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For A Better Us - Donation Form - YMCA
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<form name="process" id="ProcessForm" action="https://secure2.convio.net/ymca/site/Donation2" method="post"  >

<div class="donation-form-container responsive">
<script type="text/javascript">
<!--
function reloadPage() {
window.location.reload(true);
}
function testAjax() {

var xmlHttp = null;
// Opera 8.0+, Firefox, Chrome, Safari
try {
xmlHttp = new XMLHttpRequest();
}catch (e){
// Internet Explorer Browsers
try{
xmlHttp = new ActiveXObject("Msxml2.XMLHTTP");
}catch (e) {
try{
xmlHttp = new ActiveXObject("Microsoft.XMLHTTP");
}catch (e){
return false;
}
}
}

xmlHttp.open('POST','AjaxHelper;jsessionid=00000000.app260a?NONCE_TOKEN=5390E41521AD549E2FAFD6EACE6517F4', true);
xmlHttp.send();

}
addOnLoadHandler(testAjax);
// -->
</script>


<div class="donation-form-content">






<input type="hidden" name="user_donation_amt" id="user_donation_amt" value="" />
<input type="hidden" name="company_min_matching_amt" id="company_min_matching_amt" value="" />
<input type="hidden" name="currency_locale" id="currency_locale" value="en_US" />





<div class="form-row">
<div class="html-caption-container">
<p><img class="header-banner" src="../images/content/pagebuilder/YUSA_Harvey_2017header_v2.png" alt="" /></p>
</div>
</div>




<h2 class="section-header-container">

Support the Y's Hurricane Harvey Relief Fund

</h2>




<div class="don-standard-levels form-row">
<div class="levels-label">

</div>

<div id="level_standard_row" class="form-row form-donation-level">

<div class="form-content">
<span class="field-required"></span> <span class="aural-only">Field Is Required</span>

<span class="FormLabelText">What would you like to give?</span> 


<div class="donation-level-general-ask">
<span style="font-size:14px;">
Hurricane Harvey has left unprecedented flooding and destruction in its wake in Southeast Texas. Many YMCAs in the region sustained significant damage and are without power. Ys that are operational have become safe havens for the stranded and homeless&mdash;a place where families and individuals alike can find electricity, a hot shower and a comforting environment.
<br /><br /><b>Please, if you are able, consider making a donation right now to support the Y&#8217;s Hurricane Harvey Relief Fund</b>. Every dollar we raise will go directly to YMCAs serving the communities in Texas hit hardest by this historic and devastating storm&#8212;and those Ys are working around the clock to reopen so they can do the same.</span>
</div>

<div class="donation-levels">

<div class="donation-level-container">
<div class="form-content">

<div class="donation-level-input-container form-input">

<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded4268"
value="4268"


onclick="evalMatchingGift('');"
/>
</div>

<label for="level_standardexpanded4268" onclick="">



<div class="donation-level-label-container">
$25
</div>


</label>





</div>

<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_4268expandedsubmit" value="true" /> 
</div>
</div>
<div class="donation-level-container">
<div class="form-content">

<div class="donation-level-input-container form-input">

<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded4269"
value="4269"


onclick="evalMatchingGift('');"
/>
</div>

<label for="level_standardexpanded4269" onclick="">



<div class="donation-level-label-container">
$75
</div>


</label>





</div>

<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_4269expandedsubmit" value="true" /> 
</div>
</div>
<div class="donation-level-container">
<div class="form-content">

<div class="donation-level-input-container form-input">

<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded4270"
value="4270"

checked="checked"
onclick="evalMatchingGift('');"
/>
</div>

<label for="level_standardexpanded4270" onclick="">



<div class="donation-level-label-container">
$100
</div>


</label>





</div>

<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_4270expandedsubmit" value="true" /> 
</div>
</div>
<div class="donation-level-container">
<div class="form-content">

<div class="donation-level-input-container form-input">

<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded4271"
value="4271"


onclick="evalMatchingGift('');"
/>
</div>

<label for="level_standardexpanded4271" onclick="">



<div class="donation-level-label-container">
$250
</div>


</label>





</div>

<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_4271expandedsubmit" value="true" /> 
</div>
</div>
<div class="donation-level-container">
<div class="form-content">

<div class="donation-level-input-container form-input">

<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded4272"
value="4272"


onclick="evalMatchingGift('');"
/>
</div>

<label for="level_standardexpanded4272" onclick="">



<div class="donation-level-label-container">
$500
</div>


</label>





</div>

<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_4272expandedsubmit" value="true" /> 
</div>
</div>
<div class="donation-level-container">
<div class="form-content">

<div class="donation-level-input-container form-input">

<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded4273"
value="4273"


onclick="evalMatchingGift('');"
/>
</div>

<label for="level_standardexpanded4273" onclick="">



<div class="donation-level-label-container">
$1,000
</div>


</label>





</div>

<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_4273expandedsubmit" value="true" /> 
</div>
</div>
<div class="donation-level-container">
<div class="form-content">

<div class="donation-level-input-container form-input">

<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded4274"
value="4274"


onclick="evalMatchingGift(document.getElementById('level_standardexpanded4274amount').value);"
/>
</div>

<label for="level_standardexpanded4274" onclick="">



<div class="donation-level-label-container">
Other $
</div>


</label>


<div class="donation-level-user-entered">
<label for="level_standardexpanded4274amount"><span class="aural-only">Enter amount</span></label>
<input type="text" name="level_standardexpanded4274amount" id="level_standardexpanded4274amount" value="" size="12"
onfocus="var el = document.getElementById ('level_standardexpanded4274');if (el) el.click(); fire_obs_comp_event('level_standardexpanded4274amount', this, event);evalMatchingGift(value); "
onchange="fire_obs_comp_event('level_standardexpanded4274amount', this, event);evalMatchingGift(value);"
onkeyup="fire_obs_comp_event('level_standardexpanded4274amount', this, event);evalMatchingGift(value);"/>
</div>



</div>

<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_4274expandedsubmit" value="true" /> 
</div>
</div>
</div>
</div>
<script type="text/javascript">
Y.use("jquery-ui", function(Y) {
jQuery(function(){
// subscribe observables
jQuery('div.donation-level-element-container').find('input[type="radio"]').each(function() {
var syncAction = function(obj) {
if (obj.is(':checked')) {
obj.closest('div.donation-level-container').addClass('selected');
}
else {
obj.closest('div.donation-level-container').removeClass('selected');
};
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('div.donation-level-container').removeClass('selected');
syncAction(jQuery(this));
});
});
});
});
</script><noscript>&nbsp;</noscript>
</div>

<div class="levels-gift-aid">

</div>
<input type="hidden" name="level_standardsubmit" id="level_standardsubmit" value="true" />
<script type="text/javascript">
function evalMatchingGift(gift) {

}
</script><noscript>&nbsp;</noscript>
</div>



<h2 class="section-header-container">

What is your payment information?

</h2>




<div id="billing_first_name_row" class="form-row form-text">

<div class="form-content">
<span class="field-required"></span>
<label for="billing_first_namename">First Name</label>

<input type="text" name="billing_first_namename" id="billing_first_namename"
value=""
maxlength="50"
 />

<input type="hidden" name="billing_first_namesubmit" id="billing_first_namesubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_first_name', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_first_name_row', _display);
this.disable_submit_flag (_hidden);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>



<div id="billing_last_name_row" class="form-row form-text">

<div class="form-content">
<span class="field-required"></span>
<label for="billing_last_namename">Last Name</label>

<input type="text" name="billing_last_namename" id="billing_last_namename"
value=""
maxlength="50"
 />

<input type="hidden" name="billing_last_namesubmit" id="billing_last_namesubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_last_name', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_last_name_row', _display);
this.disable_submit_flag (_hidden);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>



<div id="donor_email_address_row" class="form-row form-text">

<div class="form-content">
<span class="field-required"></span>
<label for="donor_email_addressname">Email Address</label>

<input type="text" name="donor_email_addressname" id="donor_email_addressname"
value=""
maxlength="255"
 />

<input type="hidden" name="donor_email_addresssubmit" id="donor_email_addresssubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('donor_email_address', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('donor_email_address_row', _display);
this.disable_submit_flag (_hidden);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>




<div id="donor_remember_me_row" class="form-row form-checkbox">

<div class="form-content">


<input type="checkbox" name="donor_remember_mename" id="donor_remember_mename"
checked="checked"
onclick="fire_obs_comp_event('donor_remember_me', this);" />
<label for="donor_remember_mename">Remember Me</label>
<input type="hidden" name="donor_remember_mesubmit" id="donor_remember_mesubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('donor_remember_me', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('donor_remember_me_row', _display);
this.disable_submit_flag (_hidden);
}
comp.set = function (_value)
{
if (document.getElementById('donor_remember_mename')) {
document.getElementById('donor_remember_mename').checked = _value;
this.fireEvent();
}
}
comp.get = function()
{
if (document.getElementById('donor_remember_mename')) {
return document.getElementById('donor_remember_mename').checked;
}
}
comp.clear = function()
{
this.set(false);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>




<div id="billing_addr_street1_row" class="form-row form-text">

<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_street1name">Street 1</label>

<input type="text" name="billing_addr_street1name" id="billing_addr_street1name"
value=""
maxlength="50"
 />

<input type="hidden" name="billing_addr_street1submit" id="billing_addr_street1submit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_addr_street1', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_street1_row', _display);
this.disable_submit_flag (_hidden);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>




<div id="billing_addr_street2_row" class="form-row form-text">

<div class="form-content">

<label for="billing_addr_street2name">Street 2</label>

<input type="text" name="billing_addr_street2name" id="billing_addr_street2name"
value=""
maxlength="50"
 />

<input type="hidden" name="billing_addr_street2submit" id="billing_addr_street2submit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_addr_street2', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_street2_row', _display);
this.disable_submit_flag (_hidden);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>




<div id="billing_addr_city_row" class="form-row form-text">

<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_cityname">City</label>

<input type="text" name="billing_addr_cityname" id="billing_addr_cityname"
value=""
maxlength="50"
 />

<input type="hidden" name="billing_addr_citysubmit" id="billing_addr_citysubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_addr_city', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_city_row', _display);
this.disable_submit_flag (_hidden);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>




<div id="billing_addr_state_row" class="form-row form-selectlist">

<div class="form-content">
<span class="field-required"></span>
<label class="FormLabel" for="billing_addr_state">State/Province</label>
<select name="billing_addr_state" id="billing_addr_state" size="1" 
 onchange="fire_obs_comp_event('billing_addr_state', this)">
<option ></option>
<option value="AK" >AK - Alaska</option>
<option value="AL" >AL - Alabama</option>
<option value="AR" >AR - Arkansas</option>
<option value="AZ" >AZ - Arizona</option>
<option value="CA" >CA - California</option>
<option value="CO" >CO - Colorado</option>
<option value="CT" >CT - Connecticut</option>
<option value="DC" >DC - District of Columbia</option>
<option value="DE" >DE - Delaware</option>
<option value="FL" >FL - Florida</option>
<option value="GA" >GA - Georgia</option>
<option value="HI" >HI - Hawaii</option>
<option value="IA" >IA - Iowa</option>
<option value="ID" >ID - Idaho</option>
<option value="IL" >IL - Illinois</option>
<option value="IN" >IN - Indiana</option>
<option value="KS" >KS - Kansas</option>
<option value="KY" >KY - Kentucky</option>
<option value="LA" >LA - Louisiana</option>
<option value="MA" >MA - Massachusetts</option>
<option value="MD" >MD - Maryland</option>
<option value="ME" >ME - Maine</option>
<option value="MI" >MI - Michigan</option>
<option value="MN" >MN - Minnesota</option>
<option value="MO" >MO - Missouri</option>
<option value="MS" >MS - Mississippi</option>
<option value="MT" >MT - Montana</option>
<option value="NC" >NC - North Carolina</option>
<option value="ND" >ND - North Dakota</option>
<option value="NE" >NE - Nebraska</option>
<option value="NH" >NH - New Hampshire</option>
<option value="NJ" >NJ - New Jersey</option>
<option value="NM" >NM - New Mexico</option>
<option value="NV" >NV - Nevada</option>
<option value="NY" >NY - New York</option>
<option value="OH" >OH - Ohio</option>
<option value="OK" >OK - Oklahoma</option>
<option value="OR" >OR - Oregon</option>
<option value="PA" >PA - Pennsylvania</option>
<option value="RI" >RI - Rhode Island</option>
<option value="SC" >SC - South Carolina</option>
<option value="SD" >SD - South Dakota</option>
<option value="TN" >TN - Tennessee</option>
<option value="TX" >TX - Texas</option>
<option value="UT" >UT - Utah</option>
<option value="VA" >VA - Virginia</option>
<option value="VT" >VT - Vermont</option>
<option value="WA" >WA - Washington</option>
<option value="WI" >WI - Wisconsin</option>
<option value="WV" >WV - West Virginia</option>
<option value="WY" >WY - Wyoming</option>
<option value="AS" >AS - American Samoa</option>
<option value="FM" >FM - Federated States of Micronesia</option>
<option value="GU" >GU - Guam</option>
<option value="MH" >MH - Marshall Islands</option>
<option value="MP" >MP - Northern Mariana Islands</option>
<option value="PR" >PR - Puerto Rico</option>
<option value="PW" >PW - Palau</option>
<option value="VI" >VI - Virgin Islands</option>
<option value="AA" >AA - Armed Forces Americas</option>
<option value="AE" >AE - Armed Forces</option>
<option value="AP" >AP - Armed Forces Pacific</option>
<option value="AB" >AB - Alberta</option>
<option value="BC" >BC - British Columbia</option>
<option value="MB" >MB - Manitoba</option>
<option value="NB" >NB - New Brunswick</option>
<option value="NL" >NL - Newfoundland and Labrador</option>
<option value="NS" >NS - Nova Scotia</option>
<option value="NT" >NT - Northwest Territories</option>
<option value="NU" >NU - Nunavut</option>
<option value="ON" >ON - Ontario</option>
<option value="PE" >PE - Prince Edward Island</option>
<option value="QC" >QC - Quebec</option>
<option value="SK" >SK - Saskatchewan</option>
<option value="YT" >YT - Yukon</option>
<option selected="selected" value="None" >None</option>

</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_addr_state', '');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_state_Row', _display);
this.disable_submit_flag (_hidden);
} 
//-->
</script>
<noscript><br/>Required</noscript>

<input type="hidden" name="billing_addr_statesubmit" id="billing_addr_statesubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_addr_state', '');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_state_row', _display);
this.disable_submit_flag (_hidden);
}


function billing_addr_state_listChanged(_evt)
{
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_addr_state', src);
}
}
var el = document.getElementById('billing_addr_state');
if (el) {
Utils.addEvent (el, 'change', billing_addr_state_listChanged);
}
</script><noscript>&nbsp;</noscript>
</div>
</div>





<div id="billing_addr_zip_row" class="form-row form-text">

<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_zipname">ZIP/Postal Code</label>

<input type="text" name="billing_addr_zipname" id="billing_addr_zipname"
value=""
maxlength="50"
 />

<input type="hidden" name="billing_addr_zipsubmit" id="billing_addr_zipsubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_addr_zip', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_zip_row', _display);
this.disable_submit_flag (_hidden);
}


</script><noscript>&nbsp;</noscript>
</div>
</div>




<div id="billing_addr_country_row" class="form-row form-selectlist">

<div class="form-content">

<label class="FormLabel" for="billing_addr_country">Country</label>
<select name="billing_addr_country" id="billing_addr_country" size="1" 
 onchange="fire_obs_comp_event('billing_addr_country', this)">
<option ></option>
<option selected="selected" value="United States" >United States</option>
<option value="Afghanistan" >Afghanistan</option>
<option value="Aland Islands" >Aland Islands</option>
<option value="Albania" >Albania</option>
<option value="Algeria" >Algeria</option>
<option value="American Samoa" >American Samoa</option>
<option value="Andorra" >Andorra</option>
<option value="Angola" >Angola</option>
<option value="Anguilla" >Anguilla</option>
<option value="Antarctica" >Antarctica</option>
<option value="Antigua and Barbuda" >Antigua and Barbuda</option>
<option value="Argentina" >Argentina</option>
<option value="Armenia" >Armenia</option>
<option value="Aruba" >Aruba</option>
<option value="Australia" >Australia</option>
<option value="Austria" >Austria</option>
<option value="Azerbaijan" >Azerbaijan</option>
<option value="Bahamas" >Bahamas</option>
<option value="Bahrain" >Bahrain</option>
<option value="Bangladesh" >Bangladesh</option>
<option value="Barbados" >Barbados</option>
<option value="Belarus" >Belarus</option>
<option value="Belgium" >Belgium</option>
<option value="Belize" >Belize</option>
<option value="Benin" >Benin</option>
<option value="Bermuda" >Bermuda</option>
<option value="Bhutan" >Bhutan</option>
<option value="Bolivarian Republic of Venezuela" >Bolivarian Republic of Venezuela</option>
<option value="Bonaire, Sint Eustatios and Saba" >Bonaire, Sint Eustatios and Saba</option>
<option value="Bosnia and Herzegovina" >Bosnia and Herzegovina</option>
<option value="Botswana" >Botswana</option>
<option value="Bouvet Island" >Bouvet Island</option>
<option value="Brazil" >Brazil</option>
<option value="British Indian Ocean Territory" >British Indian Ocean Territory</option>
<option value="Brunei Darussalam" >Brunei Darussalam</option>
<option value="Bulgaria" >Bulgaria</option>
<option value="Burkina Faso" >Burkina Faso</option>
<option value="Burundi" >Burundi</option>
<option value="Cambodia" >Cambodia</option>
<option value="Cameroon" >Cameroon</option>
<option value="Canada" >Canada</option>
<option value="Cape Verde" >Cape Verde</option>
<option value="Cayman Islands" >Cayman Islands</option>
<option value="Central African Republic" >Central African Republic</option>
<option value="Chad" >Chad</option>
<option value="Chile" >Chile</option>
<option value="China" >China</option>
<option value="Christmas Island" >Christmas Island</option>
<option value="Cocos (Keeling) Islands" >Cocos (Keeling) Islands</option>
<option value="Colombia" >Colombia</option>
<option value="Comoros" >Comoros</option>
<option value="Congo" >Congo</option>
<option value="Cook Islands" >Cook Islands</option>
<option value="Costa Rica" >Costa Rica</option>
<option value="Cote D'Ivoire" >Cote D'Ivoire</option>
<option value="Croatia" >Croatia</option>
<option value="Cuba" >Cuba</option>
<option value="Curacao" >Curacao</option>
<option value="Cyprus" >Cyprus</option>
<option value="Czech Republic" >Czech Republic</option>
<option value="Democratic People's Republic of Korea" >Democratic People's Republic of Korea</option>
<option value="The Democratic Republic of the Congo" >The Democratic Republic of the Congo</option>
<option value="Denmark" >Denmark</option>
<option value="Djibouti" >Djibouti</option>
<option value="Dominica" >Dominica</option>
<option value="Dominican Republic" >Dominican Republic</option>
<option value="Ecuador" >Ecuador</option>
<option value="Egypt" >Egypt</option>
<option value="El Salvador" >El Salvador</option>
<option value="Equatorial Guinea" >Equatorial Guinea</option>
<option value="Eritrea" >Eritrea</option>
<option value="Estonia" >Estonia</option>
<option value="Ethiopia" >Ethiopia</option>
<option value="Falkland Islands (Malvinas)" >Falkland Islands (Malvinas)</option>
<option value="Faroe Islands" >Faroe Islands</option>
<option value="Federated States of Micronesia" >Federated States of Micronesia</option>
<option value="Fiji" >Fiji</option>
<option value="Finland" >Finland</option>
<option value="The Former Yugoslav Republic of Macedonia" >The Former Yugoslav Republic of Macedonia</option>
<option value="France" >France</option>
<option value="French Guiana" >French Guiana</option>
<option value="French Polynesia" >French Polynesia</option>
<option value="French Southern Territories" >French Southern Territories</option>
<option value="Gabon" >Gabon</option>
<option value="Gambia" >Gambia</option>
<option value="Georgia" >Georgia</option>
<option value="Germany" >Germany</option>
<option value="Ghana" >Ghana</option>
<option value="Gibraltar" >Gibraltar</option>
<option value="Greece" >Greece</option>
<option value="Greenland" >Greenland</option>
<option value="Grenada" >Grenada</option>
<option value="Guadeloupe" >Guadeloupe</option>
<option value="Guam" >Guam</option>
<option value="Guatemala" >Guatemala</option>
<option value="Guernsey" >Guernsey</option>
<option value="Guinea" >Guinea</option>
<option value="Guinea-Bissau" >Guinea-Bissau</option>
<option value="Guyana" >Guyana</option>
<option value="Haiti" >Haiti</option>
<option value="Heard Island and McDonald Islands" >Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)" >Holy See (Vatican City State)</option>
<option value="Honduras" >Honduras</option>
<option value="Hong Kong" >Hong Kong</option>
<option value="Hungary" >Hungary</option>
<option value="Iceland" >Iceland</option>
<option value="India" >India</option>
<option value="Indonesia" >Indonesia</option>
<option value="Iraq" >Iraq</option>
<option value="Ireland" >Ireland</option>
<option value="Islamic Republic of Iran" >Islamic Republic of Iran</option>
<option value="Isle of Man" >Isle of Man</option>
<option value="Israel" >Israel</option>
<option value="Italy" >Italy</option>
<option value="Jamaica" >Jamaica</option>
<option value="Japan" >Japan</option>
<option value="Jersey" >Jersey</option>
<option value="Jordan" >Jordan</option>
<option value="Kazakhstan" >Kazakhstan</option>
<option value="Kenya" >Kenya</option>
<option value="Kiribati" >Kiribati</option>
<option value="Kuwait" >Kuwait</option>
<option value="Kyrgyzstan" >Kyrgyzstan</option>
<option value="Lao People's Democratic Republic" >Lao People's Democratic Republic</option>
<option value="Latvia" >Latvia</option>
<option value="Lebanon" >Lebanon</option>
<option value="Lesotho" >Lesotho</option>
<option value="Liberia" >Liberia</option>
<option value="Libya" >Libya</option>
<option value="Liechtenstein" >Liechtenstein</option>
<option value="Lithuania" >Lithuania</option>
<option value="Luxembourg" >Luxembourg</option>
<option value="Macao" >Macao</option>
<option value="Madagascar" >Madagascar</option>
<option value="Malawi" >Malawi</option>
<option value="Malaysia" >Malaysia</option>
<option value="Maldives" >Maldives</option>
<option value="Mali" >Mali</option>
<option value="Malta" >Malta</option>
<option value="Marshall Islands" >Marshall Islands</option>
<option value="Martinique" >Martinique</option>
<option value="Mauritania" >Mauritania</option>
<option value="Mauritius" >Mauritius</option>
<option value="Mayotte" >Mayotte</option>
<option value="Mexico" >Mexico</option>
<option value="Monaco" >Monaco</option>
<option value="Mongolia" >Mongolia</option>
<option value="Montenegro" >Montenegro</option>
<option value="Montserrat" >Montserrat</option>
<option value="Morocco" >Morocco</option>
<option value="Mozambique" >Mozambique</option>
<option value="Myanmar" >Myanmar</option>
<option value="Namibia" >Namibia</option>
<option value="Nauru" >Nauru</option>
<option value="Nepal" >Nepal</option>
<option value="Netherlands" >Netherlands</option>
<option value="New Caledonia" >New Caledonia</option>
<option value="New Zealand" >New Zealand</option>
<option value="Nicaragua" >Nicaragua</option>
<option value="Niger" >Niger</option>
<option value="Nigeria" >Nigeria</option>
<option value="Niue" >Niue</option>
<option value="Norfolk Island" >Norfolk Island</option>
<option value="Northern Mariana Islands" >Northern Mariana Islands</option>
<option value="Norway" >Norway</option>
<option value="Oman" >Oman</option>
<option value="Pakistan" >Pakistan</option>
<option value="Palau" >Palau</option>
<option value="Palestinian Territory, Occupied" >Palestinian Territory, Occupied</option>
<option value="Panama" >Panama</option>
<option value="Papua New Guinea" >Papua New Guinea</option>
<option value="Paraguay" >Paraguay</option>
<option value="Peru" >Peru</option>
<option value="Philippines" >Philippines</option>
<option value="Pitcairn" >Pitcairn</option>
<option value="Plurinational State of Bolivia" >Plurinational State of Bolivia</option>
<option value="Poland" >Poland</option>
<option value="Portugal" >Portugal</option>
<option value="Puerto Rico" >Puerto Rico</option>
<option value="Qatar" >Qatar</option>
<option value="Republic of Korea" >Republic of Korea</option>
<option value="Republic of Moldova" >Republic of Moldova</option>
<option value="Reunion" >Reunion</option>
<option value="Romania" >Romania</option>
<option value="Russian Federation" >Russian Federation</option>
<option value="Rwanda" >Rwanda</option>
<option value="Saint Barthelemy" >Saint Barthelemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha" >Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis" >Saint Kitts and Nevis</option>
<option value="Saint Lucia" >Saint Lucia</option>
<option value="Saint Martin (French)" >Saint Martin (French)</option>
<option value="Saint Pierre and Miquelon" >Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines" >Saint Vincent and the Grenadines</option>
<option value="Samoa" >Samoa</option>
<option value="San Marino" >San Marino</option>
<option value="Sao Tome and Principe" >Sao Tome and Principe</option>
<option value="Saudi Arabia" >Saudi Arabia</option>
<option value="Senegal" >Senegal</option>
<option value="Serbia" >Serbia</option>
<option value="Seychelles" >Seychelles</option>
<option value="S. Georgia &amp; S. Sandwich Isls." >S. Georgia &amp; S. Sandwich Isls.</option>
<option value="Sierra Leone" >Sierra Leone</option>
<option value="Singapore" >Singapore</option>
<option value="Sint Maarten (Dutch)" >Sint Maarten (Dutch)</option>
<option value="Slovakia" >Slovakia</option>
<option value="Slovenia" >Slovenia</option>
<option value="Solomon Islands" >Solomon Islands</option>
<option value="Somalia" >Somalia</option>
<option value="South Africa" >South Africa</option>
<option value="South Sudan" >South Sudan</option>
<option value="Spain" >Spain</option>
<option value="Sri Lanka" >Sri Lanka</option>
<option value="Sudan" >Sudan</option>
<option value="Suriname" >Suriname</option>
<option value="Svalbard and Jan Mayen" >Svalbard and Jan Mayen</option>
<option value="Swaziland" >Swaziland</option>
<option value="Sweden" >Sweden</option>
<option value="Switzerland" >Switzerland</option>
<option value="Syrian Arab Republic" >Syrian Arab Republic</option>
<option value="Taiwan, Province of China" >Taiwan, Province of China</option>
<option value="Tajikistan" >Tajikistan</option>
<option value="Thailand" >Thailand</option>
<option value="Timor-Leste" >Timor-Leste</option>
<option value="Togo" >Togo</option>
<option value="Tokelau" >Tokelau</option>
<option value="Tonga" >Tonga</option>
<option value="Trinidad and Tobago" >Trinidad and Tobago</option>
<option value="Tunisia" >Tunisia</option>
<option value="Turkey" >Turkey</option>
<option value="Turkmenistan" >Turkmenistan</option>
<option value="Turks and Caicos Islands" >Turks and Caicos Islands</option>
<option value="Tuvalu" >Tuvalu</option>
<option value="Uganda" >Uganda</option>
<option value="Ukraine" >Ukraine</option>
<option value="United Arab Emirates" >United Arab Emirates</option>
<option value="United Kingdom" >United Kingdom</option>
<option value="United Republic of Tanzania" >United Republic of Tanzania</option>
<option value="Uruguay" >Uruguay</option>
<option value="USA Minor Outlying Islands" >USA Minor Outlying Islands</option>
<option value="Uzbekistan" >Uzbekistan</option>
<option value="Vanuatu" >Vanuatu</option>
<option value="Viet Nam" >Viet Nam</option>
<option value="Virgin Islands (British)" >Virgin Islands (British)</option>
<option value="Virgin Islands (USA)" >Virgin Islands (USA)</option>
<option value="Wallis and Futuna" >Wallis and Futuna</option>
<option value="Western Sahara" >Western Sahara</option>
<option value="Yemen" >Yemen</option>
<option value="Zambia" >Zambia</option>
<option value="Zimbabwe" >Zimbabwe</option>

</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_addr_country', '');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_country_Row', _display);
this.disable_submit_flag (_hidden);
} 
//-->
</script>
<noscript><br/>Required</noscript>

<input type="hidden" name="billing_addr_countrysubmit" id="billing_addr_countrysubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('billing_addr_country', '');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('billing_addr_country_row', _display);
this.disable_submit_flag (_hidden);
}


function billing_addr_country_listChanged(_evt)
{
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_addr_country', src);
}
}
var el = document.getElementById('billing_addr_country');
if (el) {
Utils.addEvent (el, 'change', billing_addr_country_listChanged);
}
</script><noscript>&nbsp;</noscript>
</div>
</div>






<div class="payment-type-element-container">


<div id="payment_cc_container" class="payment-field-container">
<h3>Credit Card Information:</h3>
<div id="responsive_payment_typecc_type_row" class="form-row form-radio-array">

<div class="form-content">
<fieldset>
<legend>Credit Card Type:</legend>
<ul class="radio-array-list">
<li class="tender-row ">
<img src="../images/visa_small.gif" alt="Visa" name="responsive_payment_typecc_type_Visa" id="responsive_payment_typecc_type_Visa" />
</li><li class="tender-row ">
<img src="../images/discovercard_sm.gif" alt="Discover" name="responsive_payment_typecc_type_Discover" id="responsive_payment_typecc_type_Discover" />
</li><li class="tender-row ">
<img src="../images/amex_small.gif" alt="American Express" name="responsive_payment_typecc_type_American_Express" id="responsive_payment_typecc_type_American_Express" />
</li><li class="tender-row ">
<img src="../images/mastercd_small.gif" alt="MasterCard" name="responsive_payment_typecc_type_MasterCard" id="responsive_payment_typecc_type_MasterCard" />
</li>
</ul>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_typesubmit" id="responsive_payment_typecc_typesubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableRadioComponent ('responsive_payment_typecc_type', 'name');
comp.hide = function(_hidden)
{ 
var _display = _hidden ? 'none' : '';
set_display ('responsive_payment_typecc_type_row', _display);
this.disable_submit_flag (_hidden);
}
</script><noscript>&nbsp;</noscript>
</div>
</div>
<div id="responsive_payment_typecc_number_row" class="form-row form-text">

<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_numbername">Credit Card Number:</label>

<input type="text" name="responsive_payment_typecc_numbername" id="responsive_payment_typecc_numbername"
value=""
maxlength="22"
autocomplete="off" />

<input type="hidden" name="responsive_payment_typecc_numbersubmit" id="responsive_payment_typecc_numbersubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('responsive_payment_typecc_number', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('responsive_payment_typecc_number_row', _display);
this.disable_submit_flag (_hidden);
}


observe_component ('null', new ComponentDisplayer ('responsive_payment_typecc_number'));

</script><noscript>&nbsp;</noscript>
</div>
</div>
<div id="responsive_payment_typecc_exp_date_row" class="form-row form-date">

<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_exp_date_MONTH">
<span class="label-text">Expiration Date:</span><span class="aural-only">Select month of credit card</span>
</label>
<label for="responsive_payment_typecc_exp_date_YEAR" ><span class="aural-only">Select Expiration Year</span></label>
<div class="date-input-container">

<fieldset class="cardExpGroup">
<select name="responsive_payment_typecc_exp_date_MONTH" id="responsive_payment_typecc_exp_date_MONTH" onChange="fire_obs_comp_event('responsive_payment_typecc_exp_date_MONTH', this)">
<option value="1" >01</option>
<option value="2" selected="selected">02</option>
<option value="3" >03</option>
<option value="4" >04</option>
<option value="5" >05</option>
<option value="6" >06</option>
<option value="7" >07</option>
<option value="8" >08</option>
<option value="9" >09</option>
<option value="10" >10</option>
<option value="11" >11</option>
<option value="12" >12</option>
</select>
<select name="responsive_payment_typecc_exp_date_YEAR" id="responsive_payment_typecc_exp_date_YEAR" onChange="fire_obs_comp_event('responsive_payment_typecc_exp_date_YEAR', this)">
<option value="2018" selected="selected">2018</option>
<option value="2019" >2019</option>
<option value="2020" >2020</option>
<option value="2021" >2021</option>
<option value="2022" >2022</option>
<option value="2023" >2023</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>

</select>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_exp_date_DAY" id="responsive_payment_typecc_exp_date_DAY" value="1" />
<script type="text/javascript">
<!--
var comp1 = new ObservableComponent ('responsive_payment_typecc_exp_date_MONTH', '');
comp1.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display ('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag (_hidden);
}
var comp2 = new ObservableComponent ('responsive_payment_typecc_exp_date_YEAR', '');
comp2.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display ('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag (_hidden); 
}
//--> 
</script><noscript>&nbsp;</noscript>
</div>
<input type="hidden" name="responsive_payment_typecc_exp_datesubmit" id="responsive_payment_typecc_exp_datesubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('responsive_payment_typecc_exp_date', 'input');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('responsive_payment_typecc_exp_date_row', _display);
disable_submit_flag ('responsive_payment_typecc_exp_datesubmit', _hidden);
}
comp.disable = function(_disabled)
{
disable_element ('responsive_payment_typecc_exp_date_MONTH', _disabled);
disable_element ('responsive_payment_typecc_exp_date_DAY', _disabled);
disable_element ('responsive_payment_typecc_exp_date_YEAR', _disabled);
disable_element ('responsive_payment_typecc_exp_date_HOUR12',_disabled);
disable_element ('responsive_payment_typecc_exp_date_HOUR24',_disabled); //For UK, 24 hour clock used
disable_element ('responsive_payment_typecc_exp_date_MINUTE',_disabled);
disable_element ('responsive_payment_typecc_exp_date_AMPM', _disabled);
}

</script><noscript>&nbsp;</noscript>
</div>
</div>

<div id="responsive_payment_typecc_cvv_row" class="form-row form-text cvv-input">

<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_cvvname">
<span class="FormLabelText">CVV Number:</span>
</label>
<a href="http://help.convio.net/site/PageServer?s_site=ymca&pagename=user_donation_cvv" class="HelpLink"
title="What is this? Opens new window.">What is this?</a>
<input type="text" name="responsive_payment_typecc_cvvname" id="responsive_payment_typecc_cvvname"
value=""
maxlength="4"
autocomplete="off" />
<input type="hidden" name="responsive_payment_typecc_cvvsubmit" id="responsive_payment_typecc_cvvsubmit" value="true" />
<script type="text/javascript">
var comp = new ObservableComponent ('responsive_payment_typecc_cvv', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('responsive_payment_typecc_cvv_row', _display);
this.disable_submit_flag (_hidden);
}

</script><noscript>&nbsp;</noscript>
</div>
</div>

</div>



<input type="hidden" name="responsive_payment_typesubmit" id="responsive_payment_typesubmit" value="true" />
<script type="text/javascript">
function PaymentObserver()
{
this.observe = function(_event)
{
var sVal = _event.component.get();
switch (sVal)
{
case 'check':
hide_element('payment_cc_container');
hide_element('payment_bank_container');
show_element('payment_check_container');
break;
case 'credit':
hide_element('payment_bank_container');
hide_element('payment_check_container');
show_element('payment_cc_container');
break;
case 'ach':
hide_element('payment_cc_container');
hide_element('payment_check_container');
show_element('payment_bank_container');
break;
case 'paypal':
case 'amazon':
default:
// hide all
hide_element('payment_bank_container');
hide_element('payment_cc_container');
hide_element('payment_check_container');
break;
}
}
}
// Set the observer to show/hide the relevant fields
observe_component ('responsive_payment_typepay_typeradio', new PaymentObserver());
</script><noscript>&nbsp;</noscript>
</div>




<div class="button-container clearfix">
<div class="button-sub-container">

<button class="step-button action-button finish-step" type="submit" id="pstep_finish" name="pstep_finish" value="Donate">Donate</button>




</div>
</div>
<input type="hidden" name="idb" id="idb" value="159521172" />
<input type="hidden" name="df_id" id="df_id" value="2736" />
<input type="hidden" name="mfc_pref" id="mfc_pref" value="T" />



<div class="form-row">
<div class="html-caption-container">
<p>By making your generous gift you'll receive periodic updates about how your support makes a difference in our work to help everyone have the opportunity to learn, grow and thrive. <a style="color: #b2b2b2;" href="http://www.ymca.net/privacy-policy/index.html">You can see our privacy policy here.</a><br /><br />
Your gift will be allocated to the YMCA closest to your billing address or closest to the ZIP code you provided for gifts to a specific community.</p>
</div>
</div>




<div class="form-row form-checkbox" id="donor_email_opt_in_Row">

<div class="form-content">

<span class="check-box-form-label-text"></span>


<input type="hidden" name="donor_email_opt_inname" id="donor_email_opt_inname" value="implicit" />
<span class="auto-opt-in-warning-message">If you donate and have not already registered, you will receive periodic updates and communications from YMCA.</span>


<script type="text/javascript">
var comp = new ObservableComponent ('donor_email_opt_in', 'name');
comp.hide = function(_hidden)
{
var _display = _hidden ? 'none' : '';
set_display ('donor_email_opt_in_Row', _display);
this.disable_submit_flag (_hidden);
}
comp.set = function (_value)
{
if (document.getElementById('donor_email_opt_inname')) {
document.getElementById('donor_email_opt_inname').checked = _value;
this.fireEvent();
}
}
comp.get = function()
{
if (document.getElementById('donor_email_opt_inname'))
return document.getElementById('donor_email_opt_inname').checked;
}
comp.clear = function()
{
this.set(false);
}

 
</script><noscript>&nbsp;</noscript>
<input type="hidden" name="donor_email_opt_insubmit" id="donor_email_opt_insubmit" value="true" />
</div>
</div>




</div>
 
<input type="hidden" name="2736.donation" id="2736.donation" value="form1" />
 
</div>
<script type="text/javascript">
function deny_submit()
{
alert ('Form submission is not enabled when previewing an individual data element.');
return false;
}
</script><noscript>&nbsp;</noscript>

</form>





    
    </p>
<!-- df_id: 2736 -->
<p>
    <style>
input[type="text"] {
  height: 35px;
}

#billing_first_name_row, #billing_last_name_row, #donor_email_address_row, #billing_addr_street1_row, #billing_addr_street2_row, #billing_addr_city_row, #billing_addr_state_row, #billing_addr_zip_row, #billing_addr_country_row,#responsive_payment_typepay_typeradio_row, #responsive_payment_typecc_exp_date_row, #responsive_payment_typecc_cvv_row {
  float: left !important;
  margin: 0 !important;
}

#donor_email_address_row, #donor_email_address_row .form-content, input#donor_email_addressname {
  width: 95.4% !important;
}

#billing_addr_street1name, #billing_addr_street2name, #billing_addr_city_row, #billing_addr_cityname, #billing_addr_zip_row, #billing_addr_zipname, #billing_addr_country{
  width: 300px !important;
}

#billing_addr_zip_row{
  clear: left;
}

#ProcessForm select {
  border: 1px solid #d9d6cf;
  border-radius: 5px;
  color: #666666;
  height: 46px;
  margin: 4px 0 0 16px;
  width: 316px !important;
}

#responsive_payment_typepay_typeradio_row {
  clear: both;
  margin: 25px 0 !important;
  width: 100%;
}

#responsive_payment_typecc_numbername, #responsive_payment_typecc_number_row .form-content {
  width: 97% !important;
}

select#responsive_payment_typecc_exp_date_MONTH, select#responsive_payment_typecc_exp_date_YEAR, #responsive_payment_typecc_cvv_row{
  width: 213px !important;
  margin: 0 15px 25px 0;
}

#responsive_payment_typecc_cvv_row .form-content {
  width: 175px;
}

#responsive_payment_typecc_cvvname {
  width: 100% !important;
  margin: 0;
}

#responsive_payment_typecc_cvv_row {
  padding: 0;
}

#responsive_payment_typecc_cvv_row .HelpLink {
  display: none;
}

.section-header-container {
  float: left;
  margin: 20px 0 40px !important;
  width: 100%;
}

.button-container {
  text-align: center;
}

#pstep_finish {
  float:none;
  margin: 30px 60px;
  min-width: 160px;
  min-height: 60px;
  max-width:200px;
}

h2.section-header-container {
  padding: 0 15px;
}

.paypal-match {
  display: inline-block;
  margin: 20px 0 -20px 7px;
}

div.responsive div.ErrorMessage.page-error > span.field-error-text {
  width: 95%;
}

div.responsive div.form-error {
  border: medium none;
  border-radius: 0;
  background-color: transparent;
}

.donation-form-content .ErrorMessage {
  color: #990000;
  font-size: 1em;
  margin: -8px 0 0;
  position: absolute;
}

#responsive_payment_typecc_number_row,#responsive_payment_typecc_type_row {
  clear: both;
}

.ty-body {
  padding: 0 4%;
  width: 92% !important;
}

.donation-form-content p:last-child {
  padding: 0 15px;
}

/** MEDIA QUERIES **/
@media all and (max-width: 830px) {

div.form-row:not(.custom-field-container):not(:first-of-type), div.payment-type-selection-container.payment-field-container {
  padding: 0 15px !important;
}

#donor_email_address_row, #donor_email_address_row .form-content, input#donor_email_addressname {
  width: 94.4% !important;
}

.donation-level-container {
  float: left;
}
}

@media all and (max-width: 820px) {

#billing_first_name_row, #billing_last_name_row, #donor_email_address_row, #billing_addr_street1_row, #billing_addr_street2_row, #billing_addr_city_row, #billing_addr_state_row, #billing_addr_zip_row, #billing_addr_country_row, #responsive_payment_typepay_typeradio_row, #responsive_payment_typecc_exp_date_row, #responsive_payment_typecc_cvv_row {
  padding: 0 3% !important;
  width: 94% !important;
}

#billing_last_name_row .form-content, #billing_first_name_row .form-content, #billing_first_namename, #billing_last_namename, #billing_addr_street1_row .form-content, #billing_addr_street2_row .form-content, #billing_addr_city_row .form-content, #billing_addr_state_row .form-content, #billing_addr_zip_row .form-content, #billing_addr_country_row .form-content {
  width: 94.4% !important;
}

 #billing_addr_cityname,#billing_addr_zipname {
  width: 100% !important;
}
select#billing_addr_state {
  margin: 0;
  width: 102% !important;
}
select#billing_addr_country {
  margin: 0 !important;
  width: 96% !important;
}
}

@media all and (max-width: 610px) {

.donation-level-container {
  float: left;
  margin: 0 1% 0 0 !important;
  width: 48%;
}
.donation-levels .form-content, .donation-level-input-container label {
  width: 100% !important;
}
.donation-level-input-container label {
  text-align: center;
}
div.donation-level-input-container, div.generic-repeat-label-checkbox-container {
  width: 80%;
}
.donation-level-container:last-child, .donation-level-container:last-child .form-content,div.donation-level-container:last-of-type div.form-input {
  width: 100% !important;
}
.donation-level-container:last-child .form-content .donation-level-input-container .donation-level-user-entered {
  width: 48%;
}
.donation-level-container:last-child .form-content .donation-level-input-container label {
  float: left;
  margin: 0 6px 0 0;
  width: 38.6% !important;
}
.donation-level-container:last-child .form-content .donation-level-input-container .donation-level-user-entered input {
  width: 93% !important;
}
.donation-level-container:last-child {
  margin: 15px 0 0 0 !important;
}
input#community_zip_code_input, input#camp_zip_code_input, input#communityzipcodestring_input, input#campzipcodestring_input {
  position: static !important;
}
#ProcessForm div.button-container {
  margin-top: 0px !important;
}
}

@media all and (max-width: 600px) {
  .donation-level-container {
  margin: 0 5% 0 0 !important;
  width: 40%;
}
.donation-level-container:last-child .form-content .donation-level-input-container label {
  width: 24% !important;
}
}
</style>
<script>

$(document).ready(function() {

  
  $('.radio-button-container input').click(function() {

    var designationValue = $(this).val().replace(/ /g,'_').replace(/'/g, '');

    YUI().use('cookie', function(Y) {
        Y.Cookie.remove('giftDesignation');
        Y.Cookie.set('giftDesignation', designationValue);
    });

  });
  
var checked = false;
$('.donation-level-input-container input[type="radio"]').each(function() {
  $(this).parent().next('label').removeAttr('style');
  if($(this).is(':checked')) {
    $(this).parent().next('label').addClass('active');
    checked = true;
  }

});


var label = 'level_standardexpanded4274';

if(!checked) {
  $('label[for="' + label + '"]').addClass('active');
}


//State dropdown
$('#billing_addr_state option').each(function() {
  if($(this).val() == 'None') {
    $(this).text('State');
  }
});
});
</script>



<style type="text/css">
div.donation-form-container.responsive {
  width:768px !important;
  border-radius:0px !important;
  padding:0;
  border:0px !important;
  background:#ffffff
}
.section-header-container {
  border:0 !important;
}
div.don-standard-levels span.FormLabelText {
  display:none;
}
div#level_standard_row {
    margin-left: 0;
    margin-right: 0;
}
label[for=yusa_donation_designation_dropdown] {
  display: none;
}
div.donation-levels {
  display:flex;
}
div.form-row:first-of-type, div.form-row:nth-last-of-type(2), div.payment-type-element-container div.form-row {
    margin-left: 0px;
    margin-right: 0px;
}
h2.section-header-container, div.form-row, div.payment-type-element-container {
  margin-left:10px;
  margin-right:10px;
}
p.opt-in-message {
  font-size:80%;
  width:90%;
  margin-left:auto;
  margin-right:auto;
}
span.auto-opt-in-warning-message {
    display: none;
}

/*responsive*/
img.header-banner {
  max-width:100% !important;
  margin:0;
}
div.donation-form-container.responsive {
  max-width:100% !important;
}
@media screen and (max-width: 767px) {
  div#billing_last_name_row {
      float: left !important;
      margin-top: 0 !important;
  }
  input#billing_last_namename, input#billing_first_namename, input#donor_email_addressname {
    width: 100% !important;
  }
  #employer_street_row input, #billing_addr_street1_row input, #billing_addr_street2_row input, #billing_addr_street3_row input, #billing_addr_country_row input.ui-autocomplete-input, #donor_addr_street1_row input, #donor_addr_street2_row input, #donor_addr_street3_row input, #donor_addr_country_row input.ui-autocomplete-input, #shipping_addr_street1_row input, #shipping_addr_street2_row input, #shipping_addr_street3_row input, #shipping_addr_country_row input.ui-autocomplete-input, #tribute_notify_recip_street1_row input, #tribute_notify_recip_street2_row input, #tribute_notify_recip_street3_row input, #tribute_notify_recip_country_row input.ui-autocomplete-input, #tribute_signature_row input, #tribute_message_closing_row input, div.employer-address-container input#employer_street, div#billing_addr_country_row {
      width: 100% !important;
  }
  h2.section-header-container {
    font-size: 16px !important;
  }
  div.form-row:not(.custom-field-container):not(:first-of-type) {
    padding-right: 10px !important;
    padding-left: 10px !important;
  }
  div#level_standard_row {
    padding-right: 0 !important;
    padding-left: 0 !important;
  }
  div.donation-levels {
    display:block;
  }
  div.donation-level-container div.form-input, div.donation-level-container:last-of-type div.form-input {
    padding-top:5px !important;
    padding-bottom:5px !important;
  }
  div.donation-levels div.form-content {
    margin-top:0px;
    margin-bottom:0px;
  }
  div.custom-field-container fieldset div.radio-button-container:nth-child(2), div.custom-field-container fieldset div.radio-button-container:nth-child(3)  {
    left: 0 !important;
    top: 0 !important;
  }
  input#community_zip_code_input {
    top: -62px !important;
    left: 280px !important;
    }
  input#camp_zip_code_input {
    top: -70px !important;
    left: 280px !important;
    }
  input#communityzipcodestring_input {
    top: -62px !important;
    left: 280px !important;
    }
  input#campzipcodestring_input {
    top: -70px !important;
    left: 280px !important;
    }
    div.button-container {
      margin-top: 0 !important;
      margin-left:20px !important;
  }
}

/*fields*/
div.responsive span.field-required, div.form-text > div.form-content > label, div.form-selectlist > div.form-content > label, div.form-date > div.form-content > label, div.payment-field-container > h3, label[for="community_zip_code_input"], label[for="camp_zip_code_input"], label[for="communityzipcodestring_input"], label[for="campzipcodestring_input"], div.custom-field-container > div.form-content > div.form-input-label-block, 
label[for="level_standardexpanded4274amount"] {
    display: none !important;
}
div.donation-levels {
    margin-bottom: -30px;
}
select#billing_addr_state, select#billing_addr_country, select#responsive_payment_typecc_exp_date_MONTH, select#responsive_payment_typecc_exp_date_YEAR {
  font-size:initial;
}
div.form-row:not(.custom-field-container):not(:first-of-type), div.payment-type-selection-container.payment-field-container {
    padding-right: 20px;
    padding-left: 30px;
}
div#level_standard_row {
    padding-left: 0px;
    padding-right: 0px;
}
div#responsive_payment_typecc_type_row .radio-array-list {
    margin-left: 30px;
}


/*segmented buttons*/
.donation-level-input-container {
  padding: 0px;
}
.donation-level-input-container input[type="radio"] {
  width: 0px;
  height: 0px;
  display: none;
}
.donation-level-input-container label {
  display: -moz-inline-box;
  -moz-box-orient: vertical;
  display: inline-block;
  vertical-align: middle;
  *vertical-align: auto;
  -moz-border-radius: 4px;
  -webkit-border-radius: 4px;
  -o-border-radius: 4px;
  -ms-border-radius: 4px;
  -khtml-border-radius: 4px;
  border-radius: 4px;
  text-shadow: white;
  background: #ffffff;
  border: 1px solid #b2b2b2;
  color: #666666;
  padding: 5px 24px;
  padding-bottom: 3px;
  font-size: 12px;
  cursor: pointer;
  font-family: Helvetica;
  -moz-border-radius: 0px;
  -webkit-border-radius: 0px;
  -o-border-radius: 0px;
  -ms-border-radius: 0px;
  -khtml-border-radius: 0px;
  border-radius: 0px;
  margin-right: -10px;
}
.donation-level-input-container label {
  *display: inline;
}
.donation-level-input-container label:hover {
  -moz-box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
  -webkit-box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
  -o-box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
  box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
  color: #ffffff;
  background-color: #cccccc !important;
}
input#level_standardexpanded4274amount:hover, level_standardexpanded4274:checked + input#level_standardexpanded4274amount {
  -moz-box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
  -webkit-box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
  -o-box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
  box-shadow: 0 0 5px 1px rgba(0, 0, 0, 0.1);
}
.donation-level-input-container label:active, .donation-level-input-container label.active {
  background: #00aeef;
}
.donation-level-input-container label:disabled, .donation-level-input-container label.disabled {
  background: -webkit-gradient(linear, 50% 0%, 50% 100%, color-stop(0%, #ffffff), color-stop(100%, #efefef));
  background: -webkit-linear-gradient(#ffffff, #efefef);
  background: -moz-linear-gradient(#ffffff, #efefef);
  background: -o-linear-gradient(#ffffff, #efefef);
  background: -ms-linear-gradient(#ffffff, #efefef);
  background: linear-gradient(#ffffff, #efefef);
  cursor: default;
  color: #b2b2b2;
  border-color: #cccccc;
  -moz-box-shadow: none;
  -webkit-box-shadow: none;
  -o-box-shadow: none;
  box-shadow: none;
}
.donation-level-input-container label.first {
  -moz-border-radius-topleft: 4px;
  -webkit-border-top-left-radius: 4px;
  -o-border-top-left-radius: 4px;
  -ms-border-top-left-radius: 4px;
  -khtml-border-top-left-radius: 4px;
  border-top-left-radius: 4px;
  -moz-border-radius-bottomleft: 4px;
  -webkit-border-bottom-left-radius: 4px;
  -o-border-bottom-left-radius: 4px;
  -ms-border-bottom-left-radius: 4px;
  -khtml-border-bottom-left-radius: 4px;
  border-bottom-left-radius: 4px;
}
.donation-level-input-container label.last {
  -moz-border-radius-topright: 4px;
  -webkit-border-top-right-radius: 4px;
  -o-border-top-right-radius: 4px;
  -ms-border-top-right-radius: 4px;
  -khtml-border-top-right-radius: 4px;
  border-top-right-radius: 4px;
  -moz-border-radius-bottomright: 4px;
  -webkit-border-bottom-right-radius: 4px;
  -o-border-bottom-right-radius: 4px;
  -ms-border-bottom-right-radius: 4px;
  -khtml-border-bottom-right-radius: 4px;
  border-bottom-right-radius: 4px;
}
.donation-level-input-container input:checked ~ label[for="level_standardexpanded3403"], .donation-level-input-container label.selected {
  background: #00aeef;
}
.donation-level-input-container input:disabled + label {
  background: -webkit-gradient(linear, 50% 0%, 50% 100%, color-stop(0%, #ffffff), color-stop(100%, #efefef));
  background: -webkit-linear-gradient(#ffffff, #efefef);
  background: -moz-linear-gradient(#ffffff, #efefef);
  background: -o-linear-gradient(#ffffff, #efefef);
  background: -ms-linear-gradient(#ffffff, #efefef);
  background: linear-gradient(#ffffff, #efefef);
  cursor: default;
  color: #b2b2b2;
  border-color: #cccccc;
  -moz-box-shadow: none;
  -webkit-box-shadow: none;
  -o-box-shadow: none;
  box-shadow: none;
}
div.donation-level-user-entered {
  margin-top:0px;
}
input#level_standardexpanded4274amount {
    border-radius: 0px;
    height: 30px;
    width:92px;
}
div.donation-level-container:last-of-type div.form-input {
    width: 216px;
    padding-top:26px;
}
label[for="level_standardexpanded4274"] {
    float: left;
    margin-left: 5px;
}
label+div.donation-level-user-entered {
    margin-left: 0;
    display: inline-block;
}
@media screen and (-ms-high-contrast: active), (-ms-high-contrast: none) {
  div.donation-level-container:last-of-type div.form-input {
    padding-top:10px;
  }
}


/*name fields*/
div#billing_last_name_row {
    float: right;
    margin-top: -51px;
}
input#billing_last_namename, input#billing_first_namename, input#donor_email_addressname {
    width: 300px;
}

/*designation radio buttons*/
div.custom-field-container fieldset div.radio-button-container:nth-child(2) {
    position: relative;
    left: 190px;
    top: -19px;
}
div.custom-field-container fieldset div.radio-button-container:nth-child(3) {
    position: relative;
    left: 480px;
    top: -38px;
}
div.custom-field-container input[type="radio"] {
    margin-top: 1px;
}

/*designation text fields*/
input#community_zip_code_input {
    position: relative;
    top: -45px;
    left: 240px;
}
input#camp_zip_code_input {
    position: relative;
    top: -70px;
    left: 530px;
}
input#communityzipcodestring_input {
    position: relative;
    top: -45px;
    left: 240px;
}
input#campzipcodestring_input {
    position: relative;
    top: -70px;
    left: 530px;
}

/*button*/
div.button-container {
  border:0px;
}
h2.section-header-container {
  color:#00aeef;
  font-size:22px;
  font-weight:bold;
}
div.responsive a.next-step, div.responsive button.next-step, div.responsive button.finish-step {
  float:left;
  position:relative;
  z-index:10;
}
div.button-sub-container > button {
  font-size:18px;
  font-weight:normal;
  color:#ffffff !important;
  background-color:#c6168d !important;
  background-image:none !important;
  border:0px !important;
}
div.button-container {
  margin-top:0px;
  padding-top:0px;
}

/*fonts*/
h2.section-header-container {
  color:#00aeef;
  font-size:22px;
  font-weight:bold;
}
* {
  font-family: Verdana,Sans-Serif;
}
div.donation-level-input-container > label {
    font-size: 15px;
    padding-top: 10px;
    padding-bottom: 12px;
    font-family: Verdana,Sans-Serif;
}

fieldset .radio-button-container:nth-child(2),fieldset .radio-button-container:nth-child(3) {
  margin: 2px 0 0;
}

.html-caption-container p {
  padding: 0 !important;
}
</style>

<script>
$(document).ready(function() {
  $('#ProcessForm input[type="text"]').each(function(field) {
      var id = $(this).attr('id');
      var labelText = $('label[for="' + id + '"]').text().replace(':','');
      $(this).attr('placeholder', labelText);
  });

  $('.donation-level-user-entered input[type="text"]').removeAttr('placeholder');

  $('.donation-level-container label').click(function(){
    $('.donation-level-container label').each(function(){
      $(this).removeClass('active');
    });
    $(this).addClass('active');
    $('.donation-level-user-entered input[type="text"]').val('');
  });

  $('.donation-level-user-entered input[type="text"]').focus(function() {
    $('.donation-level-container label').each(function(){
      $(this).removeClass('active');
    });
    $('.donation-level-user-entered').prev().addClass('active');
  });

});
</script>


        
</p>
</body>
]]
</html>
