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for="CIVICRM_QFID_1_14">I want to contribute this amount</label> every     <select name="frequency_unit" id="frequency_unit" class="form-select"> <option value="month">month</option> <option value="year">year</option> </select>  for   <input size="6" maxlength="14" name="installments" type="text" id="installments" class="form-text"/>  <label for="installments">installments</label></strong> </p> <p><span class="description">Your recurring contribution will be processed automatically for the number of installments you specify. You can leave the number of installments blank if you want to make an open-ended commitment. In either case, you can choose to cancel at any time. You will receive an email receipt for each recurring contribution. The receipts will include a link you can use if you decide to modify or cancel your future contributions. </span></p> </div> </div> <div class="crm-section email-5-section"> <div class="label"><label for="email-5"> Email Address <span class="crm-marker" title="This field is required.">*</span> </label></div> <div class="content"> <input size="30" maxlength="60" name="email-5" type="text" id="email-5" class="form-text big required"/> </div> <div class="clear"></div> </div> <div class="crm-group custom_pre_profile-group"> <fieldset><legend>Your Information</legend><div class="messages help"><p> <span class="description">The following name and address fields are not necessary to complete if you would prefer to keep this information private. 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value="1030">British Indian Ocean Territory</option> <option value="1032">Brunei Darussalam</option> <option value="1033">Bulgaria</option> <option value="1034">Burkina Faso</option> <option value="1036">Burundi</option> <option value="1037">Cambodia</option> <option value="1038">Cameroon</option> <option value="1039">Canada</option> <option value="1040">Cape Verde</option> <option value="1041">Cayman Islands</option> <option value="1042">Central African Republic</option> <option value="1043">Chad</option> <option value="1044">Chile</option> <option value="1045">China</option> <option value="1046">Christmas Island</option> <option value="1047">Cocos (Keeling) Islands</option> <option value="1048">Colombia</option> <option value="1049">Comoros</option> <option value="1051">Congo</option> <option value="1050">Congo, The Democratic Republic of the</option> <option value="1052">Cook Islands</option> <option value="1053">Costa Rica</option> <option value="1054">C么te d'Ivoire</option> <option value="1055">Croatia</option> <option value="1056">Cuba</option> <option value="1057">Cyprus</option> <option value="1058">Czech Republic</option> <option value="1059">Denmark</option> <option value="1060">Djibouti</option> <option value="1061">Dominica</option> <option value="1062">Dominican Republic</option> <option value="1064">Ecuador</option> <option value="1065">Egypt</option> <option value="1066">El Salvador</option> <option value="1067">Equatorial Guinea</option> <option value="1068">Eritrea</option> <option value="1069">Estonia</option> <option value="1070">Ethiopia</option> <option value="1072">Falkland Islands (Malvinas)</option> <option value="1073">Faroe Islands</option> <option value="1074">Fiji</option> <option value="1075">Finland</option> <option value="1076">France</option> <option value="1077">French Guiana</option> <option value="1078">French Polynesia</option> <option value="1079">French Southern Territories</option> <option value="1080">Gabon</option> <option value="1213">Gambia</option> <option value="1081">Georgia</option> <option value="1082">Germany</option> <option value="1083">Ghana</option> <option value="1084">Gibraltar</option> <option value="1085">Greece</option> <option value="1086">Greenland</option> <option value="1087">Grenada</option> <option value="1088">Guadeloupe</option> <option value="1089">Guam</option> <option value="1090">Guatemala</option> <option value="1245">Guernsey</option> <option value="1091">Guinea</option> <option value="1092">Guinea-Bissau</option> <option value="1093">Guyana</option> <option value="1094">Haiti</option> <option value="1095">Heard Island and McDonald Islands</option> <option value="1096">Holy See (Vatican City State)</option> <option value="1097">Honduras</option> <option value="1098">Hong Kong</option> <option value="1099">Hungary</option> <option value="1100">Iceland</option> <option value="1101">India</option> <option value="1102">Indonesia</option> <option value="1103">Iran, Islamic Republic of</option> <option value="1104">Iraq</option> <option value="1105">Ireland</option> <option value="1246">Isle of Man</option> <option value="1106">Israel</option> <option value="1107">Italy</option> <option value="1108">Jamaica</option> <option value="1109">Japan</option> <option value="1244">Jersey</option> <option value="1110">Jordan</option> <option value="1111">Kazakhstan</option> <option value="1112">Kenya</option> <option value="1113">Kiribati</option> <option value="1114">Korea, Democratic People's Republic of</option> <option value="1115">Korea, Republic of</option> <option value="1116">Kuwait</option> <option value="1117">Kyrgyzstan</option> <option value="1118">Lao People's Democratic Republic</option> <option value="1119">Latvia</option> <option value="1120">Lebanon</option> <option value="1121">Lesotho</option> <option value="1122">Liberia</option> <option value="1123">Libyan Arab Jamahiriya</option> <option value="1124">Liechtenstein</option> <option value="1125">Lithuania</option> <option value="1126">Luxembourg</option> <option value="1127">Macao</option> <option value="1128">Macedonia, Republic of</option> <option value="1129">Madagascar</option> <option value="1130">Malawi</option> <option value="1131">Malaysia</option> <option value="1132">Maldives</option> <option value="1133">Mali</option> <option value="1134">Malta</option> <option value="1135">Marshall Islands</option> <option value="1136">Martinique</option> <option value="1137">Mauritania</option> <option value="1138">Mauritius</option> <option value="1139">Mayotte</option> <option value="1140">Mexico</option> <option value="1141">Micronesia, Federated States of</option> <option value="1142">Moldova</option> <option value="1143">Monaco</option> <option value="1144">Mongolia</option> <option value="1243">Montenegro</option> <option value="1145">Montserrat</option> <option value="1146">Morocco</option> <option value="1147">Mozambique</option> <option value="1035">Myanmar</option> <option value="1148">Namibia</option> <option value="1149">Nauru</option> <option value="1150">Nepal</option> <option value="1152">Netherlands</option> <option value="1151">Netherlands Antilles</option> <option value="1153">New Caledonia</option> <option value="1154">New Zealand</option> <option value="1155">Nicaragua</option> <option value="1156">Niger</option> <option value="1157">Nigeria</option> <option value="1158">Niue</option> <option value="1159">Norfolk Island</option> <option value="1160">Northern Mariana Islands</option> <option value="1161">Norway</option> <option value="1162">Oman</option> <option value="1163">Pakistan</option> <option value="1164">Palau</option> <option value="1165">Palestinian Territory, Occupied</option> <option value="1166">Panama</option> <option value="1167">Papua New Guinea</option> <option value="1168">Paraguay</option> <option value="1169">Peru</option> <option value="1170">Philippines</option> <option value="1171">Pitcairn</option> <option value="1172">Poland</option> <option value="1173">Portugal</option> <option value="1174">Puerto Rico</option> <option value="1175">Qatar</option> <option value="1179">Reunion</option> <option value="1176">Romania</option> <option value="1177">Russian Federation</option> <option value="1178">Rwanda</option> <option value="1180">Saint Helena</option> <option value="1181">Saint Kitts and Nevis</option> <option value="1182">Saint Lucia</option> <option value="1183">Saint Pierre and Miquelon</option> <option value="1184">Saint Vincent and the Grenadines</option> <option value="1185">Samoa</option> <option value="1186">San Marino</option> <option value="1207">Sao Tome and Principe</option> <option value="1187">Saudi Arabia</option> <option value="1188">Senegal</option> <option value="1242">Serbia</option> <option value="1238">Serbia and Montenegro</option> <option value="1189">Seychelles</option> <option value="1190">Sierra Leone</option> <option 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value="2249">Schleswig-Holstein</option> <option value="2770">Scottish Borders</option> <option value="2576">Seine-et-Marne</option> <option value="2577">Seine-Maritime</option> <option value="2578">Seine-Saint-Denis</option> <option value="2773">Shetland Islands</option> <option value="2774">Shropshire</option> <option value="2777">Somerset</option> <option value="2579">Somme</option> <option value="1642">South Australia</option> <option value="2778">South Ayrshire</option> <option value="1039">South Carolina</option> <option value="1040">South Dakota</option> <option value="10015">South Glamorgan</option> <option value="2779">South Gloucestershire</option> <option value="2780">South Lanarkshire</option> <option value="9991">South Yorkshire</option> <option value="2785">Staffordshire</option> <option value="2786">Stirling</option> <option value="2791">Suffolk</option> <option value="2793">Surrey</option> <option value="2580">Tarn</option> <option value="2581">Tarn-et-Garonne</option> <option value="1643">Tasmania</option> <option value="1041">Tennessee</option> <option value="2583">Territoire de Belfort</option> <option value="1042">Texas</option> <option value="2255">Thueringen</option> <option value="9986">Tyne and Wear</option> <option value="1058">United States Minor Outlying Islands</option> <option value="1043">Utah</option> <option value="2582">Val d'Oise</option> <option value="2584">Val-de-Marne</option> <option value="2585">Var</option> <option value="2586">Vaucluse</option> <option value="2587">Vend茅e</option> <option value="1044">Vermont</option> <option value="1644">Victoria</option> <option value="2588">Vienne</option> <option value="1057">Virgin Islands</option> <option value="1045">Virginia</option> <option value="2589">Vosges</option> <option value="2811">Warwickshire</option> <option value="1046">Washington</option> <option value="2813">West Dunbartonshire</option> <option value="9998">West Glamorgan</option> <option value="2814">West Lothian</option> <option value="9994">West Midlands</option> <option value="2815">West Sussex</option> <option value="1047">West Virginia</option> <option value="9990">West Yorkshire</option> <option value="1645">Western Australia</option> <option value="2818">Wiltshire</option> <option value="1048">Wisconsin</option> <option value="2823">Worcestershire</option> <option value="1049">Wyoming</option> <option value="2590">Yonne</option> <option value="1112">Yukon Territory</option> <option value="2591">Yvelines</option> </select></div><div class="clear"></div></div><div class="crm-section custom_4-section"><div class="label"><label>Yes, you can share my name as an OSI supporter</label></div><div class="content"><input value="1" type="radio" id="CIVICRM_QFID_1_16" name="custom_4" class="form-radio"/><label for="CIVICRM_QFID_1_16">Yes</label> <input value="0" type="radio" id="CIVICRM_QFID_0_18" name="custom_4" checked="checked" class="form-radio"/><label 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