</option><option value="76">Equatorial Guinea</option><option value="175">Eritrea</option><option value="185">Estonia</option><option value="77">Ethiopia</option><option value="78">Falkland Islands</option><option value="222">Fiji Islands</option><option value="79">Finland</option><option value="80">France</option><option value="81">French Guiana</option><option value="82">French Polynesia</option><option value="83">Gabon</option><option value="84">Gambia</option><option value="86">Georgia</option><option value="184">Germany</option><option value="85">Ghana</option><option value="200">Gibralter</option><option value="87">Greece</option><option value="201">Grenada</option><option value="202">Guadeloupe</option><option value="89">Guatemala</option><option value="90">Guinea</option><option value="242">Guinea-Bissau</option><option value="191">Guyana</option><option value="91">Haiti</option><option value="93">Honduras</option><option value="94">Hungary</option><option value="95">Iceland</option><option value="96">India</option><option value="97">Indonesia</option><option value="98">Iran</option><option value="235">Iraq</option><option value="99">Ireland</option><option value="100">Israel</option><option value="101">Italy</option><option value="102">Ivory Coast</option><option value="103">Jamaica</option><option value="189">Japan</option><option value="104">Jordan</option><option value="137">Kazakhstan</option><option value="105">Kenya</option><option value="203">Kiribati</option><option value="106">Kuwait</option><option value="88">Kyrgyzstan</option><option value="107">Laos</option><option value="92">Latvia</option><option value="236">Lebanon</option><option value="109">Lesotho</option><option value="237">Liberia</option><option value="110">Libya</option><option value="111">Liechtenstein</option><option value="224">Lithuania</option><option value="112">Luxembourg</option><option value="71">Macedonia</option><option value="114">Madagascar</option><option value="115">Malawi</option><option value="116">Malaysia</option><option value="117">Maldives</option><option value="118">Mali</option><option value="206">Malta</option><option value="207">Martinique</option><option value="119">Mauritania</option><option value="181">Mauritius</option><option value="120">Mexico</option><option value="187">Moldova</option><option value="121">Monaco</option><option value="208">Mongolian Peoples Republic</option><option value="29">Montenegro</option><option value="122">Morocco</option><option value="123">Mozambique</option><option value="49">Myanmar</option><option value="209">Namibia</option><option value="124">Nauru</option><option value="125">Nepal</option><option value="183">Netherlands</option><option value="126">Netherlands Antilles</option><option value="127">New Caledonia</option><option value="128">New Guinea</option><option value="129">New Zealand</option><option value="130">Nicaragua</option><option value="131">Niger</option><option value="132">Nigeria</option><option value="204">North Korea</option><option value="133">Norway</option><option value="134">Oman</option><option value="135">Pakistan</option><option value="136">Panama</option><option value="241">Papua New Guinea</option><option value="138">Paraguay</option><option value="60">People's Republic of China</option><option value="139">Peru</option><option value="140">Philippines</option><option value="141">Pitcairn</option><option value="142">Poland</option><option value="143">Portugal</option><option value="144">Qatar</option><option value="205">Republic of Korea</option><option value="230">Republic of Kosovo</option><option value="210">Reunion</option><option value="146">Romania</option><option value="56">Russia</option><option value="147">Rwanda</option><option value="217">San Marino</option><option value="229">SAR</option><option value="148">Saudi Arabia</option><option value="149">Senegal</option><option value="238">Serbia</option><option value="218">Seychelles</option><option value="240">Sierra Leone</option><option value="150">Singapore</option><option value="176">Slovakia</option><option value="154">Slovenija</option><option value="151">Solomon Islands</option><option value="239">Somalia</option><option value="152">South Africa</option><option value="153">Spain</option><option value="155">Sri Lanka</option><option value="211">St. Helena</option><option value="212">St. Kitts-Nevis</option><option value="213">St. Lucia</option><option value="214">St. Pierre & Miquelon Is.</option><option value="215">St. Thomas & Principe</option><option value="216">St. Vincent & The Grenadines</option><option value="156">Sudan</option><option value="157">Surinam</option><option value="158">Swaziland</option><option value="159">Sweden</option><option value="160">Switzerland</option><option value="161">Syria</option><option value="162">Taiwan</option><option value="39">Tajikistan</option><option value="163">Tanzania</option><option value="164">Thailand</option><option value="165">Togo</option><option value="166">Tonga Island</option><option value="192">Trinidad and Tobago</option><option value="167">Tunisia</option><option value="168">Turkey</option><option value="75">Turkmenistan</option><option value="219">Turks & Caicos Islands</option><option value="169">Uganda</option><option value="54">Ukraine</option><option value="223">United Arab Emirates</option><option value="227">United Kingdom</option><option value="171">Uruguay</option><option value="113">Uzbekistan</option><option value="220">Vanuatu</option><option value="221">Vatican City State</option><option value="172">Venezuela</option><option value="173">Vietnam</option><option value="225">West Africa</option><option value="174">Western Samoa</option><option value="177">Yemen</option><option value="178">Zaire</option><option value="179">Zambia</option><option value="180">Zimbabwe</option></select></div> </div> </div></div> <div data-drupal-selector="edit-jhu-contact" class="jhu-webform-contact--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-contact--wrapper"><div class="section section_contact_information isVisitor"><div class=" col-xs-12 col-sm-12 col-md-12 emailWrapper form-item js-form-item form-type-email js-form-type-email form-item-jhu-contact-email-address js-form-item-jhu-contact-email-address form-group"> <label for="edit-jhu-contact-email-address" class="control-label js-form-required form-required">Email Address</label> <input data-webform-composite-id="jhu-webform-contact--4--email_address" validationMessage="Email Address is invalid." validationBlankMessage="Email Address is required." class="emailAddress form-email required form-control" pattern="^([0-9a-zA-Z]+([_.-]?[0-9a-zA-Z]+)*@[0-9a-zA-Z]+[0-9,a-z,A-Z,.,-]*(.){1}[a-zA-Z]{2,4})+$" data-drupal-selector="edit-jhu-contact-email-address" aria-describedby="edit-jhu-contact-email-address--description" type="email" id="edit-jhu-contact-email-address" name="jhu_contact[email_address]" value="" size="60" maxlength="80" placeholder="Enter Email Address" required="required" aria-required="true" title="JHU will use your email address to send a transaction confirmation, and for other university communication. Your information is private and is not shared with outside entities. " data-toggle="tooltip" /> </div> <div class="phone_container phone_1 col-xs-12 col-sm-6 col-md-6 "><div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-contact-phone-1 js-form-item-jhu-contact-phone-1 form-group"> <label for="edit-jhu-contact-phone-1" class="control-label js-form-required form-required">Phone Number</label> <input data-webform-composite-id="jhu-webform-contact--4--phone_1" validationMessage="Phone Number must be at least 10 digits." validationBlankMessage="Phone Number is required." class="phoneNumber1 form-text required form-control" inputmode="numeric" pattern="^[0-9]{10,}|^[0-9()\- ]{14,}$| " data-drupal-selector="edit-jhu-contact-phone-1" type="text" id="edit-jhu-contact-phone-1" name="jhu_contact[phone_1]" value="" size="60" maxlength="14" placeholder="Phone Number" required="required" aria-required="true" /> </div> <div class="phoneTypeWrapper form-item js-form-item form-type-select js-form-type-select form-item-jhu-contact-phone-type-1 js-form-item-jhu-contact-phone-type-1 form-group"> <label for="edit-jhu-contact-phone-type-1" class="control-label js-form-required form-required">Type</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-contact--4--phone_type_1" validationMessage="" class="phoneType1 webform-entity-select form-select required form-control" validationBlankMessage="Phone Type is required." data-drupal-selector="edit-jhu-contact-phone-type-1" id="edit-jhu-contact-phone-type-1" name="jhu_contact[phone_type_1]" required="required" aria-required="true"><option value="" selected="selected">- Type -</option><option value="22">Cell</option><option value="23">Home</option><option value="24">Work</option></select></div> </div> </div><div class="phone_container phone_2 col-xs-12 col-sm-6 col-md-6 "><div class="form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-contact-phone-2 js-form-item-jhu-contact-phone-2 form-group"> <label for="edit-jhu-contact-phone-2" class="control-label">Phone Number</label> <input data-webform-composite-id="jhu-webform-contact--4--phone_2" validationMessage="Phone Number must be at least 10 digits." class="phoneNumber2 form-text form-control" inputmode="numeric" pattern="^[0-9]{10,}|^[0-9()\- ]{14,}$| " data-drupal-selector="edit-jhu-contact-phone-2" type="text" id="edit-jhu-contact-phone-2" name="jhu_contact[phone_2]" value="" size="60" maxlength="14" placeholder="Phone Number" /> </div> <div class="phoneTypeWrapper form-item js-form-item form-type-select js-form-type-select form-item-jhu-contact-phone-type-2 js-form-item-jhu-contact-phone-type-2 form-group"> <label for="edit-jhu-contact-phone-type-2" class="control-label">Type</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-contact--4--phone_type_2" class="phoneType2 webform-entity-select form-select form-control" data-drupal-selector="edit-jhu-contact-phone-type-2" id="edit-jhu-contact-phone-type-2" name="jhu_contact[phone_type_2]"><option value="" selected="selected">- Type -</option><option value="22">Cell</option><option value="23">Home</option><option value="24">Work</option></select></div> </div> </div></div> <div class="form-item js-form-item form-type-jhu-webform-additionalinformation js-form-type-jhu-webform-additionalinformation form-item-jhu-addtl-75 js-form-item-jhu-addtl-75 form-no-label form-group"> <div class="section section_additional_information_widget isVisitor"><div data-drupal-selector="edit-jhu-addtl-75-additionalinformation-header-email-address-type"></div> <div data-webform-composite-id="Email address type--html_tag" data-drupal-selector="edit-jhu-addtl-75-additionalinformation-email-address-type-close"></div> </div><fieldset data-webform-composite-id="Email address type--t1" validationMessage="" class="registrantfield-radios registrantfield-radios-element col-xs-12 col-sm-12 col-md-3 registrantfield-title-hidden isVisitor registrantfield-title-hidden fieldgroup form-composite js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type" id="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type--wrapper"> <legend> <span class="visually-hidden fieldset-legend">Email address type</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-addtl-75-table-email-address-type-additionalinformation----email-address-type js-form-item-jhu-addtl-75-table-email-address-type-additionalinformation----email-address-type radio"> <label for="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type-home" class="control-label option"><input data-webform-composite-id="Email address type--t1" validationMessage="" class="registrantfield-radios registrantfield-radios-element col-xs-12 col-sm-12 col-md-3 registrantfield-title-hidden isVisitor registrantfield-title-hidden form-radio" data-drupal-selector="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type-home" type="radio" id="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type-home" name="jhu_addtl_75[table][Email address type][additionalinformation -- Email address type]" value="Home" />Home</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-addtl-75-table-email-address-type-additionalinformation----email-address-type js-form-item-jhu-addtl-75-table-email-address-type-additionalinformation----email-address-type radio"> <label for="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type-business" class="control-label option"><input data-webform-composite-id="Email address type--t1" validationMessage="" class="registrantfield-radios registrantfield-radios-element col-xs-12 col-sm-12 col-md-3 registrantfield-title-hidden isVisitor registrantfield-title-hidden form-radio" data-drupal-selector="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type-business" type="radio" id="edit-jhu-addtl-75-table-email-address-type-additionalinformation-email-address-type-business" name="jhu_addtl_75[table][Email address type][additionalinformation -- Email address type]" value="Business" />Business</label> </div> </div> </div> </fieldset> </div> <div data-drupal-selector="edit-jhu-in-honor-or-memory" class="jhu-webform-inhonormemory--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-in-honor-or-memory--wrapper"><div class="section section_giftType isVisitor"><h3 data-webform-composite-id="jhu-webform-inhonormemory--4--html_tag" data-drupal-selector="edit-jhu-in-honor-or-memory-html">Gift Options</h3> <fieldset data-webform-composite-id="jhu-webform-inhonormemory--4--is_iho_imo" class="radioInSingleLine ihoimoYesNoRadios singleSelectOnly radioAsButton col-xs-12 col-sm-12 col-md-12 radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-in-honor-or-memory-is-iho-imo" id="edit-jhu-in-honor-or-memory-is-iho-imo--wrapper"> <legend id="edit-jhu-in-honor-or-memory-is-iho-imo--wrapper-legend"> <span class="fieldset-legend">Is this a gift in honor or in memory of someone?</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-in-honor-or-memory-is-iho-imo" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-in-honor-or-memory-is-iho-imo js-form-item-jhu-in-honor-or-memory-is-iho-imo radio"> <label for="edit-jhu-in-honor-or-memory-is-iho-imo-0" class="control-label option"><input data-webform-composite-id="jhu-webform-inhonormemory--4--is_iho_imo" class="radioInSingleLine ihoimoYesNoRadios singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-in-honor-or-memory-is-iho-imo-0" type="radio" id="edit-jhu-in-honor-or-memory-is-iho-imo-0" name="jhu_in_honor_or_memory[is_iho_imo]" value="0" />No</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-in-honor-or-memory-is-iho-imo js-form-item-jhu-in-honor-or-memory-is-iho-imo radio"> <label for="edit-jhu-in-honor-or-memory-is-iho-imo-1" class="control-label option"><input data-webform-composite-id="jhu-webform-inhonormemory--4--is_iho_imo" class="radioInSingleLine ihoimoYesNoRadios singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-in-honor-or-memory-is-iho-imo-1" type="radio" id="edit-jhu-in-honor-or-memory-is-iho-imo-1" name="jhu_in_honor_or_memory[is_iho_imo]" value="1" />Yes</label> </div> </div> </div> </fieldset> <fieldset data-webform-composite-id="jhu-webform-inhonormemory--4--is_iho_or_imo" class="radioInSingleLine radioAsButton singleSelectOnly ihoimoRadios col-xs-12 col-sm-12 col-md-12 iho_imo_radios radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" validationMessage="" validationBlankMessage="Gift Type is required." data-drupal-selector="edit-jhu-in-honor-or-memory-is-iho-or-imo" id="edit-jhu-in-honor-or-memory-is-iho-or-imo--wrapper" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-inhonormemory--4--is_iho_imo\u0022]":{"value":"1"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-inhonormemory--4--is_iho_imo\u0022]":{"value":"1"}}]}"> <legend style="display:none" id="edit-jhu-in-honor-or-memory-is-iho-or-imo--wrapper-legend"> <span class="fieldset-legend"></span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-in-honor-or-memory-is-iho-or-imo" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-in-honor-or-memory-is-iho-or-imo js-form-item-jhu-in-honor-or-memory-is-iho-or-imo radio"> <label for="edit-jhu-in-honor-or-memory-is-iho-or-imo-1" class="control-label option"><input data-webform-composite-id="jhu-webform-inhonormemory--4--is_iho_or_imo" class="radioInSingleLine radioAsButton singleSelectOnly ihoimoRadios form-radio" validationMessage="" validationBlankMessage="Gift Type is required." data-drupal-selector="edit-jhu-in-honor-or-memory-is-iho-or-imo-1" type="radio" id="edit-jhu-in-honor-or-memory-is-iho-or-imo-1" name="jhu_in_honor_or_memory[is_iho_or_imo]" value="1" />In Honor Of</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-in-honor-or-memory-is-iho-or-imo js-form-item-jhu-in-honor-or-memory-is-iho-or-imo radio"> <label for="edit-jhu-in-honor-or-memory-is-iho-or-imo-2" class="control-label option"><input data-webform-composite-id="jhu-webform-inhonormemory--4--is_iho_or_imo" class="radioInSingleLine radioAsButton singleSelectOnly ihoimoRadios form-radio" validationMessage="" validationBlankMessage="Gift Type is required." data-drupal-selector="edit-jhu-in-honor-or-memory-is-iho-or-imo-2" type="radio" id="edit-jhu-in-honor-or-memory-is-iho-or-imo-2" name="jhu_in_honor_or_memory[is_iho_or_imo]" value="2" />In Memory Of</label> </div> </div> </div> </fieldset> <div class="col-xs-12 col-sm-6 col-md-6 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-in-honor-or-memory-honoree-name js-form-item-jhu-in-honor-or-memory-honoree-name form-group"> <label for="edit-jhu-in-honor-or-memory-honoree-name" class="control-label">Honoree</label> <input data-webform-composite-id="jhu-webform-inhonormemory--4--honoree_name" autocomplete="off" validationMessage="Name cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Name is required." pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/ ]+$" data-drupal-selector="edit-jhu-in-honor-or-memory-honoree-name" class="form-text form-control" type="text" id="edit-jhu-in-honor-or-memory-honoree-name" name="jhu_in_honor_or_memory[honoree_name]" value="" size="60" maxlength="35" placeholder="Honoree Name" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-inhonormemory--4--is_iho_imo\u0022]":{"value":"1"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-inhonormemory--4--is_iho_imo\u0022]":{"value":"1"}}]}" /> </div> <div class="helpText form-item js-form-item form-type-item js-form-type-item form-item-jhu-in-honor-or-memory-honormemory-info js-form-item-jhu-in-honor-or-memory-honormemory-info form-no-label form-group" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-inhonormemory--4--is_iho_imo\u0022]":{"value":"1"}}]}" id="edit-jhu-in-honor-or-memory-honormemory-info"> At your request, we will notify the designated party that a gift has been made in his/her honor. <br>For memorial gifts, we will notify the family. Please fill in the contact information below if you would like notification to be sent. </div> <div class="col-xs-12 col-sm-12 col-md-12 form-item js-form-item form-type-textarea js-form-type-textarea form-item-jhu-in-honor-or-memory-honormemory-contact-info js-form-item-jhu-in-honor-or-memory-honormemory-contact-info form-group"> <label for="edit-jhu-in-honor-or-memory-honormemory-contact-info" class="control-label">Contact Information</label> <div class="form-textarea-wrapper"> <textarea data-webform-composite-id="jhu-webform-inhonormemory--4--honormemory_contact_info" autocomplete="off" validationMessage="Name cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Name is required." pattern="^(?!\s+$)[\-0-9a-zA-Z`@'".!%_,#\[\] &:\/-/ / ]*$" data-drupal-selector="edit-jhu-in-honor-or-memory-honormemory-contact-info" class="form-textarea form-control resize-vertical" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-inhonormemory--4--is_iho_imo\u0022]":{"value":"1"}}]}" id="edit-jhu-in-honor-or-memory-honormemory-contact-info" name="jhu_in_honor_or_memory[honormemory_contact_info]" rows="2" cols="60" maxlength="200" placeholder="Contact Information"></textarea> </div> </div> </div></div> <div data-drupal-selector="edit-jhu-matching-gift" class="jhu-webform-matchinggift--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-matching-gift--wrapper"><div class="section section_giftType isVisitor"><h3 data-webform-composite-id="jhu-webform-matchinggift--4--html_tag" data-drupal-selector="edit-jhu-matching-gift-html">Gift Options</h3> <fieldset data-webform-composite-id="jhu-webform-matchinggift--4--this_is_matching_gift" class="radioInSingleLine matchinggiftRadio singleSelectOnly radioAsButton col-xs-12 col-sm-12 col-md-12 radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-matching-gift-this-is-matching-gift" id="edit-jhu-matching-gift-this-is-matching-gift--wrapper"> <legend id="edit-jhu-matching-gift-this-is-matching-gift--wrapper-legend"> <span class="fieldset-legend">Will your company match this gift?</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-matching-gift-this-is-matching-gift" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-matching-gift-this-is-matching-gift js-form-item-jhu-matching-gift-this-is-matching-gift radio"> <label for="edit-jhu-matching-gift-this-is-matching-gift-0" class="control-label option"><input data-webform-composite-id="jhu-webform-matchinggift--4--this_is_matching_gift" class="radioInSingleLine matchinggiftRadio singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-matching-gift-this-is-matching-gift-0" type="radio" id="edit-jhu-matching-gift-this-is-matching-gift-0" name="jhu_matching_gift[this_is_matching_gift]" value="0" />No</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-matching-gift-this-is-matching-gift js-form-item-jhu-matching-gift-this-is-matching-gift radio"> <label for="edit-jhu-matching-gift-this-is-matching-gift-1" class="control-label option"><input data-webform-composite-id="jhu-webform-matchinggift--4--this_is_matching_gift" class="radioInSingleLine matchinggiftRadio singleSelectOnly radioAsButton form-radio" data-drupal-selector="edit-jhu-matching-gift-this-is-matching-gift-1" type="radio" id="edit-jhu-matching-gift-this-is-matching-gift-1" name="jhu_matching_gift[this_is_matching_gift]" value="1" />Yes</label> </div> </div> </div> </fieldset> <span class="helpPopupLabel"><a href="/hep-popup" class="use-ajax" data-dialog-type="modal" data-dialog-options="{"title":"", "dialogClass": "HEPpopup"}"><b>Click here</b></a> to search if your employer will match this gift.</span><div class="helpText form-item js-form-item form-type-item js-form-type-item form-item-jhu-matching-gift-matchinggift-info js-form-item-jhu-matching-gift-matchinggift-info form-no-label form-group" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-matchinggift--4--this_is_matching_gift\u0022]":{"value":"1"}}]}" id="edit-jhu-matching-gift-matchinggift-info"> If your company will match this gift please include the following information. </div> <div class="col-xs-12 col-sm-12 col-md-12 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-matching-gift-matching-company-name js-form-item-jhu-matching-gift-matching-company-name form-group"> <label for="edit-jhu-matching-gift-matching-company-name" class="control-label">Company Name</label> <input data-webform-composite-id="jhu-webform-matchinggift--4--matching_company_name" autocomplete="off" validationMessage="Company Name cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Company Name is required." pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/ ]+$" data-drupal-selector="edit-jhu-matching-gift-matching-company-name" class="form-text form-control" type="text" id="edit-jhu-matching-gift-matching-company-name" name="jhu_matching_gift[matching_company_name]" value="" size="60" maxlength="35" placeholder="Company Name" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-matchinggift--4--this_is_matching_gift\u0022]":{"value":"1"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-matchinggift--4--this_is_matching_gift\u0022]":{"value":"1"}}]}" /> </div> <fieldset data-webform-composite-id="jhu-webform-matchinggift--4--matching_form_submitted" class="singleSelectOnly col-xs-12 col-sm-12 col-md-12 radioInSingleLine radioAsButton radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-matching-gift-matching-form-submitted" id="edit-jhu-matching-gift-matching-form-submitted--wrapper" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-matchinggift--4--this_is_matching_gift\u0022]":{"value":"1"}}]}"> <legend id="edit-jhu-matching-gift-matching-form-submitted--wrapper-legend"> <span class="fieldset-legend">Gift information has been submitted to my company's matching gift program</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-matching-gift-matching-form-submitted" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-matching-gift-matching-form-submitted js-form-item-jhu-matching-gift-matching-form-submitted radio"> <label for="edit-jhu-matching-gift-matching-form-submitted-0" class="control-label option"><input data-webform-composite-id="jhu-webform-matchinggift--4--matching_form_submitted" class="singleSelectOnly form-radio" data-drupal-selector="edit-jhu-matching-gift-matching-form-submitted-0" type="radio" id="edit-jhu-matching-gift-matching-form-submitted-0" name="jhu_matching_gift[matching_form_submitted]" value="0" />No</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-matching-gift-matching-form-submitted js-form-item-jhu-matching-gift-matching-form-submitted radio"> <label for="edit-jhu-matching-gift-matching-form-submitted-1" class="control-label option"><input data-webform-composite-id="jhu-webform-matchinggift--4--matching_form_submitted" class="singleSelectOnly form-radio" data-drupal-selector="edit-jhu-matching-gift-matching-form-submitted-1" type="radio" id="edit-jhu-matching-gift-matching-form-submitted-1" name="jhu_matching_gift[matching_form_submitted]" value="1" />Yes</label> </div> </div> </div> </fieldset> <div class="col-xs-6 col-sm-6 col-md-6 form-inline form-item js-form-item form-type-number js-form-type-number form-item-jhu-matching-gift-matching-gift-ratio js-form-item-jhu-matching-gift-matching-gift-ratio form-group"> <label for="edit-jhu-matching-gift-matching-gift-ratio" class="control-label">Matching Gift Ratio (if known)</label> <input data-webform-composite-id="jhu-webform-matchinggift--4--matching_gift_ratio" autocomplete="off" validationMessage="The Matching Gift Ratio must be between 0.00 and 100.00." data-drupal-selector="edit-jhu-matching-gift-matching-gift-ratio" aria-describedby="edit-jhu-matching-gift-matching-gift-ratio--description" class="form-number form-control" type="number" id="edit-jhu-matching-gift-matching-gift-ratio" name="jhu_matching_gift[matching_gift_ratio]" value="" step="any" min="0" max="100" placeholder="Matching Gift Ratio (if known)" size="60" title="Enter between 0.00 to 100.00" data-toggle="tooltip" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-matchinggift--4--this_is_matching_gift\u0022]":{"value":"1"}}]}" /> </div> <div class="col-xs-6 col-sm-6 col-md-6 amountLabelWrapper webform-has-field-prefix form-inline form-item js-form-item form-type-number js-form-type-number form-item-jhu-matching-gift-matching-gift-amount js-form-item-jhu-matching-gift-matching-gift-amount form-group"> <label for="edit-jhu-matching-gift-matching-gift-amount" class="control-label">Matching Gift Amount</label> <div class="input-group"><span class="input-group-addon"><div class="amountPrefix">$</div></span><input data-webform-composite-id="jhu-webform-matchinggift--4--matching_gift_amount" class="form-number form-control" validationMessage="Matching Gift Amount cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" inputmode="numeric" data-drupal-selector="edit-jhu-matching-gift-matching-gift-amount" type="number" id="edit-jhu-matching-gift-matching-gift-amount" name="jhu_matching_gift[matching_gift_amount]" value="" step="any" placeholder="0.00" size="60" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-matchinggift--4--this_is_matching_gift\u0022]":{"value":"1"}}]}" /></div> </div> <div class="fontSize14 col-xs-12 form-item js-form-item form-type-item js-form-type-item form-item-jhu-matching-gift-matchinggift-address js-form-item-jhu-matching-gift-matchinggift-address form-group" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-matchinggift--4--this_is_matching_gift\u0022]":{"value":"1"}}]}" id="edit-jhu-matching-gift-matchinggift-address"> <label class="control-label">Please send matching gift form to:</label> <br>JHU/Development Business Services<br>Attn: Gift Processing Supervisor<br>3910 Keswick Road N2100<br>Baltimore, Maryland 21211<br><br>Questions about matching gifts? Please email <a href="mailto:matchinggifts@jhu.edu?subject=Help with Matching Gift">matchinggifts@jhu.edu</a> </div> </div></div> <div data-drupal-selector="edit-jhu-payment" class="jhu-webform-payment--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-payment--wrapper"><div class="section section_payment_information isVisitor"><h3 data-webform-composite-id="jhu-webform-payment--4--html_tag" data-drupal-selector="edit-jhu-payment-html">Payment Information</h3> <fieldset data-webform-composite-id="jhu-webform-payment--4--payment_method" class="singleSelectOnly radioInSingleLine paymentMethodRadio radioAsButton col-xs-12 col-sm-12 col-md-12 paymethod_wrapper radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-payment-payment-method" id="edit-jhu-payment-payment-method--wrapper"> <legend id="edit-jhu-payment-payment-method--wrapper-legend"> <span class="fieldset-legend">What payment method would you like to use?</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-payment-payment-method" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-payment-payment-method js-form-item-jhu-payment-payment-method radio"> <label for="edit-jhu-payment-payment-method-0" class="control-label option"><input data-webform-composite-id="jhu-webform-payment--4--payment_method" class="singleSelectOnly radioInSingleLine paymentMethodRadio radioAsButton form-radio" data-drupal-selector="edit-jhu-payment-payment-method-0" type="radio" id="edit-jhu-payment-payment-method-0" name="jhu_payment[payment_method]" value="0" />Credit Card</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-payment-payment-method js-form-item-jhu-payment-payment-method radio"> <label for="edit-jhu-payment-payment-method-1" class="control-label option"><input data-webform-composite-id="jhu-webform-payment--4--payment_method" class="singleSelectOnly radioInSingleLine paymentMethodRadio radioAsButton form-radio" data-drupal-selector="edit-jhu-payment-payment-method-1" type="radio" id="edit-jhu-payment-payment-method-1" name="jhu_payment[payment_method]" value="1" />Checking / Savings</label> </div> </div> </div> </fieldset> <div class="col-xs-12 col-sm-6 col-md-6 ccNumberWrapper form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-card-number-maksed js-form-item-jhu-payment-card-number-maksed form-group"> <label for="edit-jhu-payment-card-number-maksed" class="control-label">Card Number</label> <input data-webform-composite-id="jhu-webform-payment--4--card_number" validationMessage="The Credit Card must be valid." validationBlankMessage="Credit Card is required." class="ccNumber numbersOnly form-text form-control" inputmode="numeric" maxlength="19" onfocus="showCardValue()" onblur="hideCardValue(this.value)" onkeypress="formatCardNumber(event, this)" onkeyup="formatCardNumber(event, this)" onpaste="return false" oncut="return false" autocomplete="off" pattern="([0-9*]{4} *[0-9*]{4} *[0-9*]{4} *\d{3,4})" data-drupal-selector="edit-jhu-payment-card-number-maksed" type="text" id="edit-jhu-payment-card-number-maksed" name="jhu_payment[card_number_MAKSED]" value="" size="60" placeholder="Credit Card Number" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}]}" /> </div> <div class="hidden form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-card-number js-form-item-jhu-payment-card-number form-group"> <label for="edit-jhu-payment-card-number" class="control-label">Card Number REAL</label> <input data-webform-composite-id="jhu-webform-payment--4--card_number_real" class="ccNumberREAL form-text form-control" autocomplete="off" data-drupal-selector="edit-jhu-payment-card-number" type="text" id="edit-jhu-payment-card-number" name="jhu_payment[card_number]" value="" size="60" maxlength="255" placeholder="Credit Card Number REAL" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}]}" /> </div> <div class="col-xs-6 col-sm-3 col-md-3 form-item js-form-item form-type-datelist js-form-type-datelist form-item-jhu-payment-expiration-date-month js-form-item-jhu-payment-expiration-date-month form-group" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}]}"> <div id="edit-jhu-payment-expiration-date-month" class="ccDate container-inline form-inline"> <div class="form-item js-form-item form-type-select js-form-type-select form-item-jhu-payment-expiration-date-month-month js-form-item-jhu-payment-expiration-date-month-month form-no-label form-group"> <label for="edit-jhu-payment-expiration-date-month-month" class="control-label sr-only">: Month</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-payment--4--expiration_date_month" validationMessage="Expiration Month & Year cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Expiration Month & Year is required." validationPastMonthMessage="Expiration Month cannot be in past." class="ccDate form-select form-control" data-drupal-selector="edit-jhu-payment-expiration-date-month-month" title="Month" id="edit-jhu-payment-expiration-date-month-month" name="jhu_payment[expiration_date_month][month]"><option value="" selected="selected">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></div> </div> <div class="form-item js-form-item form-type-select js-form-type-select form-item-jhu-payment-expiration-date-month-year js-form-item-jhu-payment-expiration-date-month-year form-no-label form-group"> <label for="edit-jhu-payment-expiration-date-month-year" class="control-label sr-only">: Year</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-payment--4--expiration_date_month" validationMessage="Expiration Month & Year cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Expiration Month & Year is required." validationPastMonthMessage="Expiration Month cannot be in past." class="ccDate form-select form-control" data-drupal-selector="edit-jhu-payment-expiration-date-month-year" title="Year" id="edit-jhu-payment-expiration-date-month-year" name="jhu_payment[expiration_date_month][year]"><option value="" selected="selected">Year</option><option value="2024">2024</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></select></div> </div> </div> </div> <div class="col-xs-6 col-sm-3 col-md-3 cvvWrapper form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-security-code js-form-item-jhu-payment-security-code form-group"> <label for="edit-jhu-payment-security-code" class="control-label">Security Code</label> <input data-webform-composite-id="jhu-webform-payment--4--security_code" validationMessage="The Security Code must be 3 or 4 digits." validationBlankMessage="Security Code is required." class="ccCVV disablePaste form-text form-control" inputmode="numeric" autocomplete="off" pattern="^[0-9]{3,4}$" data-drupal-selector="edit-jhu-payment-security-code" type="text" id="edit-jhu-payment-security-code" name="jhu_payment[security_code]" value="" size="60" maxlength="4" placeholder="CVV" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"0"}}]}" /> </div> <div class="clearfix"></div><fieldset data-webform-composite-id="jhu-webform-payment--4--account_type" validationMessage="" validationBlankMessage="Account Type is required." class="singleSelectOnly radioInSingleLine achAccountTypeRadio radioAsButton col-xs-12 col-sm-12 col-md-12 radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-jhu-payment-account-type" id="edit-jhu-payment-account-type--wrapper" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}]}"> <legend id="edit-jhu-payment-account-type--wrapper-legend"> <span class="fieldset-legend">Please select your account type</span> </legend> <div class="fieldset-wrapper"> <div id="edit-jhu-payment-account-type" class="js-webform-radios webform-options-display-one-column"><div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-payment-account-type js-form-item-jhu-payment-account-type radio"> <label for="edit-jhu-payment-account-type-0" class="control-label option"><input data-webform-composite-id="jhu-webform-payment--4--account_type" validationMessage="" validationBlankMessage="Account Type is required." class="singleSelectOnly radioInSingleLine achAccountTypeRadio radioAsButton form-radio" data-drupal-selector="edit-jhu-payment-account-type-0" type="radio" id="edit-jhu-payment-account-type-0" name="jhu_payment[account_type]" value="0" />Checking</label> </div> <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-jhu-payment-account-type js-form-item-jhu-payment-account-type radio"> <label for="edit-jhu-payment-account-type-1" class="control-label option"><input data-webform-composite-id="jhu-webform-payment--4--account_type" validationMessage="" validationBlankMessage="Account Type is required." class="singleSelectOnly radioInSingleLine achAccountTypeRadio radioAsButton form-radio" data-drupal-selector="edit-jhu-payment-account-type-1" type="radio" id="edit-jhu-payment-account-type-1" name="jhu_payment[account_type]" value="1" />Savings</label> </div> </div> </div> </fieldset> <div class="col-xs-12 col-sm-4 col-md-4 routingWrapper form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-routing-number js-form-item-jhu-payment-routing-number form-group"> <label for="edit-jhu-payment-routing-number" class="control-label">Routing Number</label> <input data-webform-composite-id="jhu-webform-payment--4--routing_number" validationMessage="Routing Number can only accept numbers." validationBlankMessage="Routing Number is required." class="achRoutingNumber numbersOnly form-text form-control" inputmode="numeric" autocomplete="off" pattern="^[0-9]+$" data-drupal-selector="edit-jhu-payment-routing-number" aria-describedby="edit-jhu-payment-routing-number--description" type="text" id="edit-jhu-payment-routing-number" name="jhu_payment[routing_number]" value="" size="60" maxlength="9" placeholder="Routing Number" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}]}" /> <div class="description help-block"> <div id="edit-jhu-payment-routing-number--description" class="webform-element-description form-group"><a href="/themes/custom/darecom/images/check_guide.png" title="" class="colorbox webform-element-help achHelpImage">?</a></div> </div> </div> <div class="col-xs-12 col-sm-4 col-md-4 accountWrapper form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-account-number js-form-item-jhu-payment-account-number form-group"> <label for="edit-jhu-payment-account-number" class="control-label">Account Number</label> <input data-webform-composite-id="jhu-webform-payment--4--account_number" validationMessage="Account Number does not match with Confirm Account Number" validationBlankMessage="Account Number is required." class="AcNumber numbersOnly form-text form-control" inputmode="numeric" autocomplete="off" pattern="^[0-9]+$" data-drupal-selector="edit-jhu-payment-account-number" aria-describedby="edit-jhu-payment-account-number--description" type="text" id="edit-jhu-payment-account-number" name="jhu_payment[account_number]" value="" size="60" maxlength="17" placeholder="Account Number" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}]}" /> <div class="description help-block"> <div id="edit-jhu-payment-account-number--description" class="webform-element-description form-group"><a href="/themes/custom/darecom/images/check_guide.png" title="" class="colorbox webform-element-help achHelpImage">?</a></div> </div> </div> <div class="col-xs-12 col-sm-4 col-md-4 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-account-number-confirm js-form-item-jhu-payment-account-number-confirm form-group"> <label for="edit-jhu-payment-account-number-confirm" class="control-label">Confirm Account Number</label> <input data-webform-composite-id="jhu-webform-payment--4--account_number_confirm" validationMessage="Confirm Account Number does not match with Account Number" validationBlankMessage="Confirm Account Number is required." class="confirmAcNumber numbersOnly form-text form-control" inputmode="numeric" autocomplete="off" pattern="^[0-9]+$" data-drupal-selector="edit-jhu-payment-account-number-confirm" type="text" id="edit-jhu-payment-account-number-confirm" name="jhu_payment[account_number_confirm]" value="" size="60" maxlength="17" placeholder="Confirm Account Number" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}],"required":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}]}" /> </div> <div class="helpText form-item js-form-item form-type-item js-form-type-item form-item-jhu-payment-ach-info js-form-item-jhu-payment-ach-info form-no-label form-group" data-drupal-states="{"visible":[{"[data-webform-composite-id=\u0022jhu-webform-payment--4--payment_method\u0022]":{"value":"1"}}]}" id="edit-jhu-payment-ach-info"> Payment processing may take up to 3-5 banking days to settle and post to your account. Only U.S. Domicile Accounts are accepted. </div> <div class="col-xs-12 col-sm-12 col-md-12 form-item js-form-item form-type-checkbox js-form-type-checkbox form-item-jhu-payment-if-different-billing-address js-form-item-jhu-payment-if-different-billing-address checkbox"> <label for="edit-jhu-payment-if-different-billing-address" class="control-label option"><input data-webform-composite-id="jhu-webform-payment--4--if_different_billing_address" class="billing-DifferentAddress form-checkbox" data-drupal-selector="edit-jhu-payment-if-different-billing-address" type="checkbox" id="edit-jhu-payment-if-different-billing-address" name="jhu_payment[if_different_billing_address]" value="1" />Check if the Billing Address is different from the address entered above</label> </div> <div class="group group_billing_information"><div class="billing_wrapper"><div class="addressLineBlock"><div class="col-xs-12 col-sm-6 col-md-6 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-billing-address-line-1 js-form-item-jhu-payment-billing-address-line-1 form-group"> <label for="edit-jhu-payment-billing-address-line-1" class="control-label">Billing Address Line 1</label> <input data-webform-composite-id="jhu-webform-payment--4--billing_address_line_1" autocomplete="off" validationMessage="Address cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="Address is required." class="billing-AddressLine1 form-text form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/!%?@+,=> ]+$" data-drupal-selector="edit-jhu-payment-billing-address-line-1" type="text" id="edit-jhu-payment-billing-address-line-1" name="jhu_payment[billing_address_line_1]" value="" size="60" maxlength="35" placeholder="Billing Address Line 1" data-drupal-states="{"visible":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"required":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}}}" /> </div> <div class="col-xs-12 col-sm-6 col-md-6 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-billing-address-line-2 js-form-item-jhu-payment-billing-address-line-2 form-group"> <label for="edit-jhu-payment-billing-address-line-2" class="control-label">Billing Address Line 2</label> <input data-webform-composite-id="jhu-webform-payment--4--billing_address_line_2" autocomplete="off" validationMessage="Address cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" class="billing-AddressLine2 form-text form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'.\-#\[\]&:\/!%?@+,=> ]+$" data-drupal-selector="edit-jhu-payment-billing-address-line-2" type="text" id="edit-jhu-payment-billing-address-line-2" name="jhu_payment[billing_address_line_2]" value="" size="60" maxlength="35" placeholder="Billing Address Line 2" data-drupal-states="{"visible":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"disabled":{"#edit-jhu-ticket-total-main-total":{"value":"$0.00"}}}" /> </div> </div><div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-billing-address-city js-form-item-jhu-payment-billing-address-city form-group"> <label for="edit-jhu-payment-billing-address-city" class="control-label">City</label> <input data-webform-composite-id="jhu-webform-payment--4--billing_address_city" autocomplete="off" validationMessage="City cannot contain special characters. e.g. ~ $ ^ * = < > { } ;" validationBlankMessage="City is required." class="billing-AddressCity form-text form-control" pattern="^(?!\s+$)[0-9a-zA-Z`'\- ]+$" data-drupal-selector="edit-jhu-payment-billing-address-city" type="text" id="edit-jhu-payment-billing-address-city" name="jhu_payment[billing_address_city]" value="" size="60" maxlength="35" placeholder="Billing City" data-drupal-states="{"visible":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"required":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"disabled":{"#edit-jhu-ticket-total-main-total":{"value":"$0.00"}}}" /> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-select js-form-type-select form-item-jhu-payment-billing-address-state js-form-item-jhu-payment-billing-address-state form-group"> <label for="edit-jhu-payment-billing-address-state" class="control-label">State</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-payment--4--billing_address_state" autocomplete="off" validationMessage="" validationBlankMessage="State is required." class="billing-AddressState webform-entity-select form-select form-control" data-drupal-selector="edit-jhu-payment-billing-address-state" id="edit-jhu-payment-billing-address-state" name="jhu_payment[billing_address_state]" data-drupal-states="{"visible":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"required":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"disabled":{"#edit-jhu-ticket-total-main-total":{"value":"$0.00"}}}"><option value="" selected="selected">- Select -</option><option value="243">Non-U.S. Address</option><option value="244">Alabama</option><option value="245">Alaska</option><option value="246">Arizona</option><option value="247">Arkansas</option><option value="248">Armed Forces (other)</option><option value="249">Armed Forces Pacific</option><option value="250">Armed Forces US</option><option value="251">California</option><option value="252">Colorado</option><option value="253">Connecticut</option><option value="254">Delaware</option><option value="255">Florida</option><option value="256">Georgia</option><option value="257">Guam</option><option value="258">Hawaii</option><option value="259">Idaho</option><option value="260">Illinois</option><option value="261">Indiana</option><option value="262">Iowa</option><option value="263">Kansas</option><option value="264">Kentucky</option><option value="265">Louisiana</option><option value="266">Maine</option><option value="267">Marshall Islands</option><option value="268">Maryland</option><option value="269">Massachusetts</option><option value="270">Michigan</option><option value="271">Minnesota</option><option value="272">Mississippi</option><option value="273">Missouri</option><option value="274">Montana</option><option value="275">Nebraska</option><option value="276">Nevada</option><option value="277">New Hampshire</option><option value="278">New Jersey</option><option value="279">New Mexico</option><option value="280">New York</option><option value="281">North Carolina</option><option value="282">North Dakota</option><option value="283">Northern Mariana Islands</option><option value="284">Ohio</option><option value="285">Oklahoma</option><option value="286">Oregon</option><option value="287">Pennsylvania</option><option value="288">Puerto Rico</option><option value="289">Rhode Island</option><option value="290">South Carolina</option><option value="291">South Dakota</option><option value="292">Tennessee</option><option value="293">Texas</option><option value="294">Utah</option><option value="295">Vermont</option><option value="296">Virgin Islands</option><option value="297">Virginia</option><option value="298">Washington</option><option value="299">Washington D.C.</option><option value="300">West Virginia</option><option value="301">Wisconsin</option><option value="302">Wyoming</option></select></div> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-payment-billing-address-zip js-form-item-jhu-payment-billing-address-zip form-group"> <label for="edit-jhu-payment-billing-address-zip" class="control-label">Zip Code</label> <input data-webform-composite-id="jhu-webform-payment--4--billing_address_zip" autocomplete="off" validationMessage="Zip Code must be 5 digits." validationBlankMessage="Zip Code is required." class="billing-AddressZip js-webform-input-mask form-text form-control" data-inputmask-mask="99999" pattern="^[0-9- ]+$" data-drupal-selector="edit-jhu-payment-billing-address-zip" type="text" id="edit-jhu-payment-billing-address-zip" name="jhu_payment[billing_address_zip]" value="" size="60" maxlength="10" placeholder="Billing Zip Code" data-drupal-states="{"visible":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"required":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"disabled":{"#edit-jhu-ticket-total-main-total":{"value":"$0.00"}}}" /> </div> <div class="col-xs-12 col-sm-6 col-md-3 form-item js-form-item form-type-select js-form-type-select form-item-jhu-payment-billing-address-country js-form-item-jhu-payment-billing-address-country form-group"> <label for="edit-jhu-payment-billing-address-country" class="control-label">Country</label> <div class="select-wrapper"><select data-webform-composite-id="jhu-webform-payment--4--billing_address_country" autocomplete="off" validationMessage="" validationBlankMessage="Country is required." class="billing-AddressCountry webform-entity-select form-select form-control" data-drupal-selector="edit-jhu-payment-billing-address-country" id="edit-jhu-payment-billing-address-country" name="jhu_payment[billing_address_country]" data-drupal-states="{"visible":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"required":{"[data-webform-composite-id=\u0022jhu-webform-payment--4--if_different_billing_address\u0022]":{"checked":true}},"disabled":{"#edit-jhu-ticket-total-main-total":{"value":"$0.00"}}}"><option value="" selected="selected">- Select -</option><option value="46">United States of America</option><option value="233">Afghanistan</option><option value="194">Albania</option><option value="27">Algeria</option><option value="195">Andorra</option><option value="28">Angola</option><option value="25">Anguilla</option><option value="196">Antarctica</option><option value="188">Antigua and Barbuda</option><option value="30">Argentina</option><option value="193">Armenia</option><option value="31">Aruba</option><option value="32">Australia</option><option value="33">Austria</option><option value="145">Azerbaijan</option><option value="34">Azores</option><option value="35">Bahamas</option><option value="36">Bahrain</option><option value="37">Bangladesh</option><option value="38">Barbados</option><option value="47">Belarus</option><option value="40">Belgium</option><option value="190">Belize</option><option value="226">Belorussia</option><option value="182">Benin</option><option value="41">Bermuda</option><option value="42">Bhutan</option><option value="43">Bolivia</option><option value="67">Bosnia-Herzegovina</option><option value="44">Botswana</option><option value="45">Brazil</option><option value="186">British Virgin Islands</option><option value="48">Brunei</option><option value="197">Bulgaria</option><option value="170">Burkina Faso</option><option value="50">Burundi</option><option value="51">Cambodia</option><option value="52">Cameroon</option><option value="53">Canada</option><option value="55">Cape Verde Islands</option><option value="108">Cayman Islands</option><option value="57">Central Africa Republic</option><option value="234">Chad</option><option value="59">Chile</option><option value="61">Colombia</option><option value="62">Comoros Islands</option><option value="63">Congo</option><option value="64">Costa Rica</option><option value="70">Croatia</option><option value="65">Cuba</option><option value="66">Cyprus</option><option value="58">Czech Republic</option><option value="68">Denmark</option><option value="198">Djibouti</option><option value="199">Dominica</option><option value="69">Dominican Republic</option><option value="228">East Timor</option><option value="72">Ecuador</option><option value="73">Egypt</option><option value="74">El Salvador</option><option value="76">Equatorial Guinea</option><option value="175">Eritrea</option><option value="185">Estonia</option><option value="77">Ethiopia</option><option value="78">Falkland Islands</option><option value="222">Fiji Islands</option><option value="79">Finland</option><option value="80">France</option><option value="81">French Guiana</option><option value="82">French Polynesia</option><option value="83">Gabon</option><option value="84">Gambia</option><option value="86">Georgia</option><option value="184">Germany</option><option value="85">Ghana</option><option value="200">Gibralter</option><option value="87">Greece</option><option value="201">Grenada</option><option value="202">Guadeloupe</option><option value="89">Guatemala</option><option value="90">Guinea</option><option value="242">Guinea-Bissau</option><option value="191">Guyana</option><option value="91">Haiti</option><option value="93">Honduras</option><option value="94">Hungary</option><option value="95">Iceland</option><option value="96">India</option><option value="97">Indonesia</option><option value="98">Iran</option><option value="235">Iraq</option><option value="99">Ireland</option><option value="100">Israel</option><option value="101">Italy</option><option value="102">Ivory Coast</option><option value="103">Jamaica</option><option value="189">Japan</option><option value="104">Jordan</option><option value="137">Kazakhstan</option><option value="105">Kenya</option><option value="203">Kiribati</option><option value="106">Kuwait</option><option value="88">Kyrgyzstan</option><option value="107">Laos</option><option value="92">Latvia</option><option value="236">Lebanon</option><option value="109">Lesotho</option><option value="237">Liberia</option><option value="110">Libya</option><option value="111">Liechtenstein</option><option value="224">Lithuania</option><option value="112">Luxembourg</option><option value="71">Macedonia</option><option value="114">Madagascar</option><option value="115">Malawi</option><option value="116">Malaysia</option><option value="117">Maldives</option><option value="118">Mali</option><option value="206">Malta</option><option value="207">Martinique</option><option value="119">Mauritania</option><option value="181">Mauritius</option><option value="120">Mexico</option><option value="187">Moldova</option><option value="121">Monaco</option><option value="208">Mongolian Peoples Republic</option><option value="29">Montenegro</option><option value="122">Morocco</option><option value="123">Mozambique</option><option value="49">Myanmar</option><option value="209">Namibia</option><option value="124">Nauru</option><option value="125">Nepal</option><option value="183">Netherlands</option><option value="126">Netherlands Antilles</option><option value="127">New Caledonia</option><option value="128">New Guinea</option><option value="129">New Zealand</option><option value="130">Nicaragua</option><option value="131">Niger</option><option value="132">Nigeria</option><option value="204">North Korea</option><option value="133">Norway</option><option value="134">Oman</option><option value="135">Pakistan</option><option value="136">Panama</option><option value="241">Papua New Guinea</option><option value="138">Paraguay</option><option value="60">People's Republic of China</option><option value="139">Peru</option><option value="140">Philippines</option><option value="141">Pitcairn</option><option value="142">Poland</option><option value="143">Portugal</option><option value="144">Qatar</option><option value="205">Republic of Korea</option><option value="230">Republic of Kosovo</option><option value="210">Reunion</option><option value="146">Romania</option><option value="56">Russia</option><option value="147">Rwanda</option><option value="217">San Marino</option><option value="229">SAR</option><option value="148">Saudi Arabia</option><option value="149">Senegal</option><option value="238">Serbia</option><option value="218">Seychelles</option><option value="240">Sierra Leone</option><option value="150">Singapore</option><option value="176">Slovakia</option><option value="154">Slovenija</option><option value="151">Solomon Islands</option><option value="239">Somalia</option><option value="152">South Africa</option><option value="153">Spain</option><option value="155">Sri Lanka</option><option value="211">St. Helena</option><option value="212">St. Kitts-Nevis</option><option value="213">St. Lucia</option><option value="214">St. Pierre & Miquelon Is.</option><option value="215">St. Thomas & Principe</option><option value="216">St. Vincent & The Grenadines</option><option value="156">Sudan</option><option value="157">Surinam</option><option value="158">Swaziland</option><option value="159">Sweden</option><option value="160">Switzerland</option><option value="161">Syria</option><option value="162">Taiwan</option><option value="39">Tajikistan</option><option value="163">Tanzania</option><option value="164">Thailand</option><option value="165">Togo</option><option value="166">Tonga Island</option><option value="192">Trinidad and Tobago</option><option value="167">Tunisia</option><option value="168">Turkey</option><option value="75">Turkmenistan</option><option value="219">Turks & Caicos Islands</option><option value="169">Uganda</option><option value="54">Ukraine</option><option value="223">United Arab Emirates</option><option value="227">United Kingdom</option><option value="171">Uruguay</option><option value="113">Uzbekistan</option><option value="220">Vanuatu</option><option value="221">Vatican City State</option><option value="172">Venezuela</option><option value="173">Vietnam</option><option value="225">West Africa</option><option value="174">Western Samoa</option><option value="177">Yemen</option><option value="178">Zaire</option><option value="179">Zambia</option><option value="180">Zimbabwe</option></select></div> </div> </div></div></div></div> <div data-drupal-selector="edit-jhu-donation-total" class="jhu-webform-donation-total--wrapper fieldgroup form-composite form-group js-form-wrapper form-wrapper" id="edit-jhu-donation-total--wrapper"><div class="donationTotalBox col-xs-12 col-sm-6 col-md-3 pull-right isVisitor"><div class="col-xs-4 col-sm-4 col-md-4 frequency_total_wrapper webform-readonly form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-donation-total-frequency-total js-form-item-jhu-donation-total-frequency-total form-group"> <label for="edit-jhu-donation-total-frequency-total" class="control-label">Gift Frequency</label> <input data-webform-composite-id="jhu-webform-donation-total--4--frequency_total" class="frequencyTotal form-text form-control" readonly="readonly" data-drupal-selector="edit-jhu-donation-total-frequency-total" type="text" id="edit-jhu-donation-total-frequency-total" name="jhu_donation_total[frequency_total]" value="" size="60" maxlength="255" /> </div> <div class="col-xs-4 col-sm-4 col-md-4 pledge_total_wrapper webform-readonly webform-element-help-container--title webform-element-help-container--title-after form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-donation-total-pledge-total js-form-item-jhu-donation-total-pledge-total form-group"> <label for="edit-jhu-donation-total-pledge-total" class="control-label">Pledge Amount<span class="webform-element-help js-webform-element-help" role="tooltip" tabindex="0" aria-label="Pledge Amount" data-webform-help="<div class="webform-element-help--title">Pledge Amount</div><div class="webform-element-help--content">This is the total gift amount including the first gift and each subsequent recurring gift.</div>"><span aria-hidden="true">?</span></span></label> <input data-webform-composite-id="jhu-webform-donation-total--4--pledge_total" class="pledgeMainTotal form-text form-control" readonly="readonly" data-drupal-selector="edit-jhu-donation-total-pledge-total" type="text" id="edit-jhu-donation-total-pledge-total" name="jhu_donation_total[pledge_total]" value="" size="60" maxlength="255" /> </div> <div class="col-xs-4 col-sm-4 col-md-4 finalMainTotalWrapper webform-readonly form-item js-form-item form-type-textfield js-form-type-textfield form-item-jhu-donation-total-main-total js-form-item-jhu-donation-total-main-total form-group"> <label for="edit-jhu-donation-total-main-total" class="control-label">Total</label> <input data-webform-composite-id="jhu-webform-donation-total--4--main_total" class="finalMainTotal form-text form-control" readonly="readonly" data-drupal-selector="edit-jhu-donation-total-main-total" type="text" id="edit-jhu-donation-total-main-total" name="jhu_donation_total[main_total]" value="" size="60" maxlength="255" /> </div> </div><input data-webform-composite-id="jhu-webform-donation-total--4--appeal_code" data-drupal-selector="edit-jhu-donation-total-appeal-code" type="hidden" name="jhu_donation_total[appeal_code]" value="" /><input data-webform-composite-id="jhu-webform-donation-total--4--donor_ip" class="donor_ip" data-drupal-selector="edit-jhu-donation-total-donor-ip" type="hidden" name="jhu_donation_total[donor_ip]" value="HTTP_X_FORWARDED_FOR = 8.222.208.146" /></div> 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