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<div class="container container-donation">
    <form id="js-donation-form" method="post" Class="col-md-6 col-md-offset-3 col-xs-12 page-holder" >
        
        <div Class="row page">
            <input data-val="true" data-val-required="The CampaignID field is required." id="CampaignID" name="CampaignID" type="hidden" value="48c3f8a0-5641-4c54-a2eb-6142edce43c8" />
            <input id="CampaignTinyID" name="CampaignTinyID" type="hidden" value="GaryGreene-Hurricane" />
            <input id="Header" name="Header" type="hidden" value="&lt;p>The Gary Greene Realtors Foundation is a 501(c)(3) public charity where we are collecting money to help Gary Greene agents and employees who have been affected by Hurricane Harvey and the devastating floods.&amp;nbsp;&lt;/p>
&lt;p>We are hearing so many stories from our agents and employees at Gary Greene who have been overwhelmed by this natural disaster. All proceeds will be used to help Gary Greene agents and employees who have been hit with flood waters.&amp;nbsp;&amp;nbsp; This will be ongoing for many days and months to come.&amp;nbsp; Many have lost everything, homes, cars, and clothing. Your donations will go so far to help them as they try to find a place to stay and people to work in their homes.&lt;/p>
&lt;p>You can make a donation by credit card through this secure website below.&amp;nbsp; All gifts are tax deductible to the extent allowed by law.&lt;/p>
&lt;p>Thank you so much in advance for your generosity and feel free to share this link with family, friends and colleagues who wish to contribute as well.&lt;/p>
&lt;p>Sincerely,&lt;/p>
&lt;p>Ann Woodroof&lt;/p>
&lt;p>Chairman&amp;nbsp;&lt;/p>
&lt;p>Gary Greene Realtors Foundation&lt;/p>
&lt;p>&amp;nbsp;&lt;/p>" />
            <input id="Title" name="Title" type="hidden" value="Hurricane Harvey" />
            <input id="AboutUs" name="AboutUs" type="hidden" value="&lt;p style=&quot;box-sizing: border-box; margin-bottom: 10px; color: #333333; font-family: AvenirLTStd-Book, sans-serif; font-size: 15px;&quot;>&lt;span style=&quot;box-sizing: border-box; font-size: medium;&quot;>The Gary Greene Foundation was founded in 1994 and works to bring meaningful change to communities and individuals through a diverse array of causes &amp;ndash; from research to fight cancer to education and social services to cultural, historical and civic institutions. Since the foundation&amp;rsquo;s inception, our agents and employees have been guided by the belief that everyone has a responsibility to give back and serve others by investing one&amp;rsquo;s talent and time to make a difference in the communities we serve.&lt;/span>&lt;/p>
&lt;div>&lt;span style=&quot;box-sizing: border-box; font-size: medium;&quot;>&lt;br />
&lt;/span>&lt;/div>
&lt;p>&amp;nbsp;&lt;/p>" />
            <input data-val="true" data-val-required="The OrganizationID field is required." id="OrganizationID" name="OrganizationID" type="hidden" value="6fac20e8-f468-4abd-b504-9ed35ed7bf1e" />
            <input id="OrganizationName" name="OrganizationName" type="hidden" value="GARY GREENE REALTORS FOUNDATION" />
            <input data-val="true" data-val-required="The HasCustomCSS field is required." id="HasCustomCSS" name="HasCustomCSS" type="hidden" value="True" />
            <input data-val="true" data-val-required="The HasBannerImage field is required." id="HasBannerImage" name="HasBannerImage" type="hidden" value="True" />
            <input data-val="true" data-val-required="The FundraisingID field is required." id="FundraisingID" name="FundraisingID" type="hidden" value="00000000-0000-0000-0000-000000000000" />
            <input id="DedicationOptionsString" name="DedicationOptionsString" type="hidden" value="" />
            <input id="DesignationOptionsJSON" name="DesignationOptionsJSON" type="hidden" value="[]" />
            <input data-val="true" data-val-required="The IsActive field is required." id="IsActive" name="IsActive" type="hidden" value="True" />
            <input id="NotifyEmail" name="NotifyEmail" type="hidden" value="hurricaneharvey@garygreene.com" />

            

            <div class="banner">
                <div class="row">
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            <div class="text-center">
                <h1 id="page-title" class="page-title">Hurricane Harvey</h1>
            </div>

            <div class="header">
<p>The Gary Greene Realtors Foundation is a 501(c)(3) public charity where we are collecting money to help Gary Greene agents and employees who have been affected by Hurricane Harvey and the devastating floods. </p>
<p>We are hearing so many stories from our agents and employees at Gary Greene who have been overwhelmed by this natural disaster. All proceeds will be used to help Gary Greene agents and employees who have been hit with flood waters.   This will be ongoing for many days and months to come.  Many have lost everything, homes, cars, and clothing. Your donations will go so far to help them as they try to find a place to stay and people to work in their homes.</p>
<p>You can make a donation by credit card through this secure website below.  All gifts are tax deductible to the extent allowed by law.</p>
<p>Thank you so much in advance for your generosity and feel free to share this link with family, friends and colleagues who wish to contribute as well.</p>
<p>Sincerely,</p>
<p>Ann Woodroof</p>
<p>Chairman </p>
<p>Gary Greene Realtors Foundation</p>
<p> </p>            </div>



            <div Class="col-md-12 section ">
                <div>
                    <ul class="nav nav-tabs" role="tablist">

                        <li role = "presentation" Class="active">
                            <a href = "#current" aria-controls="current" role="tab" data-toggle="tab">Current</a>
                        </li>

                        <li role = "presentation" >
                            <a href="#about" aria-controls="about" role="tab" data-toggle="tab">About Us</a>
                                                                    </li>

                        <li role = "presentation" >
                            <a href="#contributers" aria-controls="contributers" role="tab" data-toggle="tab">Top Contributors</a>
                                                                    </li>

                    </ul>

                    <div Class="tab-content">
                        <div role = "tabpanel" Class="tab-pane active" id="current">
                            <h3 Class="tab-title">Current Progress</h3>
                            <input id="Thermometer_CurrentDonation" name="Thermometer.CurrentDonation" type="hidden" value="51988.58" />
                            <input id="Thermometer_DonationGoal" name="Thermometer.DonationGoal" type="hidden" value="200000.00" />
                            <input id="Thermometer_Percentage" name="Thermometer.Percentage" type="hidden" value="26" />


                            <div class="raise-holder">
                               <span class="raised">$51988.58</span> of $200000.00 raised
                                <span class="pull-right">

                                 26%
                                </span>
                            </div>

                            <div class="progress" id="main-progress">
                                <div class="progress-bar" id="main-progress-bar" role="progressbar" style="width: 26%;" aria-valuenow="26" aria-valuemin="0" aria-valuemax="100" >
                                </div>
                            </div>

                        </div>

                        <div role="tabpanel" class="tab-pane" id="contributers">
                            <h3 class="tab-title">Top Contributors</h3>
                            
                            <div class="contributer-list">

                                <div class="top-contributer">
                                    <span class="contributer-place">
                                        1.
                                    </span>
                                    <span class="contributer-name">
                                        Michael
                                    </span>
                                    <span class="contributer-donation">
                                        $8,000.00
                                    </span>
                                    <input type="hidden" name="TopDonors[0].Name" value="Michael" />
                                    <input type="hidden" name="TopDonors[0].Donation" value="$8,000.00" />
                                </div>
                                <div class="top-contributer">
                                    <span class="contributer-place">
                                        2.
                                    </span>
                                    <span class="contributer-name">
                                        Sherry
                                    </span>
                                    <span class="contributer-donation">
                                        $5,145.08
                                    </span>
                                    <input type="hidden" name="TopDonors[1].Name" value="Sherry" />
                                    <input type="hidden" name="TopDonors[1].Donation" value="$5,145.08" />
                                </div>
                                <div class="top-contributer">
                                    <span class="contributer-place">
                                        3.
                                    </span>
                                    <span class="contributer-name">
                                        Alicia
                                    </span>
                                    <span class="contributer-donation">
                                        $5,000.00
                                    </span>
                                    <input type="hidden" name="TopDonors[2].Name" value="Alicia" />
                                    <input type="hidden" name="TopDonors[2].Donation" value="$5,000.00" />
                                </div>
                                <div class="top-contributer">
                                    <span class="contributer-place">
                                        4.
                                    </span>
                                    <span class="contributer-name">
                                        Michael
                                    </span>
                                    <span class="contributer-donation">
                                        $2,500.00
                                    </span>
                                    <input type="hidden" name="TopDonors[3].Name" value="Michael" />
                                    <input type="hidden" name="TopDonors[3].Donation" value="$2,500.00" />
                                </div>
                                <div class="top-contributer">
                                    <span class="contributer-place">
                                        5.
                                    </span>
                                    <span class="contributer-name">
                                        Alex
                                    </span>
                                    <span class="contributer-donation">
                                        $1,500.00
                                    </span>
                                    <input type="hidden" name="TopDonors[4].Name" value="Alex" />
                                    <input type="hidden" name="TopDonors[4].Donation" value="$1,500.00" />
                                </div>
                            </div>
                        </div>

                        <div role = "tabpanel" Class="tab-pane" id="about">
                            <h3 class="tab-title">About Us</h3>
                            
                            <p style="box-sizing: border-box; margin-bottom: 10px; color: #333333; font-family: AvenirLTStd-Book, sans-serif; font-size: 15px;"><span style="box-sizing: border-box; font-size: medium;">The Gary Greene Foundation was founded in 1994 and works to bring meaningful change to communities and individuals through a diverse array of causes – from research to fight cancer to education and social services to cultural, historical and civic institutions. Since the foundation’s inception, our agents and employees have been guided by the belief that everyone has a responsibility to give back and serve others by investing one’s talent and time to make a difference in the communities we serve.</span></p>
<div><span style="box-sizing: border-box; font-size: medium;"><br />
</span></div>
<p> </p>
                        </div>


                    </div>
                </div>
            </div>

            
            <div Class="col-md-12 section">
                <h2 class="section-title"> Your Donation</h2>
                (in US dollars)<br />
                    <input type="hidden" name="CustomDonationValues[0].Value" value="20"  />
                    <label Class="radio-inline radio-donation notranslate">
                        <input type="hidden" class="donation-checked" name="CustomDonationValues[0].IsChecked" value="False"  />
                        <input type="radio" class="donation-radio" value="20" name="donationCheck" />
                        $20
                    </label>
                    <input type="hidden" name="CustomDonationValues[1].Value" value="50"  />
                    <label Class="radio-inline radio-donation notranslate">
                        <input type="hidden" class="donation-checked" name="CustomDonationValues[1].IsChecked" value="False"  />
                        <input type="radio" class="donation-radio" value="50" name="donationCheck" />
                        $50
                    </label>
                    <input type="hidden" name="CustomDonationValues[2].Value" value="75"  />
                    <label Class="radio-inline radio-donation notranslate">
                        <input type="hidden" class="donation-checked" name="CustomDonationValues[2].IsChecked" value="False"  />
                        <input type="radio" class="donation-radio" value="75" name="donationCheck" />
                        $75
                    </label>
                    <input type="hidden" name="CustomDonationValues[3].Value" value="100"  />
                    <label Class="radio-inline radio-donation notranslate">
                        <input type="hidden" class="donation-checked" name="CustomDonationValues[3].IsChecked" value="False"  />
                        <input type="radio" class="donation-radio" value="100" name="donationCheck" />
                        $100
                    </label>
                    <input type="hidden" name="CustomDonationValues[4].Value" value="200"  />
                    <label Class="radio-inline radio-donation notranslate">
                        <input type="hidden" class="donation-checked" name="CustomDonationValues[4].IsChecked" value="False"  />
                        <input type="radio" class="donation-radio" value="200" name="donationCheck" />
                        $200
                    </label>
                    <input type="hidden" name="CustomDonationValues[5].Value" value="500"  />
                    <label Class="radio-inline radio-donation notranslate">
                        <input type="hidden" class="donation-checked" name="CustomDonationValues[5].IsChecked" value="False"  />
                        <input type="radio" class="donation-radio" value="500" name="donationCheck" />
                        $500
                    </label>

                <div class="form-inline">
                    <div class="radio">
                        <label class="radio-donation">


                            <input type="hidden" name="CustomDonationValues[6].Value" value="other"  />
                            <input type="hidden" class="donation-checked" name="CustomDonationValues[6].IsChecked" value="False" />

                            <input type="radio" class="donation-radio" value="other" name="donationCheck" />
                            Other
                        </label>
                    </div>
                    <div class="form-group">
                        <div class="input-group">
                            <span class="input-group-addon notranslate" id="basic-addon1">$</span>
                            <input class="form-control custom-control" id="other-amount" maxlength="6" name="CustomDonationAmount" type="text" value="" />
                        </div>
                    </div>
                </div>

                <div>
                    <div class="help-block" style="padding-left: 10px;display:none;">
                        $10.00 is the minimum for Other amounts
                    </div>
                </div>

                <span class="field-validation-valid" data-valmsg-for="CustomDonationAmount" data-valmsg-replace="true"></span>
                <span class="field-validation-valid" data-valmsg-for="DonationAmount" data-valmsg-replace="true"></span>
                <input data-val="true" data-val-maxlength="The field DonationAmount must be a string or array type with a maximum length of &#39;6&#39;." data-val-maxlength-max="6" data-val-required="You must enter a donation amount" id="donation-amount" maxlength="6" name="DonationAmount" type="hidden" value="" />

                <hr class="seperator" />

                <div class="form-group">
                    <label class="custom-label">Donor's Full Name</label>
                    <input class="form-control custom-control" data-val="true" data-val-maxlength="The field DonorsFullName must be a string or array type with a maximum length of &#39;50&#39;." data-val-maxlength-max="50" id="DonorsFullName" maxlength="50" name="DonorsFullName" type="text" value="" />
                    <span class="field-validation-valid" data-valmsg-for="DonorsFullName" data-valmsg-replace="true"></span>
                </div>

                <div class="checkbox ">
                    <label>
                        <input data-val="true" data-val-required="The IsAnonymous field is required." id="IsAnonymous" name="IsAnonymous" type="checkbox" value="true" /><input name="IsAnonymous" type="hidden" value="false" />
                        Would you like to make this donation anonymously?
                    </label>
                </div> 

                <div class="form-group ">
                    <label class="custom-label">Designation</label>
                    <input class="form-control custom-control" data-val="true" data-val-maxlength="The field Designation must be a string or array type with a maximum length of &#39;50&#39;." data-val-maxlength-max="50" id="Designation" maxlength="50" name="Designation" type="text" value="" />
                    <div class="help-block">
                        Select the special fund for your donation 
                    </div>
                </div>

                <div class="checkbox ">
                    <label>
                        <input data-val="true" data-val-required="The IsDedication field is required." id="dedication-checkbox" name="IsDedication" type="checkbox" value="true" /><input name="IsDedication" type="hidden" value="false" />
                        Would you like to dedicate this donation to someone?
                    </label>
                </div>  

                <div class="hide-start" id="dedication-section">
                    <div class="form-group">
                        <label class="custom-label">Dedication Honor</label>
                        <select class="form-control custom-control" id="DedicationHonor" name="DedicationHonor"><option value="">--</option>
<option value="In honor Of">In honor Of</option>
</select>
                        <span class="field-validation-valid" data-valmsg-for="DedicationHonor" data-valmsg-replace="true"></span>
                    </div>

                    <div class="form-group">
                        <label class="custom-label">Name of Person</label>
                        <input class="form-control custom-control" data-val="true" data-val-maxlength="The field DedicationName must be a string or array type with a maximum length of &#39;50&#39;." data-val-maxlength-max="50" id="DedicationName" maxlength="50" name="DedicationName" type="text" value="" />
                        <span class="field-validation-valid" data-valmsg-for="DedicationName" data-valmsg-replace="true"></span>
                    </div>

                    <div class="form-group" >
                        <label class="custom-label">Dedication</label>
                        <textarea class="form-control custom-control" cols="20" data-val="true" data-val-maxlength="The field Dedication must be a string or array type with a maximum length of &#39;150&#39;." data-val-maxlength-max="150" id="Dedication" maxlength="150" name="Dedication" rows="2">
</textarea>
                        <span class="field-validation-valid" data-valmsg-for="Dedication" data-valmsg-replace="true"></span>
                    </div>
                </div>

                <div class="checkbox ">
                    <label>
                        <input class="" data-val="true" data-val-required="The IsMatchingGift field is required." id="matching-gift-checkbox" name="IsMatchingGift" type="checkbox" value="true" /><input name="IsMatchingGift" type="hidden" value="false" />
                        Is this a matching gift?
                    </label>
                </div>


                <hr class="seperator" />

                <div class="row ">
                    <div class="col-xs-12">
                        <label>Will this be a one time donation or recurring?</label>
                        <div class="">
                                <label class="radio-inline">
                                    <input checked="checked" class="recurring-radio" data-val="true" data-val-required="The IsRecurring field is required." id="recurring-radio-false" name="IsRecurring" type="radio" value="False" />
                                    One-Time
                                </label>

                                <label class="radio-inline">
                                    <input class="recurring-radio" id="IsRecurring" name="IsRecurring" type="radio" value="True" />
                                    Recurring
                                </label>
                        </div>

                    </div>
                </div>

                <div id="recurring-section" class="hide-start">
                    <div class="row">
                        <div class="col-md-6 col-xs-12">
                            <div class="form-group">
                                <label class="custom-label">
                                    Recurring Schedule
                                    <span class="required-label">(Required)</span>
                                </label>
                                <select class="form-control custom-control" id="scheduledropdown" name="RecurringType"><option value="2">Monthly</option>
<option value="1">Weekly</option>
<option value="3">Quarterly</option>
</select>
                                <span class="field-validation-valid" data-valmsg-for="RecurringType" data-valmsg-replace="true"></span>
                            </div>
                        </div>

                        <div class="col-md-6 col-xs-12">
                            <div class="form-group hide-start" id="daydropdown-section">
                                <label class="custom-label">Day Of The Week</label>
                                <select class="form-control custom-control" id="RecurringDayWeek" name="RecurringDayWeek"><option value="1">Monday</option>
<option value="2">Tuesday</option>
<option value="3">Wednesday</option>
<option value="4">Thursday</option>
<option value="5">Friday</option>
<option value="6">Saturday</option>
<option value="0">Sunday</option>
</select>
                            </div>

                            <div class="form-group hide-start" id="monthdropdown-section">
                                <label class="custom-label">Day Of The Month</label>
                                <select class="form-control custom-control" id="RecurringDayMonth" name="RecurringDayMonth"><option value="1">1st</option>
<option value="2">2nd</option>
<option value="3">3rd</option>
<option value="4">4th</option>
<option value="5">5th</option>
<option value="6">6th</option>
<option value="7">7th</option>
<option value="8">8th</option>
<option value="9">9th</option>
<option value="10">10th</option>
<option value="11">11th</option>
<option value="12">12th</option>
<option value="13">13th</option>
<option value="14">14th</option>
<option value="15">15th</option>
<option value="16">16th</option>
<option value="17">17th</option>
<option value="18">18th</option>
<option value="19">19th</option>
<option value="20">20th</option>
<option value="21">21st</option>
<option value="22">22nd</option>
<option value="23">23rd</option>
<option value="24">24th</option>
<option value="25">25th</option>
<option value="26">26th</option>
<option value="27">27th</option>
<option value="28">28th</option>
<option value="29">29th</option>
<option value="30">30th</option>
<option value="31">31st</option>
</select>
                           </div>

                            <div class="form-group hide-start" id="quarterlydropdown-section">
                                <div class="help-block">
                                    Your donation will occur today and then at the beginning of each quarter.
                                </div>
                            </div>

                        </div>
                    </div>

                    <div class="form-group">
                        <label class="custom-label">Want to set an end date for this recurring date?</label>
                        <div>
                            <label class="radio-inline">
                                <input checked="checked" class="enddate-radio" data-val="true" data-val-required="The HasEndDate field is required." id="HasEndDate" name="HasEndDate" type="radio" value="False" />
                                No
                            </label>

                            <label class="radio-inline">
                                <input class="enddate-radio" id="HasEndDate" name="HasEndDate" type="radio" value="True" />
                                Yes
                            </label>
                        </div>

                    </div>

                    <div class="row">
                        <div class="col-xs-12 col-md-6">
                            <div class="form-group hide-start" id="recurring-enddate-section">
                                <label class="custom-label">
                                    Select End Date
                                    <span class="required-label">(Required)</span>
                                </label>
                                <input class="form-control custom-control" data-val="true" data-val-maxlength="The field RecurringEndDate must be a string or array type with a maximum length of &#39;50&#39;." data-val-maxlength-max="50" id="RecurringEndDate" maxlength="50" name="RecurringEndDate" type="text" value="" />
                                <span class="field-validation-valid" data-valmsg-for="RecurringEndDate" data-valmsg-replace="true"></span>
                            </div>
                        </div>
                    </div>

                </div>
            </div>

            
            <div class="col-md-12 section hide-start" id="matching-gift-section">
                <h2 class="section-title">Matching Gift</h2>

                <p><bold>Note:</bold> You can only have one-time donations if you choose the matching gift option</p>
                <div class="form-group">
                    <label class="custom-label">
                        Organization
                        <span class="required-label">(Required)</span>
                    </label>
                    <input data-val="true" data-val-required="The CompanyID field is required." id="CompanyID" name="CompanyID" type="hidden" value="00000000-0000-0000-0000-000000000000" />
                    <input class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactOrganization must be a string or array type with a maximum length of &#39;100&#39;." data-val-maxlength-max="100" id="ContactOrganization" maxlength="100" name="ContactOrganization" type="text" value="" />
                    <span class="field-validation-valid" data-valmsg-for="ContactOrganization" data-valmsg-replace="true"></span>
                    <div class="help-block">
                        Type in your organization's information or pick the organization from the suggestions as you type. Make sure to pick the right location.
                    </div>
                </div>

                <div class="form-group">
                    <label class="custom-label">
                        Employee Number
                        <span class="required-label">(Required)</span>
                    </label>
                    <input class="form-control custom-control" data-val="true" data-val-maxlength="The field EmployeeNumber must be a string or array type with a maximum length of &#39;50&#39;." data-val-maxlength-max="50" id="EmployeeNumber" maxlength="50" name="EmployeeNumber" type="text" value="" />
                    <span class="field-validation-valid" data-valmsg-for="EmployeeNumber" data-valmsg-replace="true"></span>
                </div>

                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Company City
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-maxlength="The field CompanyCity must be a string or array type with a maximum length of &#39;100&#39;." data-val-maxlength-max="100" id="CompanyCity" maxlength="100" name="CompanyCity" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="CompanyCity" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Company State/Province
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control hide-start" data-val="true" data-val-maxlength="The field CompanyState must be a string or array type with a maximum length of &#39;20&#39;." data-val-maxlength-max="20" id="CompanyState" maxlength="50" name="CompanyState" type="text" value="" />
                            <select class="form-control custom-control" id="match-state-dropdown" name="match-state-dropdown"><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">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>
</select>
                            <select class="form-control custom-control hide-start" id="match-province-dropdown" name="match-province-dropdown"><option value="">--</option>
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NL">Newfoundland and Labrador</option>
<option value="NS">Nova Scotia</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="QC">Quebec</option>
<option value="SK">Saskatchewan</option>
<option value="NT">Northwest Territories</option>
<option value="NU">Nunavut</option>
<option value="YT">Yukon</option>
</select>
                            <span class="field-validation-valid" data-valmsg-for="CompanyState" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                </div>

                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Company Country
                                <span class="required-label">(Required)</span>
                            </label>
                            <select class="form-control custom-control" data-val="true" data-val-maxlength="The field CompanyCountry must be a string or array type with a maximum length of &#39;10&#39;." data-val-maxlength-max="10" id="CompanyCountry" name="CompanyCountry"><option value="US">United States</option>
<option value="CA">Canada</option>
<option value="">--</option>
<option value="AF">Afghanistan</option>
<option value="AX">&#197;land</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="AC">AscensionIsland</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 Darussalam</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="CX">Christmas Island</option>
<option value="CC">Cocos Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CD">Congo</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">CoteDivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</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="TI">East Timor</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="EU">European Union</option>
<option value="FK">Falkland Islands</option>
<option value="FO">Faroe Islands</option>
<option value="FM">Federated States Of Micronesia</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="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</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">Guineabissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard And McDonald</option>
<option value="HN">Honduras</option>
<option value="HK">HongKong</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 Peoples 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 The Former Yugoslav</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="MD">Moldova</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="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">Palestine</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="CN">Peoples Republic Of China</option>
<option value="PE">Peru</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="TZ">Republic Of Tanzania</option>
<option value="PH">Republic Of The Philippines</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="KN">Saint Kitts And Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="VC">Saint Vincent</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome And Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="UK">Scotland</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">Slovakia</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="SU">Soviet Union</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SH">St. Helena</option>
<option value="PM">St. Pierre And Miquelon</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard And Jan Mayen</option>
<option value="SZ">Swaziland</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="TH">Thailand</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</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="GB">United Kingdom</option>
<option value="UY">Uruguay</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</option>
<option value="WF">Wallis And Futuna Islands</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
                            <span class="field-validation-valid" data-valmsg-for="CompanyCountry" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                </div>
            </div>

            
            <div class="col-md-12 section hide-start" id="contact-information-section">
                <h2 class="section-title">Your Contact Information</h2>

                <div class="row">

                    <div class="col-md-6 col-xs-12">
                        <div class="form-group">
                            <label class="custom-label">
                                First Name
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactFirstName must be a string or array type with a maximum length of &#39;20&#39;." data-val-maxlength-max="20" data-val-required="First name is required" id="ContactFirstName" maxlength="20" name="ContactFirstName" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="ContactFirstName" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                    
                    <div class="col-md-6 col-xs-12">
                        <div class="form-group">
                            <label class="custom-label">
                                Last Name
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactLastName must be a string or array type with a maximum length of &#39;30&#39;." data-val-maxlength-max="30" data-val-required="Last name is required" id="ContactLastName" maxlength="30" name="ContactLastName" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="ContactLastName" data-valmsg-replace="true"></span>
                        </div>
                    </div>

                </div>

                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Email Address
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-email="You must enter in a valid email" data-val-maxlength="The field ContactEmail must be a string or array type with a maximum length of &#39;100&#39;." data-val-maxlength-max="100" data-val-required="Email is required" id="ContactEmail" maxlength="100" name="ContactEmail" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="ContactEmail" data-valmsg-replace="true"></span>
                        </div>
                    </div>

                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Phone
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactPhone must be a string or array type with a maximum length of &#39;20&#39;." data-val-maxlength-max="20" data-val-required="Phone is required" id="ContactPhone" maxlength="20" name="ContactPhone" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="ContactPhone" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <label class="custom-label">
                        Street Address
                        <span class="required-label">(Required)</span>
                    </label>
                    <input class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactStreetAddress must be a string or array type with a maximum length of &#39;100&#39;." data-val-maxlength-max="100" data-val-required="Address is required" id="ContactStreetAddress" maxlength="100" name="ContactStreetAddress" type="text" value="" />
                    <span class="field-validation-valid" data-valmsg-for="ContactStreetAddress" data-valmsg-replace="true"></span>
                </div>
               
                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                City
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactCity must be a string or array type with a maximum length of &#39;50&#39;." data-val-maxlength-max="50" data-val-required="City is required" id="ContactCity" maxlength="50" name="ContactCity" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="ContactCity" data-valmsg-replace="true"></span>
                        </div>
                    </div>

                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label ">
                                State / Province
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="hide-start form-control custom-control" data-val="true" data-val-maxlength="The field ContactState must be a string or array type with a maximum length of &#39;20&#39;." data-val-maxlength-max="20" data-val-required="State is required" id="ContactState" maxlength="20" name="ContactState" type="text" value="" />
                            <select class="form-control custom-control" id="state-dropdown" name="state-dropdown"><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">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>
</select>
                            <select class="hide-start form-control custom-control" id="province-dropdown" name="province-dropdown"><option value="">--</option>
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NL">Newfoundland and Labrador</option>
<option value="NS">Nova Scotia</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="QC">Quebec</option>
<option value="SK">Saskatchewan</option>
<option value="NT">Northwest Territories</option>
<option value="NU">Nunavut</option>
<option value="YT">Yukon</option>
</select>
                            <span class="field-validation-valid" data-valmsg-for="ContactState" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                </div>

                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Postal Code
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactPostalCode must be a string or array type with a maximum length of &#39;10&#39;." data-val-maxlength-max="10" data-val-required="Postal code is required" id="ContactPostalCode" maxlength="10" name="ContactPostalCode" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="ContactPostalCode" data-valmsg-replace="true"></span>
                        </div>
                    </div>

                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Country
                                <span class="required-label">(Required)</span>
                            </label>
                            <select class="form-control custom-control" data-val="true" data-val-maxlength="The field ContactCountry must be a string or array type with a maximum length of &#39;10&#39;." data-val-maxlength-max="10" data-val-required="Country is required" id="ContactCountry" name="ContactCountry"><option value="US">United States</option>
<option value="CA">Canada</option>
<option value="">--</option>
<option value="AF">Afghanistan</option>
<option value="AX">&#197;land</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="AC">AscensionIsland</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 Darussalam</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="CX">Christmas Island</option>
<option value="CC">Cocos Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CD">Congo</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">CoteDivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</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="TI">East Timor</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="EU">European Union</option>
<option value="FK">Falkland Islands</option>
<option value="FO">Faroe Islands</option>
<option value="FM">Federated States Of Micronesia</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="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</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">Guineabissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard And McDonald</option>
<option value="HN">Honduras</option>
<option value="HK">HongKong</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 Peoples 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 The Former Yugoslav</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="MD">Moldova</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="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">Palestine</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="CN">Peoples Republic Of China</option>
<option value="PE">Peru</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="TZ">Republic Of Tanzania</option>
<option value="PH">Republic Of The Philippines</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="KN">Saint Kitts And Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="VC">Saint Vincent</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome And Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="UK">Scotland</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">Slovakia</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="SU">Soviet Union</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SH">St. Helena</option>
<option value="PM">St. Pierre And Miquelon</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard And Jan Mayen</option>
<option value="SZ">Swaziland</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="TH">Thailand</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</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="GB">United Kingdom</option>
<option value="UY">Uruguay</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</option>
<option value="WF">Wallis And Futuna Islands</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
                            <span class="field-validation-valid" data-valmsg-for="ContactCountry" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                </div>
            </div>

            
            <div class="col-md-12 section hide-start" id="payment-info-section">
                <h2 class="section-title">Payment Info</h2>
                <div class="form-group">
                    <label class="custom-label">
                        Credit or Debit Card Number
                        <span class="required-label">(Required)</span>
                    </label>
                    <input class="form-control custom-control" data-val="true" data-val-length="Card number must be between 15 and 16 numbers" data-val-length-max="16" data-val-length-min="15" data-val-required="Credit card is required" id="CreditCardNumber" maxlength="16" name="CreditCardNumber" type="text" value="" />
                    <span class="field-validation-valid" data-valmsg-for="CreditCardNumber" data-valmsg-replace="true"></span>
                </div>
                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                CVV
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-length="CVV must be between 3 and 4 numbers" data-val-length-max="4" data-val-length-min="3" data-val-required="CVV is required" id="CreditCardCVV" maxlength="4" name="CreditCardCVV" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="CreditCardCVV" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="custom-label">
                                Expiration Date
                                <span class="required-label">(Required)</span>
                            </label>
                            <div class="row">
                                <div class="col-xs-6">
                                    <select class="form-control custom-control" id="CreditCardMonth" name="CreditCardMonth"><option value="01">01 - Jan</option>
<option value="02">02 - Feb</option>
<option value="03">03 - Mar</option>
<option value="04">04 - Apr</option>
<option value="05">05 - May</option>
<option value="06">06 - Jun</option>
<option value="07">07 - Jul</option>
<option value="08">08 - Aug</option>
<option value="09">09 - Sep</option>
<option value="10">10 - Oct</option>
<option value="11">11 - Nov</option>
<option value="12">12 - Dec</option>
</select>
                                    <span class="field-validation-valid" data-valmsg-for="CreditCardMonth" data-valmsg-replace="true"></span>
                                </div>
                                <div class="col-xs-6">
                                    <select class="form-control custom-control" id="CreditCardYear" name="CreditCardYear"><option value="18">2018</option>
<option value="19">2019</option>
<option value="20">2020</option>
<option value="21">2021</option>
<option value="22">2022</option>
<option value="23">2023</option>
<option value="24">2024</option>
<option value="25">2025</option>
<option value="26">2026</option>
<option value="27">2027</option>
<option value="28">2028</option>
</select>
                                </div>
                            </div>
                            <span class="field-validation-valid" data-valmsg-for="CreditCardYear" data-valmsg-replace="true"></span>
                        </div>
                    </div>
                </div>

                <div class="row">
                    <divc class="col-md-6 col-xs-12">
                        <div class="form-group">
                            <label class="custom-label">
                                Billing Postal Code
                                <span class="required-label">(Required)</span>
                            </label>
                            <input class="form-control custom-control" data-val="true" data-val-maxlength="The field BillingZipCode must be a string or array type with a maximum length of &#39;10&#39;." data-val-maxlength-max="10" data-val-required="Billing postal code" id="BillingZipCode" maxlength="10" name="BillingZipCode" type="text" value="" />
                            <span class="field-validation-valid" data-valmsg-for="BillingZipCode" data-valmsg-replace="true"></span>
                        </div>
                    </divc>
                </div>


                <div class="checkbox ">
                    <label>
                        <input data-val="true" data-val-required="The HasServiceFee field is required." id="HasServiceFee" name="HasServiceFee" type="checkbox" value="true" /><input name="HasServiceFee" type="hidden" value="false" />
                        Would you like to include the processing fees for this transaction?
                    </label>
                </div>

                <div id="total-amount-holder">
                    Total: $<span id="total-amount">0.00</span>
                </div>
            </div>

            <div class="row">
                <div class="col-xs-12">
                    <div class="validation-summary-valid" data-valmsg-summary="true"><ul><li style="display:none"></li>
</ul></div>
                </div>
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                    <button type="submit" id="js-btn-donation" class="btn btn-primary btn-lg btn-donation">Make Donation</button>
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