{"id":72679,"date":"2022-09-08T08:46:10","date_gmt":"2022-09-08T12:46:10","guid":{"rendered":"\/\/www.abccuba.com\/?page_id=72679"},"modified":"2024-03-11T15:58:34","modified_gmt":"2024-03-11T19:58:34","slug":"donate-online","status":"publish","type":"page","link":"\/\/www.abccuba.com\/support-nvrh\/donate-online\/","title":{"rendered":"Donate Online"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; background_color=&#8221;rgba(0,0,0,0)&#8221; background_image=&#8221;\/\/www.abccuba.com\/wp-content\/uploads\/2019\/03\/TopFade-1.jpg&#8221; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat-x&#8221; custom_padding=&#8221;30px|0px|2px|0px|false|false&#8221; da_disable_devices=&#8221;off|off|off&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; max_width=&#8221;1178px&#8221; custom_padding=&#8221;0|0px|3px|0px|false|false&#8221; use_custom_width=&#8221;on&#8221; custom_width_px=&#8221;1178px&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Page Headline&#8221; _builder_version=&#8221;4.16&#8243; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1 style=\"text-align: center;\">Caring for our community, at every stage of life.<\/h1>\n<p style=\"text-align: center;\"><span style=\"font-size: xx-large;\">Thank you for supporting NVRH!<\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; max_width=&#8221;1178px&#8221; custom_padding=&#8221;0|0px|3px|0px|false|false&#8221; use_custom_width=&#8221;on&#8221; custom_width_px=&#8221;1178px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_4,1_2,1_4&#8243; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; max_width=&#8221;1178px&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|false&#8221; use_custom_width=&#8221;on&#8221; custom_width_px=&#8221;1178px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_image src=&#8221;\/\/www.abccuba.com\/wp-content\/uploads\/2024\/03\/Pic-for-web-page.png&#8221; title_text=&#8221;Tomczyk&#038;Miller&#8221; url_new_window=&#8221;on&#8221; _builder_version=&#8221;4.23.4&#8243; _module_preset=&#8221;default&#8221; border_radii=&#8221;on|0px|0px|0px|0px&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Main Content&#8221; _builder_version=&#8221;4.16&#8243; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221;]\t<div id=\"give-form-56865-wrap\" class=\"give-form-wrap give-display-modal give-recurring-form-wrap give-recurring-form-donor\">\n\t\t\t\t\t<form id=\"give-form-56865-1\" class=\"give-form give-form-56865 give-form-type-multi give-recurring-form\" action=\"\/\/www.abccuba.com\/wp-json\/wp\/v2\/pages\/72679\/?payment-mode=stripe&form-id=56865\" data-id=\"56865-1\" data-currency_symbol=\"&#36;\" data-currency_code=\"USD\" data-currency_position=\"before\" data-thousands_separator=\",\" data-decimal_separator=\".\" data-number_decimals=\"2\" data-publishable-key=\"pk_live_SMtnnvlq4TpJelMdklNha8iD\" data-account=\"acct_1FJhYnKIkGGzp5Wa\" method=\"post\">\n\t\t\t\t<!-- The following field is for robots only, invisible to humans: -->\n\t\t\t\t<span class=\"give-hidden\" style=\"display: none !important;\">\n\t\t\t\t\t<label for=\"give-form-honeypot-56865\"><\/label>\n\t\t\t\t\t<input id=\"give-form-honeypot-56865\" type=\"text\" name=\"give-honeypot\"\n\t\t\t\t\t\t   class=\"give-honeypot give-hidden\"\/>\n\t\t\t\t<\/span>\n\n\t\t\t\t\t<input type=\"hidden\" name=\"give-form-id-prefix\" value=\"56865-1\"\/>\n\t<input type=\"hidden\" name=\"give-form-id\" value=\"56865\"\/>\n\t<input type=\"hidden\" name=\"give-form-title\" value=\"Give to NVRH Today\"\/>\n\t<input type=\"hidden\" name=\"give-current-url\" value=\"\/\/www.abccuba.com\/wp-json\/wp\/v2\/pages\/72679\/\"\/>\n\t<input type=\"hidden\" name=\"give-form-url\" value=\"\/\/www.abccuba.com\/wp-json\/wp\/v2\/pages\/72679\/\"\/>\n\t\t\t<input type=\"hidden\" name=\"give-form-minimum\"\n\t\t\t   value=\"5.00\"\/>\n\t\t<input type=\"hidden\" name=\"give-form-maximum\"\n\t\t\t   value=\"10000.00\"\/>\n\t\t<input type=\"hidden\"  name=\"give-form-hash\" value=\"c30e3781e4\" data-time=\"1716132694\" data-nonce-life=\"86400\" data-donor-session=\"0\"\/><input type=\"hidden\" name=\"give-price-id\" value=\"4\"\/>\t<input type=\"hidden\" name=\"give-recurring-logged-in-only\"\n\t\t   class=\"give-recurring-logged-in-only\"\n\t\t   value=\"\"\/>\n\n\t<input type=\"hidden\" name=\"give-logged-in-only\"\n\t\t   class=\"give-logged-in-only\"\n\t\t   value=\"1\"\/>\n<input\n\t\t\t\t\ttype=\"hidden\"\n\t\t\t\t\tname=\"_give_is_donation_recurring\"\n\t\t\t\t\tclass=\"_give_is_donation_recurring\"\n\t\t\t\t\tid=\"_give_is_donation_recurring\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\tdata-_give_recurring=\"yes_donor\"\n\t\t\t\t\tdata-_give_checkbox_default=\"no\"\n                    data-_give_price_option=\"\"\n                \/><input\n\t\t\t\t\ttype=\"hidden\"\n\t\t\t\t\tname=\"give_recurring_donation_details\"\n\t\t\t\t\tclass=\"give_recurring_donation_details\"\n\t\t\t\t\tid=\"give_recurring_donation_details\"\n\t\t\t\t\tvalue=\"{&quot;give_recurring_option&quot;:&quot;yes_donor&quot;}\"\n                \/>\t\t<div class=\"give-total-wrap\">\n\t\t\t<div class=\"give-donation-amount form-row-wide\">\n\t\t\t\t<span class=\"give-currency-symbol give-currency-position-before\">&#036;<\/span>\t\t\t\t<label class=\"give-hidden\" for=\"give-amount\">Donation Amount:<\/label>\n\t\t\t\t<input class=\"give-text-input give-amount-top\" id=\"give-amount\" name=\"give-amount\" type=\"text\" inputmode=\"decimal\"\n\t\t\t\t\t   placeholder=\"\" value=\"50.00\" autocomplete=\"off\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<ul id=\"give-donation-level-button-wrap\" class=\"give-donation-levels-wrap give-list-inline\"><li><button type=\"button\" data-price-id=\"0\" class=\"give-donation-level-btn give-btn give-btn-level-0 \" value=\"1,000.00\" data-default=\"0\">&#036;1,000.00<\/button><\/li><li><button type=\"button\" data-price-id=\"1\" class=\"give-donation-level-btn give-btn give-btn-level-1 \" value=\"500.00\" data-default=\"0\">&#036;500.00<\/button><\/li><li><button type=\"button\" data-price-id=\"2\" class=\"give-donation-level-btn give-btn give-btn-level-2 \" value=\"250.00\" data-default=\"0\">&#036;250.00<\/button><\/li><li><button type=\"button\" data-price-id=\"3\" class=\"give-donation-level-btn give-btn give-btn-level-3 \" value=\"100.00\" data-default=\"0\">&#036;100.00<\/button><\/li><li><button type=\"button\" data-price-id=\"4\" class=\"give-donation-level-btn give-btn give-btn-level-4 give-default-level\" value=\"50.00\" data-default=\"1\">&#036;50.00<\/button><\/li><li><button type=\"button\" data-price-id=\"5\" class=\"give-donation-level-btn give-btn give-btn-level-5 \" value=\"25.00\" data-default=\"0\">&#036;25.00<\/button><\/li><li><button type=\"button\" data-price-id=\"custom\" class=\"give-donation-level-btn give-btn give-btn-level-custom\" value=\"custom\">Custom Amount<\/button><\/li><\/ul>\t<div class=\"give-recurring-donors-choice\">\n\t\t<input id=\"give-donors_choice-56865\" class=\"give-recurring-period\" name=\"give-recurring-period\" type=\"checkbox\" data-period-label=\"Monthly\" data-period=\"month\" data-interval=\"1\"  \/> <label for=\"give-donors_choice-56865\">Make this donation every <select class=\"give-recurring-donors-choice-period\" name=\"give-recurring-period-donors-choice\"><option value=\"day\" >day<\/option><option value=\"week\" >week<\/option><option value=\"month\"  selected >month<\/option><option value=\"quarter\" >quarter<\/option><option value=\"year\" >year<\/option><\/select><\/label>\t<\/div>\n\t<button type=\"button\" class=\"give-btn give-btn-modal\">Donate Now<\/button><input id=\"give-stripe-payment-method-56865-1\" type=\"hidden\" name=\"give_stripe_payment_method\" value=\"\">\n\t<fieldset id=\"give-payment-mode-select\" style=\"display: none;\">\n\t\t\t\t<legend\n\t\t\tclass=\"give-payment-mode-label\">Select Payment Method\t\t\t<span class=\"give-loading-text\"><span\n\t\t\t\t\tclass=\"give-loading-animation\"><\/span>\n\t\t\t<\/span>\n\t\t<\/legend>\n\n\t\t<div id=\"give-payment-mode-wrap\">\n\t\t\t\t\t\t<ul id=\"give-gateway-radio-list\">\n\t\t\t\t\t\t\t\t\t\t<li class=\"give-gateway-option-selected\">\n\t\t\t\t\t\t\t<input type=\"radio\" name=\"payment-mode\" class=\"give-gateway\"\n\t\t\t\t\t\t\t\t   id=\"give-gateway-stripe-56865-1\"\n\t\t\t\t\t\t\t\t   value=\"stripe\" checked='checked'>\n\t\t\t\t\t\t\t<label for=\"give-gateway-stripe-56865-1\"\n\t\t\t\t\t\t\t\t   class=\"give-gateway-option\"\n\t\t\t\t\t\t\t\t   id=\"give-gateway-option-stripe\"> Stripe - Credit Card<\/label>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\n\t\n\t<div id=\"give_purchase_form_wrap\">\n\n\t\t\t<fieldset id=\"give_checkout_user_info\" class=\"give-title-prefix-wrap\">\n\t\t<legend>\n\t\t\tPersonal Info\t\t<\/legend>\n\n\t\t\t\t\t<p id=\"give-title-wrap\" class=\"form-row form-row-title form-row-responsive\">\n\t\t\t\t<label class=\"give-label\" for=\"give-title\">\n\t\t\t\t\tTitle\t\t\t\t\t\t\t\t\t\t<span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"Title is used to personalize your donation record..\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>\t\t\t\t<\/label>\n\t\t\t\t<select\n\t\t\t\t\tclass=\"give-input\"\n\t\t\t\t\ttype=\"text\"\n\t\t\t\t\tname=\"give_title\"\n\t\t\t\t\tid=\"give-title\"\n                                    >\n                                            <option\n                            value=\"Mr.\" >Mr.<\/option>\n                                            <option\n                            value=\"Mrs.\" >Mrs.<\/option>\n                                            <option\n                            value=\"Ms.\" >Ms.<\/option>\n                                            <option\n                            value=\"Dr.\" >Dr.<\/option>\n                                    <\/select>\n            <\/p>\n        \n        <p id=\"give-first-name-wrap\" class=\"form-row form-row-first form-row-responsive\">\n            <label class=\"give-label\" for=\"give-first\">\n                First Name                                    <span class=\"give-required-indicator\">*<\/span>\n                                <span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"First Name is used to personalize your donation record.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>            <\/label>\n            <input\n                class=\"give-input required\"\n                type=\"text\"\n                name=\"give_first\"\n                autocomplete=\"given-name\"\n                placeholder=\"First Name\"\n                id=\"give-first\"\n                value=\"\"\n                 required aria-required=\"true\"             \/>\n        <\/p>\n\n        <p id=\"give-last-name-wrap\" class=\"form-row form-row-last form-row-responsive\">\n            <label class=\"give-label\" for=\"give-last\">\n                Last Name                                <span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"Last Name is used to personalize your donation record.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>            <\/label>\n\n            <input\n                class=\"give-input\"\n                type=\"text\"\n                name=\"give_last\"\n                autocomplete=\"family-name\"\n                id=\"give-last\"\n                placeholder=\"Last Name\"\n                value=\"\"\n                            \/>\n        <\/p>\n\n        \n                <p id=\"give-email-wrap\" class=\"form-row form-row-wide\">\n            <label class=\"give-label\" for=\"give-email\">\n                Email Address                                    <span class=\"give-required-indicator\">*<\/span>\n                                    <span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"We will send the donation receipt to this address.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>            <\/label>\n            <input\n                class=\"give-input required\"\n                type=\"email\"\n                name=\"give_email\"\n                autocomplete=\"email\"\n                placeholder=\"Email Address\"\n                id=\"give-email\"\n                value=\"\"\n                 required aria-required=\"true\"             \/>\n\n        <\/p>\n\n                                <p id=\"give-anonymous-donation-wrap\" class=\"form-row form-row-wide\">\n                <label class=\"give-label\" for=\"give-anonymous-donation\">\n                    <input\n                        type=\"checkbox\"\n                        class=\"give-input\"\n                        name=\"give_anonymous_donation\"\n                        id=\"give-anonymous-donation\"\n                        value=\"1\"\n                                                                    >\n                    Make this an anonymous donation.\t\t\t\t\t<span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"Would you like to prevent your name and image from being displayed publicly?\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>\n\t\t\t\t<\/label>\n\t\t\t<\/p>\n\t\t\n\t\t\t\t\t<\/fieldset>\n\t<div class=\"form-row ffm-field-container give-ffm-form-row-one-third js-phone-domestic\" data-field-type=\"phone\" data-field-name=\"home_phone\" ><label class=\"give-label\" for=\"give-home_phone-56865-1\">\n    Home Phone<\/label>\n<input\n    type=\"tel\"\n    name=\"home_phone\"\n    placeholder=\"\"\n    id=\"give-home_phone-56865-1\"\n    value=\"\"\n        \n    >\n<\/div><div class=\"form-row ffm-field-container give-ffm-form-row-one-third js-phone-domestic\" data-field-type=\"phone\" data-field-name=\"cell_phone\" ><label class=\"give-label\" for=\"give-cell_phone-56865-1\">\n    Cell phone<\/label>\n<input\n    type=\"tel\"\n    name=\"cell_phone\"\n    placeholder=\"\"\n    id=\"give-cell_phone-56865-1\"\n    value=\"\"\n        \n    >\n<\/div><div class=\"form-row ffm-field-container give-ffm-form-row-half\" data-field-type=\"select\" data-field-name=\"gift_designation\" ><label class=\"give-label\" for=\"give-gift_designation-56865-2\">\n    Gift Designation<span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"Use this field to tell us how you would like your gift used.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span><\/label>\n\n<select\n    name=\"gift_designation\"\n    id=\"give-gift_designation-56865-2\"\n            >\n    <option value=\"\"  >- select -<\/option>                    <option\n                        selected        >\n            NVRH Innovation Fund - Colonoscope        <\/option>\n                    <option\n                                >\n            West Wing Expansion Project        <\/option>\n                    <option\n                                >\n            CAP - Nursing Education        <\/option>\n                    <option\n                                >\n            Annual Fund - Greatest Needs        <\/option>\n                    <option\n                                >\n            Community Unmet Needs Fund        <\/option>\n                    <option\n                                >\n            Other        <\/option>\n    <\/select>\n<\/div><div class=\"form-row form-row-wide ffm-field-container\" data-field-type=\"textarea\" data-field-name=\"additional_gift_information_1\" ><label class=\"give-label\" for=\"give-additional_gift_information_1-56865-3\">\n    Additional Gift Information<\/label>\n\n<textarea\n    name=\"additional_gift_information_1\"\n    id=\"give-additional_gift_information_1-56865-3\"\n\t        >\n<\/textarea>\n<\/div><div class=\"form-row form-row-wide ffm-field-container\" data-field-type=\"text\" data-field-name=\"acknowledgement_name\" ><label class=\"give-label\" for=\"give-acknowledgement_name-56865-4\">\n    Acknowledgment Name<span class=\"give-tooltip hint--top hint--large hint--bounce\" aria-label=\"Use this if the name you would like to appear in published acknowledgments is different than the first and last name used to make this gift. (ex. Mary and John Smith)\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span><\/label>\n<input\n    type=\"text\"\n    name=\"acknowledgement_name\"\n    placeholder=\"Name to appear in published acknowledgments.\"\n    id=\"give-acknowledgement_name-56865-4\"\n    value=\"\"\n        \n    >\n<\/div>            <fieldset id=\"give-tributes-dedicate-donation-56865\" class=\"give-tributes-dedicate-donation\"> <!-- Give - Tributes Start -->\n                <input type=\"hidden\" class=\"give-tributes-type\" name=\"give_tributes_type\" value=\"in honor of\" \/>\n                <legend>I'd like to recognize someone special<\/legend>\n                    <div id=\"give-tributes-options-56865\">\n        <ul id=\"give-tributes-show-wrap-56865\" class=\"give-tributes-show-wrap\">\n            <li class=\"give-tributes-show-wrap-li\">\n                <input\n                        class=\"give-input\"\n                        type=\"radio\"\n                        id=\"give-tributes-yes-56865\"\n                        name=\"give_tributes_show_dedication\"\n                                            value=\"yes\"\n                \/>\n                <label for=\"give-tributes-yes-56865\" class=\"give-tributes-yes\"> Yes, please<\/label>\n            <\/li>\n            <li class=\"give-tributes-show-wrap-li\">\n                <input\n                        class=\"give-input\"\n                        type=\"radio\"\n                        id=\"give-tributes-no-56865\"\n                        name=\"give_tributes_show_dedication\"\n                     checked='checked'                        value=\"no\"\n                \/>\n                <label for=\"give-tributes-no-56865\" class=\"give-tributes-no\"> No, thank you<\/label>\n            <\/li>\n        <\/ul>\n    <\/div>\n    <div id=\"give-tributes-type-wrap-56865\" class=\"has_radios give_tributes_type_wrap\"><!-- Give - Tributes type wrap start --><label class=\"give-tributes-label\" for=\"give-tribute-type-56865\" id=\"give-tribute-type-56865\">Dedication Type<\/label><ul id=\"give-tributes-type-radio-list-56865\"><li><input type=\"radio\" id=\"give-tributes-type-radio-in-honor-of-56865\" name=\"give_tributes_radio_type\" data-tribute-type=\"in honor of\" class=\"give-tribute-type-radio\" value=\"in honor of\"  checked=\"checked\"><label for=\"give-tributes-type-radio-in-honor-of-56865\">in honor of<\/label><\/li><li><input type=\"radio\" id=\"give-tributes-type-radio-in-memory-of-56865\" name=\"give_tributes_radio_type\" data-tribute-type=\"in memory of\" class=\"give-tribute-type-radio\" value=\"in memory of\"  ><label for=\"give-tributes-type-radio-in-memory-of-56865\">in memory of<\/label><\/li><\/ul><\/div><!-- Give - Tributes type wrap end -->        <div id=\"give-tributes-info-wrap-56865\" class=\"give_tributes_info_wrap\"><!-- Give - Tributes Info Wrap Start -->\n        <h3 class=\"give-section-break give-tributes-legend\">Honoree Details<\/h3>\n        \n    <p id=\"give-tributes-first-name-wrap-56865\" class=\"form-row form-row-first form-row-responsive\">\n        <label class=\"give-label\" for=\"give-tributes-first-name-56865\">\n            First Name            \n                            <span class=\"give-required-indicator\">*<\/span>\n            \n            <span class=\"give-tooltip give-icon give-icon-question\"\n                  data-tooltip=\"The first name of the honoree.\"><\/span>\n        <\/label>\n        <input\n                class=\"give-input required\"\n                type=\"text\"\n                name=\"give_tributes_first_name\"\n                placeholder=\"Honoree First Name\"\n                id=\"give-tributes-first-name-56865\"\n                value=\"\"\n        \/>\n    <\/p>\n\n<p id=\"give-tributes-last-name-wrap-56865\" class=\"form-row form-row-last form-row-responsive\">\n    <label class=\"give-label\" for=\"give-tributes-last-name-56865\">\n        Last Name                    <span class=\"give-required-indicator\">*<\/span>\n                <span class=\"give-tooltip give-icon give-icon-question\"\n              data-tooltip=\"The last name of the honoree.\"><\/span>\n    <\/label>\n    <input\n            class=\"give-input required\"\n            type=\"text\"\n            name=\"give_tributes_last_name\"\n            placeholder=\"Honoree Last Name\"\n            id=\"give-tributes-last-name-56865\"\n            value=\"\"\n    \/>\n            <\/p>\n        <\/div><!-- Give - Tributes Info Wrap End -->\n                        <\/fieldset> <!-- Give - Tributes End -->\n            \n        <fieldset id=\"give_cc_fields\" class=\"give-do-validate\">\n            <legend>\n                Credit Card Info            <\/legend>\n\n            <div class=\"give_notices give_errors\" id=\"give_error_warning\">\n\t\t\t\t\t\t<p class=\"give_notice give_warning\" data-dismissible=\"\" data-dismiss-interval=\"5000\" data-dismiss-type=\"\">\n\t\t\t\t\t\t\t&lt;strong&gt;Notice:&lt;\/strong&gt; Credit Card fields are disabled because your site is not running securely over HTTPS.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div>        <\/fieldset>\n        \t<fieldset id=\"give_cc_address\" class=\"cc-address\">\n\t\t<legend>Billing Details<\/legend>\n\t\t\t\t<p id=\"give-card-country-wrap\" class=\"form-row form-row-wide\">\n\t\t\t<label for=\"billing_country\" class=\"give-label\">\n\t\t\t\tCountry\t\t\t\t\t\t\t\t\t<span class=\"give-required-indicator\">*<\/span>\n\t\t\t\t\t\t\t\t<span class=\"give-tooltip give-icon give-icon-question\"\n\t\t\t\t\t  data-tooltip=\"The country for your billing address.\"><\/span>\n\t\t\t<\/label>\n\n\t\t\t<select\n\t\t\t\tname=\"billing_country\"\n\t\t\t\tautocomplete=\"country\"\n\t\t\t\tid=\"billing_country\"\n\t\t\t\tclass=\"billing-country billing_country give-select required\"\n\t\t\t\t required aria-required=\"true\" \t\t\t>\n\t\t\t\t<option value=\"\"><\/option><option value=\"US\" selected='selected'>United States<\/option><option value=\"CA\">Canada<\/option><option value=\"GB\">United Kingdom<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AL\">Albania<\/option><option value=\"DZ\">Algeria<\/option><option value=\"AS\">American Samoa<\/option><option value=\"AD\">Andorra<\/option><option value=\"AO\">Angola<\/option><option value=\"AI\">Anguilla<\/option><option value=\"AQ\">Antarctica<\/option><option value=\"AG\">Antigua and Barbuda<\/option><option value=\"AR\">Argentina<\/option><option value=\"AM\">Armenia<\/option><option value=\"AW\">Aruba<\/option><option value=\"AU\">Australia<\/option><option value=\"AT\">Austria<\/option><option value=\"AZ\">Azerbaijan<\/option><option value=\"BS\">Bahamas<\/option><option value=\"BH\">Bahrain<\/option><option value=\"BD\">Bangladesh<\/option><option value=\"BB\">Barbados<\/option><option value=\"BY\">Belarus<\/option><option value=\"BE\">Belgium<\/option><option value=\"BZ\">Belize<\/option><option value=\"BJ\">Benin<\/option><option value=\"BM\">Bermuda<\/option><option value=\"BT\">Bhutan<\/option><option value=\"BO\">Bolivia<\/option><option value=\"BA\">Bosnia and Herzegovina<\/option><option value=\"BW\">Botswana<\/option><option value=\"BV\">Bouvet Island<\/option><option value=\"BR\">Brazil<\/option><option value=\"IO\">British Indian Ocean Territory<\/option><option value=\"BN\">Brunei Darrussalam<\/option><option value=\"BG\">Bulgaria<\/option><option value=\"BF\">Burkina Faso<\/option><option value=\"BI\">Burundi<\/option><option value=\"KH\">Cambodia<\/option><option value=\"CM\">Cameroon<\/option><option value=\"CV\">Cape Verde<\/option><option value=\"KY\">Cayman Islands<\/option><option value=\"CF\">Central African Republic<\/option><option value=\"TD\">Chad<\/option><option value=\"CL\">Chile<\/option><option value=\"CN\">China<\/option><option value=\"CX\">Christmas Island<\/option><option value=\"CC\">Cocos Islands<\/option><option value=\"CO\">Colombia<\/option><option value=\"KM\">Comoros<\/option><option value=\"CD\">Congo, Democratic People&#039;s Republic<\/option><option value=\"CG\">Congo, Republic of<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"CI\">Cote d&#039;Ivoire<\/option><option value=\"HR\">Croatia\/Hrvatska<\/option><option value=\"CU\">Cuba<\/option><option value=\"CY\">Cyprus Island<\/option><option value=\"CZ\">Czech Republic<\/option><option value=\"DK\">Denmark<\/option><option value=\"DJ\">Djibouti<\/option><option value=\"DM\">Dominica<\/option><option value=\"DO\">Dominican Republic<\/option><option value=\"TP\">East Timor<\/option><option value=\"EC\">Ecuador<\/option><option value=\"EG\">Egypt<\/option><option value=\"GQ\">Equatorial Guinea<\/option><option value=\"SV\">El Salvador<\/option><option value=\"ER\">Eritrea<\/option><option value=\"EE\">Estonia<\/option><option value=\"ET\">Ethiopia<\/option><option value=\"FK\">Falkland Islands<\/option><option value=\"FO\">Faroe Islands<\/option><option value=\"FJ\">Fiji<\/option><option value=\"FI\">Finland<\/option><option value=\"FR\">France<\/option><option value=\"GF\">French Guiana<\/option><option value=\"PF\">French Polynesia<\/option><option value=\"TF\">French Southern Territories<\/option><option value=\"GA\">Gabon<\/option><option value=\"GM\">Gambia<\/option><option value=\"GE\">Georgia<\/option><option value=\"DE\">Germany<\/option><option value=\"GR\">Greece<\/option><option value=\"GH\">Ghana<\/option><option value=\"GI\">Gibraltar<\/option><option value=\"GL\">Greenland<\/option><option value=\"GD\">Grenada<\/option><option value=\"GP\">Guadeloupe<\/option><option value=\"GU\">Guam<\/option><option value=\"GT\">Guatemala<\/option><option value=\"GG\">Guernsey<\/option><option value=\"GN\">Guinea<\/option><option value=\"GW\">Guinea-Bissau<\/option><option value=\"GY\">Guyana<\/option><option value=\"HT\">Haiti<\/option><option value=\"HM\">Heard and McDonald Islands<\/option><option value=\"VA\">Holy See (City Vatican State)<\/option><option value=\"HN\">Honduras<\/option><option value=\"HK\">Hong Kong<\/option><option value=\"HU\">Hungary<\/option><option value=\"IS\">Iceland<\/option><option value=\"IN\">India<\/option><option value=\"ID\">Indonesia<\/option><option value=\"IR\">Iran<\/option><option value=\"IQ\">Iraq<\/option><option value=\"IE\">Ireland<\/option><option value=\"IM\">Isle of Man<\/option><option value=\"IL\">Israel<\/option><option value=\"IT\">Italy<\/option><option value=\"JM\">Jamaica<\/option><option value=\"JP\">Japan<\/option><option value=\"JE\">Jersey<\/option><option value=\"JO\">Jordan<\/option><option value=\"KZ\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Lao People&#039;s Democratic Republic<\/option><option value=\"LV\">Latvia<\/option><option value=\"LB\">Lebanon<\/option><option value=\"LS\">Lesotho<\/option><option value=\"LR\">Liberia<\/option><option value=\"LY\">Libyan Arab Jamahiriya<\/option><option value=\"LI\">Liechtenstein<\/option><option value=\"LT\">Lithuania<\/option><option value=\"LU\">Luxembourg<\/option><option value=\"MO\">Macau<\/option><option value=\"MK\">Macedonia<\/option><option value=\"MG\">Madagascar<\/option><option value=\"MW\">Malawi<\/option><option value=\"MY\">Malaysia<\/option><option value=\"MV\">Maldives<\/option><option value=\"ML\">Mali<\/option><option value=\"MT\">Malta<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MQ\">Martinique<\/option><option value=\"MR\">Mauritania<\/option><option value=\"MU\">Mauritius<\/option><option value=\"YT\">Mayotte<\/option><option value=\"MX\">Mexico<\/option><option value=\"FM\">Micronesia<\/option><option value=\"MD\">Moldova, Republic of<\/option><option value=\"MC\">Monaco<\/option><option value=\"MN\">Mongolia<\/option><option value=\"ME\">Montenegro<\/option><option value=\"MS\">Montserrat<\/option><option value=\"MA\">Morocco<\/option><option value=\"MZ\">Mozambique<\/option><option value=\"MM\">Myanmar<\/option><option value=\"NA\">Namibia<\/option><option value=\"NR\">Nauru<\/option><option value=\"NP\">Nepal<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AN\">Netherlands Antilles<\/option><option value=\"NC\">New Caledonia<\/option><option value=\"NZ\">New Zealand<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nigeria<\/option><option value=\"NU\">Niue<\/option><option value=\"NF\">Norfolk Island<\/option><option value=\"KP\">North Korea<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"NO\">Norway<\/option><option value=\"OM\">Oman<\/option><option value=\"PK\">Pakistan<\/option><option value=\"PW\">Palau<\/option><option value=\"PS\">Palestinian Territories<\/option><option value=\"PA\">Panama<\/option><option value=\"PG\">Papua New Guinea<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">Peru<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">Pitcairn Island<\/option><option value=\"PL\">Poland<\/option><option value=\"PT\">Portugal<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">Reunion Island<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russian Federation<\/option><option value=\"RW\">Rwanda<\/option><option value=\"SH\">Saint Helena<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"PM\">Saint Pierre and Miquelon<\/option><option value=\"VC\">Saint Vincent and the Grenadines<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">Sao Tome and Principe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"RS\">Serbia<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovak Republic<\/option><option value=\"SI\">Slovenia<\/option><option value=\"SB\">Solomon Islands<\/option><option value=\"SO\">Somalia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"GS\">South Georgia<\/option><option value=\"KR\">South Korea<\/option><option value=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard and Jan Mayen Islands<\/option><option value=\"SZ\">Eswatini<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syrian Arab Republic<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/option><option value=\"TG\">Togo<\/option><option value=\"TK\">Tokelau<\/option><option value=\"TO\">Tonga<\/option><option value=\"TH\">Thailand<\/option><option value=\"TT\">Trinidad and Tobago<\/option><option value=\"TN\">Tunisia<\/option><option value=\"TR\">Turkey<\/option><option value=\"TM\">Turkmenistan<\/option><option value=\"TC\">Turks and Caicos Islands<\/option><option value=\"TV\">Tuvalu<\/option><option value=\"UG\">Uganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">United Arab Emirates<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UM\">US Minor Outlying Islands<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VE\">Venezuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"VG\">Virgin Islands (British)<\/option><option value=\"VI\">Virgin Islands (USA)<\/option><option value=\"WF\">Wallis and Futuna Islands<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"WS\">Western Samoa<\/option><option value=\"YE\">Yemen<\/option><option value=\"YU\">Yugoslavia<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option>\t\t\t<\/select>\n\t\t<\/p>\n\n\t\t<p id=\"give-card-address-wrap\" class=\"form-row form-row-wide\">\n\t\t\t<label for=\"card_address\" class=\"give-label\">\n\t\t\t\tAddress 1\t\t\t\t\t\t\t\t\t<span class=\"give-required-indicator\">*<\/span>\n\t\t\t\t\t\t\t\t<span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"The primary billing address for your credit card.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>\t\t\t<\/label>\n\n\t\t\t<input\n\t\t\t\ttype=\"text\"\n\t\t\t\tid=\"card_address\"\n\t\t\t\tname=\"card_address\"\n\t\t\t\tautocomplete=\"address-line1\"\n\t\t\t\tclass=\"card-address give-input required\"\n\t\t\t\tplaceholder=\"Address line 1\"\n\t\t\t\tvalue=\"\"\n\t\t\t\t  required aria-required=\"true\" \t\t\t\/>\n\t\t<\/p>\n\n\t\t<p id=\"give-card-address-2-wrap\" class=\"form-row form-row-wide\">\n\t\t\t<label for=\"card_address_2\" class=\"give-label\">\n\t\t\t\tAddress 2\t\t\t\t\t\t\t\t<span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"(optional) The suite, apartment number, post office box (etc) associated with your billing address.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>\t\t\t<\/label>\n\n\t\t\t<input\n\t\t\t\ttype=\"text\"\n\t\t\t\tid=\"card_address_2\"\n\t\t\t\tname=\"card_address_2\"\n\t\t\t\tautocomplete=\"address-line2\"\n\t\t\t\tclass=\"card-address-2 give-input\"\n\t\t\t\tplaceholder=\"Address line 2\"\n\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\t\/>\n\t\t<\/p>\n\n\t\t<p id=\"give-card-city-wrap\" class=\"form-row form-row-wide\">\n\t\t\t<label for=\"card_city\" class=\"give-label\">\n\t\t\t\tCity\t\t\t\t\t\t\t\t\t<span class=\"give-required-indicator \">*<\/span>\n\t\t\t\t\t\t\t\t<span class=\"give-tooltip hint--top hint--bounce\" aria-label=\"The city for your billing address.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>\t\t\t<\/label>\n\t\t\t<input\n\t\t\t\ttype=\"text\"\n\t\t\t\tid=\"card_city\"\n\t\t\t\tname=\"card_city\"\n\t\t\t\tautocomplete=\"address-level2\"\n\t\t\t\tclass=\"card-city give-input required\"\n\t\t\t\tplaceholder=\"City\"\n\t\t\t\tvalue=\"\"\n\t\t\t\t required aria-required=\"true\" \t\t\t\/>\n\t\t<\/p>\n\n\t\t\t\t<p id=\"give-card-state-wrap\"\n\t\t   class=\"form-row form-row-first form-row-responsive  \">\n\t\t\t<label for=\"card_state\" class=\"give-label\">\n\t\t\t\t<span class=\"state-label-text\">State<\/span>\n\t\t\t\t<span\n\t\t\t\t\tclass=\"give-required-indicator  \">*<\/span>\n\t\t\t\t<span class=\"give-tooltip give-icon give-icon-question\"\n\t\t\t\t\t  data-tooltip=\"The state, province, or county for your billing address.\"><\/span>\n\t\t\t<\/label>\n\t\t\t\t\t\t\t<select\n\t\t\t\t\tname=\"card_state\"\n\t\t\t\t\tautocomplete=\"address-level1\"\n\t\t\t\t\tid=\"card_state\"\n\t\t\t\t\tclass=\"card_state give-select required\"\n\t\t\t\t\t required aria-required=\"true\" >\n\t\t\t\t\t<option value=\"\"><\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\" selected='selected'>Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><option value=\"AS\">American Samoa<\/option><option value=\"CZ\">Canal Zone<\/option><option value=\"CM\">Commonwealth of the Northern Mariana Islands<\/option><option value=\"FM\">Federated States of Micronesia<\/option><option value=\"GU\">Guam<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"PW\">Palau<\/option><option value=\"PI\">Philippine Islands<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"TT\">Trust Territory of the Pacific Islands<\/option><option value=\"VI\">Virgin Islands<\/option><option value=\"AA\">Armed Forces - Americas<\/option><option value=\"AE\">Armed Forces - Europe, Canada, Middle East, Africa<\/option><option value=\"AP\">Armed Forces - Pacific<\/option>\t\t\t\t<\/select>\n\t\t\t\t\t<\/p>\n\n\t\t<p id=\"give-card-zip-wrap\" class=\"form-row form-row-last form-row-responsive\">\n\t\t\t<label for=\"card_zip\" class=\"give-label\">\n\t\t\t\tZip \/ Postal Code\t\t\t\t<span class=\"give-required-indicator\">*<\/span>\n\t\t\t\t<span class=\"give-tooltip hint--top hint--medium hint--bounce\" aria-label=\"The zip or postal code for your billing address.\" rel=\"tooltip\"><i class=\"give-icon give-icon-question\"><\/i><\/span>\t\t\t<\/label>\n\n\t\t\t<input\n\t\t\t\ttype=\"text\"\n\t\t\t\tsize=\"4\"\n\t\t\t\tid=\"card_zip\"\n\t\t\t\tname=\"card_zip\"\n\t\t\t\tautocomplete=\"postal-code\"\n\t\t\t\tclass=\"card-zip give-input required\"\n\t\t\t\tplaceholder=\"Zip \/ Postal Code\"\n\t\t\t\tvalue=\"\"\n\t\t\t\t required aria-required=\"true\" \t\t\t\/>\n\t\t<\/p>\n\t\t\t<\/fieldset>\n\t<div id=\"give-stripe-payment-errors-56865-1\"><\/div>\t<fieldset id=\"give_purchase_submit\" class=\"give-donation-submit\">\n\t\t\t<p id=\"give-final-total-wrap\" class=\"form-wrap \">\n\t\t\t\t<span class=\"give-donation-total-label\">\n\t\t\tDonation Total:\t\t<\/span>\n\t\t<span class=\"give-final-total-amount\"\n\t\t\t  data-total=\"50.00\">\n\t\t\t&#36;50.00\t\t<\/span>\n\t\t<span id=\"give-recurring-modal-period-wrap\" class=\"give-hidden\"><span id=\"give-recurring-modal-period\">One Time<\/span><\/span>\t<\/p>\n\t\t<input type=\"hidden\" name=\"give_action\" value=\"purchase\"\/>\n\t<input type=\"hidden\" name=\"give-gateway\" value=\"stripe\"\/>\n\t\t<div class=\"give-submit-button-wrap give-clearfix\">\n\t\t<input type=\"submit\" class=\"give-submit give-btn\" id=\"give-purchase-button\" name=\"give-purchase\"\n\t\t\t   value=\"Submit Gift\" data-before-validation-label=\"Submit Gift\"\/>\n\t\t<span 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