KGRKJGETMRETU895U-589TY5MIGM5JGB5SDFESFREWTGR54TY
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		<font class="MainTitle">Donate to the AFGLC!</font><br><br>
	  <!-- START of HOME BODY -->
      <DIV id=middleMainContainer><!-- Need to default to hidden eventually -->
<DIV class=hidden id=contentsContainer>
<FORM id=giftForm action=""><INPUT type=hidden value=CREDIT name=PaymentType> 
<INPUT type=hidden value=P name=PaymentStatus> <INPUT type=hidden value=Y 
name=Individual> 
<DIV id=desigsPopupParent></DIV><!-- where the designations popup will be inserted via js --><!-- ******************** My Gift ************************ -->
<DIV class=moduleMainContainer>
<DIV class=moduleMainTop><SPAN class=moduleTitleNumber>1</SPAN> <SPAN 
class=moduleTitleNumber>My Gift</SPAN> <SPAN class=note id=requiredText>* 
required fields</SPAN> </DIV>
<DIV class=moduleMainMid>
<DIV class=moduleMainMidFade>
<FIELDSET id=giftAmountFields>
<DIV id=giftAmountLine>I'm giving $<INPUT 
class="validGiftAmount warn-minGiftAmount noMargin ralign" id=totalGiftAmount 
tabIndex=1 maxLength=12 size=12 value=0.00 name=Amount> to the AFGLC.* </DIV>
<DIV class=designationChoiceDiv><INPUT id=noDesignation tabIndex=1 type=radio 
name=designate><LABEL class=clickable id=noDesigText for=noDesignation> Use my 
gift where it is needed most.</LABEL></DIV>
<DIV class=designationChoiceDiv><INPUT id=chooseDesignation tabIndex=1 
type=radio name=designate><LABEL id=chooseDesigText for=chooseDesignation> I 
want to choose the areas my gift should help.</LABEL> <A id=desigsLink 
title="Click here to see the areas you can give to" onclick="return false;" 
tabIndex=1 
href="https://www.kintera.org/atf/cf/%7BF8C04E17-831B-4F90-AED7-A10A6D3C8E01%7D/OGP_KINTERA.HTML#">View 
areas</A> I can give to. </DIV>
<DIV class="hidden selDesigIndent" id=selectedDesignationsTableDiv><SPAN 
class=hidden id=splitEvenlyText><INPUT id=splitEvenly type=checkbox 
CHECKED><LABEL class=note for=splitEvenly>Split my gift evenly for 
me.</LABEL></SPAN> 
<DIV class=note id=selectedDesigNote></DIV></DIV><!-- the template row for the table above in a hidden container -->
<DIV class=hidden>
<TABLE>
  <TBODY>
  <TR id=templateLine>
    <TD><INPUT class=selectedCheckedDisplay tabIndex=1 type=checkbox 
    CHECKED></TD>
    <TD><LABEL class=designationDisplayName></LABEL></TD>
    <TD><INPUT class="percentDisplay validate-number" tabIndex=1 maxLength=2 
      size=2>%</TD>
    <TD class=alignr>&nbsp;&nbsp;<SPAN 
  class=dollarDisplay></SPAN></TD></TR></TBODY></TABLE></DIV>
<DIV><SPAN id=errorDesSpan></SPAN></DIV></FIELDSET> <!-- ********************* matching gift fields ********************************** -->
<FIELDSET id=MatchingGiftFields>
<DIV class=moduleSubHeadLine><INPUT class=hidden id=MatchingGiftsCheckbox 
title="My gift may be matched by my employer." tabIndex=1 type=checkbox 
value=Yes name=""> <LABEL id=MatchingGiftsLegend 
title="My gift may be matched by my employer." 
for=MatchingGiftsCheckbox>Matching Gifts</LABEL> </DIV>
<DIV id=MatchingGiftsDiv>
<HR>
Many employers match gifts made by their employees, doubling or even tripling 
your gift. <A title="Find out if your employer matches gifts." tabIndex=1 
href="http://www.matchinggifts.com/umich/" target=_blank>Find out</A> if your 
employer matches gifts. <BR><BR>
<DIV class="floatl col1" id=matchingGiftEmpLabel><LABEL 
for=employer>Employer</LABEL> </DIV>
<DIV class=floatl id=matchingGiftEmp><INPUT class="defMargin defWidth" 
id=employer title="My Employer" tabIndex=1 maxLength=80 size=35> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1" id=matchingGiftSpouseEmpLabel><LABEL 
for=spouseEmployer>Spouse's Employer</LABEL> </DIV>
<DIV class=floatl id=matchingGiftSpouseEmp><INPUT class="defMargin defWidth" 
id=spouseEmployer title="My Spouse's Employer" tabIndex=1 maxLength=80 size=35> 
</DIV>
<DIV class=clear></DIV></DIV></FIELDSET> <!--- end of matching gift fieldset ---><!-- ********************* joint gift fields ********************************** -->
<FIELDSET class=question id=jointGiftFields>
<DIV class=moduleSubHeadLine><INPUT id=jointGiftFieldsCheckbox 
title="I'm giving jointly with my spouse." tabIndex=1 type=checkbox value=Yes 
name=Field4410253> <LABEL id=jointGiftFieldsLegend 
title="I'm giving jointly with my spouse." for=jointGiftFieldsCheckbox>I'm 
giving jointly with my spouse.</LABEL> </DIV>
<DIV class=hidden id=jointGiftDiv>
<HR>

<DIV class="floatl col1" id=spouseNameLabel><LABEL for=spouseName>Spouse's 
Name</LABEL><SPAN class=Alert>*</SPAN> </DIV>
<DIV class=floatl id=spouseNameDiv><INPUT 
class="ignoreValidation required defMargin defWidth" id=spouseNameForwarder 
title="My Spouse's Name" tabIndex=1 maxLength=100 size=35 name=""> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1" id=nameRecptLabel><LABEL for=nameOnRcpt>Name for 
Receipt</LABEL><SPAN class=Alert>*</SPAN> </DIV>
<DIV class=floatl id=nameReceiptedDiv><INPUT 
class="ignoreValidation required defMargin defWidth" id=nameOnRcpt 
title="Name Should Appear on Receipt" tabIndex=1 maxLength=250 size=35 
name=Field4410254><BR></DIV>
<DIV class=clear></DIV></DIV></FIELDSET> <!-- ***************************** honor of gift ********************************** -->
<FIELDSET class=question id=inHonorOfGift>
<DIV class=moduleSubHeadLine><INPUT id=inHonorOfFieldsCheckbox 
title="My gift is in honor/memory of someone." tabIndex=1 type=checkbox 
value=Yes name=Field4411352> <LABEL id=inHonorOfLegend 
title="My gift is in honor/memory of someone." for=inHonorOfFieldsCheckbox>My 
gift is in honor/memory of someone.</LABEL> </DIV>
<DIV class=hidden id=inHonorOfDiv>
<HR>

<DIV class="floatl col1 checkboxHeight"><LABEL for=giftTribute>Gift in</LABEL> 
<SELECT class=inSentence id=giftTribute 
title="My gift is in honor of/memory of choices." tabIndex=1 name=Field4410810> 
  <OPTION value=Honor selected>honor</OPTION> <OPTION 
  value=Memory>memory</OPTION></SELECT> of </DIV>
<DIV class=floatl><INPUT class="ignoreValidation required defWidth" 
id=inHonorOfName tabIndex=1 maxLength=100 size=31 name=Field4410811> </DIV>
<DIV class=clear></DIV>
<DIV class=question id=personToNotify>
<DIV class=moduleSubHeadLine><INPUT id=personToNotifyCheckbox 
title="There's a person to notify of my gift." tabIndex=1 type=checkbox 
value=Yes name=Field4411353> <LABEL id=personToNotifyLegend 
title="There's a person to notify of my gift." 
for=personToNotifyCheckbox>There's a person to notify of my gift.</LABEL> </DIV>
<DIV class=hidden id=personToNotifyDiv>
<HR>

<DIV class="floatl col1"><LABEL for=ptn_first_name>First Name</LABEL></DIV>
<DIV class=floatl><INPUT id=ptn_first_name title="Person to Notify First Name" 
tabIndex=1 maxLength=250 size=35 name=Field4410812> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=ptn_last_name>Last Name</LABEL></DIV>
<DIV class=floatl><INPUT id=ptn_last_name title="Person to Notify Last Name" 
tabIndex=1 maxLength=250 size=35 name=Field4410813> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=ptn_address_1>Address 1</LABEL></DIV>
<DIV class=floatl><INPUT id=ptn_address_1 title="Person to Notify Address 1" 
tabIndex=1 maxLength=80 size=35 name=Field4410815> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=ptn_address_2>Address 2</LABEL></DIV>
<DIV class=floatl><INPUT id=ptn_address_2 title="Person to Notify Address 2" 
tabIndex=1 maxLength=80 size=35 name=Field4410816> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=ptn_city>City</LABEL></DIV>
<DIV class=floatl><INPUT id=ptn_city title="Person to Notify City" tabIndex=1 
maxLength=50 size=25 name=Field4410817> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=NotifyState>State/Province</LABEL></DIV>
<DIV class=floatl><SELECT class=defMargin id=NotifyState 
title="Person to Notify State" tabIndex=1 size=1 name=Field4410818> <OPTION 
  value="">-- please make a selection --</OPTION> <OPTION 
  value=AL>Alabama</OPTION><OPTION value=AK>Alaska</OPTION><OPTION 
  value=AS>American Samoa</OPTION><OPTION value=AZ>Arizona</OPTION><OPTION 
  value=AR>Arkansas</OPTION><OPTION value=AA>Armed Forces 
  Americas</OPTION><OPTION value=AE>Armed Forces Europe</OPTION><OPTION 
  value=AP>Armed Forces Pacific</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=FM>F.S. 
  Micronesia</OPTION><OPTION value=FL>Florida</OPTION><OPTION 
  value=GA>Georgia</OPTION><OPTION value=GU>Guam</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=MH>Marshall Islands</OPTION><OPTION 
  value=MD>Maryland</OPTION><OPTION value=MA>Massachusetts</OPTION><OPTION 
  value=MI selected>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=MP>Northern Mariana 
  Islands</OPTION><OPTION value=OH>Ohio</OPTION><OPTION 
  value=OK>Oklahoma</OPTION><OPTION value=OR>Oregon</OPTION><OPTION 
  value=PW>Palau</OPTION><OPTION value=PA>Pennsylvania</OPTION><OPTION 
  value=PR>Puerto Rico</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=VI>Virgin 
  Islands</OPTION><OPTION value=VA>Virginia</OPTION><OPTION 
  value=WA>Washington</OPTION><OPTION value=WV>West Virginia</OPTION><OPTION 
  value=WI>Wisconsin</OPTION><OPTION value=WY>Wyoming</OPTION><OPTION 
  value=XX>Not in USA</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=NotifyCountry>Country</LABEL></DIV>
<DIV class=floatl><SELECT class=defMargin id=NotifyCountry tabIndex=1 size=1 
name=Field4410819><OPTION value="">-- please make a selection 
  --</OPTION><OPTION value=AF>Afghanistan</OPTION><OPTION 
  value=AL>Albania</OPTION><OPTION value=DZ>Algeria</OPTION><OPTION 
  value=AS>American Samoa</OPTION><OPTION value=AD>Andorra</OPTION><OPTION 
  value=AO>Angola</OPTION><OPTION value=AI>Anguilla</OPTION><OPTION 
  value=AQ>Antarctica</OPTION><OPTION value=AG>Antigua and 
  Barbuda</OPTION><OPTION value=AR>Argentina</OPTION><OPTION 
  value=AM>Armenia</OPTION><OPTION value=AW>Aruba</OPTION><OPTION 
  value=AU>Australia</OPTION><OPTION value=AT>Austria</OPTION><OPTION 
  value=AZ>Azerbaijan</OPTION><OPTION value=BS>Bahamas</OPTION><OPTION 
  value=BH>Bahrain</OPTION><OPTION value=BD>Bangladesh</OPTION><OPTION 
  value=BB>Barbados</OPTION><OPTION value=BY>Belarus</OPTION><OPTION 
  value=BE>Belgium</OPTION><OPTION value=BZ>Belize</OPTION><OPTION 
  value=BJ>Benin</OPTION><OPTION value=BM>Bermuda</OPTION><OPTION 
  value=BT>Bhutan</OPTION><OPTION value=BO>Bolivia</OPTION><OPTION 
  value=BA>Bosnia and Herzegovina</OPTION><OPTION 
  value=BW>Botswana</OPTION><OPTION value=BV>Bouvet Island</OPTION><OPTION 
  value=BR>Brazil</OPTION><OPTION value=IO>British Indian Ocean 
  Territory</OPTION><OPTION value=BN>Brunei 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=CA>Canada</OPTION><OPTION 
  value=CV>Cape Verde</OPTION><OPTION value=KY>Cayman Islands</OPTION><OPTION 
  value=CF>Central African Republic</OPTION><OPTION 
  value=TD>Chad</OPTION><OPTION value=CL>Chile</OPTION><OPTION 
  value=CN>China</OPTION><OPTION value=CX>Christmas Island</OPTION><OPTION 
  value=CC>Cocos (Keeling) Islands</OPTION><OPTION 
  value=CO>Colombia</OPTION><OPTION value=KM>Comoros</OPTION><OPTION 
  value=CG>Congo</OPTION><OPTION value=CD>Congo, The Democratic 
  Republic</OPTION><OPTION value=CK>Cook Islands</OPTION><OPTION value=CR>Costa 
  Rica</OPTION><OPTION value=CI>Cote d'Ivoire</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=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=FK>Falkland Islands 
  (Malvinas)</OPTION><OPTION value=FO>Faroe Islands</OPTION><OPTION 
  value=FJ>Fiji</OPTION><OPTION value=FI>Finland</OPTION><OPTION 
  value=FR>France</OPTION><OPTION value=GF>French Guiana</OPTION><OPTION 
  value=PF>French Polynesia</OPTION><OPTION value=TF>French Southern 
  Territories</OPTION><OPTION value=GA>Gabon</OPTION><OPTION 
  value=GM>Gambia</OPTION><OPTION value=GE>Georgia</OPTION><OPTION 
  value=DE>Germany</OPTION><OPTION value=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=GN>Guinea</OPTION><OPTION 
  value=GW>Guinea-Bissau</OPTION><OPTION value=GY>Guyana</OPTION><OPTION 
  value=HT>Haiti</OPTION><OPTION value=HM>Heard Island and McDonald 
  Islands</OPTION><OPTION value=HN>Honduras</OPTION><OPTION value=HK>Hong 
  Kong</OPTION><OPTION value=HU>Hungary</OPTION><OPTION 
  value=IS>Iceland</OPTION><OPTION value=IN>India</OPTION><OPTION 
  value=ID>Indonesia</OPTION><OPTION value=IR>Iran, Islamic Republic 
  of</OPTION><OPTION value=IQ>Iraq</OPTION><OPTION 
  value=IE>Ireland</OPTION><OPTION value=IL>Israel</OPTION><OPTION 
  value=IT>Italy</OPTION><OPTION value=JM>Jamaica</OPTION><OPTION 
  value=JP>Japan</OPTION><OPTION value=JO>Jordan</OPTION><OPTION 
  value=KZ>Kazakhstan</OPTION><OPTION value=KE>Kenya</OPTION><OPTION 
  value=KI>Kiribati</OPTION><OPTION value=KP>Korea, Democratic People's Republic 
  of</OPTION><OPTION value=KR>Korea, Republic of</OPTION><OPTION 
  value=KW>Kuwait</OPTION><OPTION value=KG>Kyrgyzstan</OPTION><OPTION 
  value=LA>Lao People's Democratic Republic</OPTION><OPTION 
  value=LV>Latvia</OPTION><OPTION value=LB>Lebanon</OPTION><OPTION 
  value=LS>Lesotho</OPTION><OPTION value=LR>Liberia</OPTION><OPTION 
  value=LY>Libyan Arab Jamahiriya</OPTION><OPTION 
  value=LI>Liechtenstein</OPTION><OPTION value=LT>Lithuania</OPTION><OPTION 
  value=LU>Luxembourg</OPTION><OPTION value=MO>Macao</OPTION><OPTION 
  value=MK>Macedonia, The Former Yugoslav Republic of</OPTION><OPTION 
  value=MG>Madagascar</OPTION><OPTION value=MW>Malawi</OPTION><OPTION 
  value=MY>Malaysia</OPTION><OPTION value=MV>Maldives</OPTION><OPTION 
  value=ML>Mali</OPTION><OPTION value=MT>Malta</OPTION><OPTION value=MH>Marshall 
  Islands</OPTION><OPTION value=MQ>Martinique</OPTION><OPTION 
  value=MR>Mauritania</OPTION><OPTION value=MU>Mauritius</OPTION><OPTION 
  value=YT>Mayotte</OPTION><OPTION value=MX>Mexico</OPTION><OPTION 
  value=FM>Micronesia, Federated States of</OPTION><OPTION value=MD>Moldova, 
  Republic of</OPTION><OPTION value=MC>Monaco</OPTION><OPTION 
  value=MN>Mongolia</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=PA>Panama</OPTION><OPTION value=PG>Papua New Guinea</OPTION><OPTION 
  value=PY>Paraguay</OPTION><OPTION value=PE>Peru</OPTION><OPTION 
  value=PH>Philippines</OPTION><OPTION value=PN>Pitcairn</OPTION><OPTION 
  value=PL>Poland</OPTION><OPTION value=PT>Portugal</OPTION><OPTION 
  value=PR>Puerto Rico</OPTION><OPTION value=QA>Qatar</OPTION><OPTION 
  value=RE>Reunion</OPTION><OPTION value=RO>Romania</OPTION><OPTION 
  value=RU>Russian Federation</OPTION><OPTION value=RW>Rwanda</OPTION><OPTION 
  value=SH>Saint Helena</OPTION><OPTION value=KN>Saint Kitts and 
  Nevis</OPTION><OPTION value=LC>Saint Lucia</OPTION><OPTION value=PM>Saint 
  Pierre and Miquelon</OPTION><OPTION value=VC>Saint Vincent and the 
  Grenadines</OPTION><OPTION value=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=SN>Senegal</OPTION><OPTION 
  value=CS>Serbia and Montenegro</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 and the South Sandwich Islands</OPTION><OPTION 
  value=ES>Spain</OPTION><OPTION value=LK>Sri Lanka</OPTION><OPTION 
  value=SD>Sudan</OPTION><OPTION value=SR>Suriname</OPTION><OPTION 
  value=SJ>Svalbard and Jan Mayen</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, Republic of China</OPTION><OPTION 
  value=TJ>Tajikistan</OPTION><OPTION value=TZ>Tanzania, United Republic 
  of</OPTION><OPTION value=TH>Thailand</OPTION><OPTION 
  value=TL>Timor-Leste</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=US selected>United 
  States</OPTION><OPTION value=UM>United States Minor Outlying 
  Islands</OPTION><OPTION value=UY>Uruguay</OPTION><OPTION 
  value=UZ>Uzbekistan</OPTION><OPTION value=VU>Vanuatu</OPTION><OPTION 
  value=VA>Vatican City</OPTION><OPTION value=VE>Venezuela</OPTION><OPTION 
  value=VN>Vietnam</OPTION><OPTION value=VG>Virgin Islands, 
  British</OPTION><OPTION value=VI>Virgin Islands, US</OPTION><OPTION 
  value=WF>Wallis and Futuna</OPTION><OPTION value=EH>Western 
  Sahara</OPTION><OPTION value=YE>Yemen</OPTION><OPTION 
  value=ZM>Zambia</OPTION><OPTION value=ZW>Zimbabwe</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=ptn_zip>Zip/Postal Code</LABEL></DIV>
<DIV class=floatl><INPUT id=ptn_zip title="Person to Notify Zip" tabIndex=1 
maxLength=10 name=Field4410820> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=ptn_relation>Relationship of individual(s) 
to honoree</LABEL> </DIV>
<DIV class=floatl><INPUT id=ptn_relation title="My Ties to the Person to Notify" 
tabIndex=1 maxLength=120 size=35 name=Field4410814><BR><SPAN class=note>e.g. 
family member, friend, co-worker, etc.</SPAN> </DIV>
<DIV class=clear></DIV></DIV></DIV></DIV></FIELDSET> <!-- ********************* pledge payment ********************************** -->
<FIELDSET class=question>
<DIV class=moduleSubHeadLine><INPUT id=pledgeCheckbox 
title="My gift is a pledge payment." tabIndex=3 type=checkbox value=Yes 
name=Field4010625> <LABEL for=pledgeCheckbox>My gift is a pledge 
payment.</LABEL> </DIV></FIELDSET> <!-- *************** Additional Gift Information ******************** -->
<FIELDSET class=question id=additInfoContainer>
<DIV class=moduleSubHeadLine id=additionalInfoDiv><INPUT 
id=additionalInfoCheckbox title="I have additional gift information." tabIndex=3 
type=checkbox> <LABEL id=additInfoLegend 
title="I have additional gift information." for=additionalInfoCheckbox>I have 
additional gift information.</LABEL> </DIV>
<DIV class=hidden id=addInfoDiv>
<HR>

<DIV class="floatl col1">Additional Information</DIV>
<DIV class=floatl><TEXTAREA id=addInfoTextArea tabIndex=3 name=Field3731370 rows=5 cols=27></TEXTAREA> 

<DIV class=note><SPAN id=charFree></SPAN>&nbsp;characters available.</DIV></DIV>
<DIV class=clear></DIV></DIV></FIELDSET> </DIV><!-- end of moduleMidFade (gradient background) ---></DIV><!--- end of moduleMainMid (middle of white frame container) --->
<DIV 
class=moduleMainBottom></DIV><!--- bottom of white frame container ---></DIV><!-- ***************** 2 Personal Information ********************** -->
<DIV class=moduleMainContainer>
<DIV class=moduleMainTop><SPAN class=moduleTitleNumber>2</SPAN> <SPAN 
class=moduleTitleNumber>Personal Information</SPAN> </DIV>
<DIV class=moduleMainMid>
<DIV class=moduleMainMidFade>
<FIELDSET>
<DIV class="floatl col1"><LABEL for=first_name>First&nbsp;Name<SPAN 
class=Alert>*</SPAN></LABEL></DIV>
<DIV class=floatl><INPUT class="required defWidth" id=first_name 
title="First Name" tabIndex=3 maxLength=250 size=35 name=first_name> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=last_name>Last&nbsp;Name</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><INPUT class="required defWidth" id=last_name 
title="Last Name" tabIndex=3 maxLength=250 size=35 name=last_name> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=email_address>Email</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class="floatl col2"><INPUT class="required validate-email defWidth" 
id=email_address title=Email tabIndex=3 maxLength=100 size=35 
name=email_address> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=phone_number>Phone</LABEL>&nbsp;</DIV>
<DIV class=floatl><INPUT id=phone_number title="Phone Number" tabIndex=3 
maxLength=16 size=16 name=phone_number> <SELECT class=defMargin tabIndex=3 
name=Field4307330> <OPTION value=Home selected>Home</OPTION> <OPTION 
  value=Business>Business</OPTION> <OPTION 
value=Cell/Mobile>Cell/Mobile</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1 checkboxHeight"><LABEL for=address_type>Address 
Type</LABEL></DIV>
<DIV class=floatl><SELECT id=address_type tabIndex=3 name=Field4254176> 
  <OPTION value=Permanent selected>Permanent</OPTION> <OPTION 
  value=Seasonal>Seasonal</OPTION> <OPTION value=Business>Business</OPTION> 
  <OPTION value=Campus>Campus</OPTION></SELECT> <INPUT class=noMargin 
id=changeAddress title="Check here if your address has changed recently" 
tabIndex=3 type=checkbox value=Yes name=Field4410808> <LABEL class=note 
for=changeAddress><SPAN class="note clickable" id=changeAddressText 
title="Check here if your address has changed recently">New 
Address</SPAN></LABEL> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=address_line_1>Address Line 1</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><INPUT class="required defWidth" id=address_line_1 
title="Address 1" tabIndex=3 maxLength=80 size=35 name=address_line_1> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL 
for=address_line_2>Address&nbsp;Line&nbsp;2&nbsp;</LABEL></DIV>
<DIV class=floatl><INPUT class=defWidth id=address_line_2 title="Address 2" 
tabIndex=3 maxLength=80 size=35 name=address_line_2> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=city>City</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><INPUT class="required defWidth" id=city title=City tabIndex=3 
maxLength=30 size=35 name=city> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=state>State/Province</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><SELECT class=defMargin id=state tabIndex=3 size=1 name=state> 
  <OPTION value=AL>Alabama</OPTION><OPTION value=AK>Alaska</OPTION><OPTION 
  value=AS>American Samoa</OPTION><OPTION value=AZ>Arizona</OPTION><OPTION 
  value=AR>Arkansas</OPTION><OPTION value=AA>Armed Forces 
  Americas</OPTION><OPTION value=AE>Armed Forces Europe</OPTION><OPTION 
  value=AP>Armed Forces Pacific</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=FM>F.S. 
  Micronesia</OPTION><OPTION value=FL>Florida</OPTION><OPTION 
  value=GA>Georgia</OPTION><OPTION value=GU>Guam</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=MH>Marshall Islands</OPTION><OPTION 
  value=MD>Maryland</OPTION><OPTION value=MA>Massachusetts</OPTION><OPTION 
  value=MI selected>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=MP>Northern Mariana 
  Islands</OPTION><OPTION value=OH>Ohio</OPTION><OPTION 
  value=OK>Oklahoma</OPTION><OPTION value=OR>Oregon</OPTION><OPTION 
  value=PW>Palau</OPTION><OPTION value=PA>Pennsylvania</OPTION><OPTION 
  value=PR>Puerto Rico</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=VI>Virgin 
  Islands</OPTION><OPTION value=VA>Virginia</OPTION><OPTION 
  value=WA>Washington</OPTION><OPTION value=WV>West Virginia</OPTION><OPTION 
  value=WI>Wisconsin</OPTION><OPTION value=WY>Wyoming</OPTION><OPTION 
  value=XX>Not in USA</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=country>Country</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><SELECT class=defMargin id=country tabIndex=3 size=1 
name=country><OPTION value="">-- please make a selection --</OPTION><OPTION 
  value=AF>Afghanistan</OPTION><OPTION value=AL>Albania</OPTION><OPTION 
  value=DZ>Algeria</OPTION><OPTION value=AS>American Samoa</OPTION><OPTION 
  value=AD>Andorra</OPTION><OPTION value=AO>Angola</OPTION><OPTION 
  value=AI>Anguilla</OPTION><OPTION value=AQ>Antarctica</OPTION><OPTION 
  value=AG>Antigua and Barbuda</OPTION><OPTION 
  value=AR>Argentina</OPTION><OPTION value=AM>Armenia</OPTION><OPTION 
  value=AW>Aruba</OPTION><OPTION value=AU>Australia</OPTION><OPTION 
  value=AT>Austria</OPTION><OPTION value=AZ>Azerbaijan</OPTION><OPTION 
  value=BS>Bahamas</OPTION><OPTION value=BH>Bahrain</OPTION><OPTION 
  value=BD>Bangladesh</OPTION><OPTION value=BB>Barbados</OPTION><OPTION 
  value=BY>Belarus</OPTION><OPTION value=BE>Belgium</OPTION><OPTION 
  value=BZ>Belize</OPTION><OPTION value=BJ>Benin</OPTION><OPTION 
  value=BM>Bermuda</OPTION><OPTION value=BT>Bhutan</OPTION><OPTION 
  value=BO>Bolivia</OPTION><OPTION value=BA>Bosnia and 
  Herzegovina</OPTION><OPTION value=BW>Botswana</OPTION><OPTION value=BV>Bouvet 
  Island</OPTION><OPTION value=BR>Brazil</OPTION><OPTION value=IO>British Indian 
  Ocean Territory</OPTION><OPTION value=BN>Brunei 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=CA>Canada</OPTION><OPTION 
  value=CV>Cape Verde</OPTION><OPTION value=KY>Cayman Islands</OPTION><OPTION 
  value=CF>Central African Republic</OPTION><OPTION 
  value=TD>Chad</OPTION><OPTION value=CL>Chile</OPTION><OPTION 
  value=CN>China</OPTION><OPTION value=CX>Christmas Island</OPTION><OPTION 
  value=CC>Cocos (Keeling) Islands</OPTION><OPTION 
  value=CO>Colombia</OPTION><OPTION value=KM>Comoros</OPTION><OPTION 
  value=CG>Congo</OPTION><OPTION value=CD>Congo, The Democratic 
  Republic</OPTION><OPTION value=CK>Cook Islands</OPTION><OPTION value=CR>Costa 
  Rica</OPTION><OPTION value=CI>Cote d'Ivoire</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=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=FK>Falkland Islands 
  (Malvinas)</OPTION><OPTION value=FO>Faroe Islands</OPTION><OPTION 
  value=FJ>Fiji</OPTION><OPTION value=FI>Finland</OPTION><OPTION 
  value=FR>France</OPTION><OPTION value=GF>French Guiana</OPTION><OPTION 
  value=PF>French Polynesia</OPTION><OPTION value=TF>French Southern 
  Territories</OPTION><OPTION value=GA>Gabon</OPTION><OPTION 
  value=GM>Gambia</OPTION><OPTION value=GE>Georgia</OPTION><OPTION 
  value=DE>Germany</OPTION><OPTION value=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=GN>Guinea</OPTION><OPTION 
  value=GW>Guinea-Bissau</OPTION><OPTION value=GY>Guyana</OPTION><OPTION 
  value=HT>Haiti</OPTION><OPTION value=HM>Heard Island and McDonald 
  Islands</OPTION><OPTION value=HN>Honduras</OPTION><OPTION value=HK>Hong 
  Kong</OPTION><OPTION value=HU>Hungary</OPTION><OPTION 
  value=IS>Iceland</OPTION><OPTION value=IN>India</OPTION><OPTION 
  value=ID>Indonesia</OPTION><OPTION value=IR>Iran, Islamic Republic 
  of</OPTION><OPTION value=IQ>Iraq</OPTION><OPTION 
  value=IE>Ireland</OPTION><OPTION value=IL>Israel</OPTION><OPTION 
  value=IT>Italy</OPTION><OPTION value=JM>Jamaica</OPTION><OPTION 
  value=JP>Japan</OPTION><OPTION value=JO>Jordan</OPTION><OPTION 
  value=KZ>Kazakhstan</OPTION><OPTION value=KE>Kenya</OPTION><OPTION 
  value=KI>Kiribati</OPTION><OPTION value=KP>Korea, Democratic People's Republic 
  of</OPTION><OPTION value=KR>Korea, Republic of</OPTION><OPTION 
  value=KW>Kuwait</OPTION><OPTION value=KG>Kyrgyzstan</OPTION><OPTION 
  value=LA>Lao People's Democratic Republic</OPTION><OPTION 
  value=LV>Latvia</OPTION><OPTION value=LB>Lebanon</OPTION><OPTION 
  value=LS>Lesotho</OPTION><OPTION value=LR>Liberia</OPTION><OPTION 
  value=LY>Libyan Arab Jamahiriya</OPTION><OPTION 
  value=LI>Liechtenstein</OPTION><OPTION value=LT>Lithuania</OPTION><OPTION 
  value=LU>Luxembourg</OPTION><OPTION value=MO>Macao</OPTION><OPTION 
  value=MK>Macedonia, The Former Yugoslav Republic of</OPTION><OPTION 
  value=MG>Madagascar</OPTION><OPTION value=MW>Malawi</OPTION><OPTION 
  value=MY>Malaysia</OPTION><OPTION value=MV>Maldives</OPTION><OPTION 
  value=ML>Mali</OPTION><OPTION value=MT>Malta</OPTION><OPTION value=MH>Marshall 
  Islands</OPTION><OPTION value=MQ>Martinique</OPTION><OPTION 
  value=MR>Mauritania</OPTION><OPTION value=MU>Mauritius</OPTION><OPTION 
  value=YT>Mayotte</OPTION><OPTION value=MX>Mexico</OPTION><OPTION 
  value=FM>Micronesia, Federated States of</OPTION><OPTION value=MD>Moldova, 
  Republic of</OPTION><OPTION value=MC>Monaco</OPTION><OPTION 
  value=MN>Mongolia</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=PA>Panama</OPTION><OPTION value=PG>Papua New Guinea</OPTION><OPTION 
  value=PY>Paraguay</OPTION><OPTION value=PE>Peru</OPTION><OPTION 
  value=PH>Philippines</OPTION><OPTION value=PN>Pitcairn</OPTION><OPTION 
  value=PL>Poland</OPTION><OPTION value=PT>Portugal</OPTION><OPTION 
  value=PR>Puerto Rico</OPTION><OPTION value=QA>Qatar</OPTION><OPTION 
  value=RE>Reunion</OPTION><OPTION value=RO>Romania</OPTION><OPTION 
  value=RU>Russian Federation</OPTION><OPTION value=RW>Rwanda</OPTION><OPTION 
  value=SH>Saint Helena</OPTION><OPTION value=KN>Saint Kitts and 
  Nevis</OPTION><OPTION value=LC>Saint Lucia</OPTION><OPTION value=PM>Saint 
  Pierre and Miquelon</OPTION><OPTION value=VC>Saint Vincent and the 
  Grenadines</OPTION><OPTION value=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=SN>Senegal</OPTION><OPTION 
  value=CS>Serbia and Montenegro</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 and the South Sandwich Islands</OPTION><OPTION 
  value=ES>Spain</OPTION><OPTION value=LK>Sri Lanka</OPTION><OPTION 
  value=SD>Sudan</OPTION><OPTION value=SR>Suriname</OPTION><OPTION 
  value=SJ>Svalbard and Jan Mayen</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, Republic of China</OPTION><OPTION 
  value=TJ>Tajikistan</OPTION><OPTION value=TZ>Tanzania, United Republic 
  of</OPTION><OPTION value=TH>Thailand</OPTION><OPTION 
  value=TL>Timor-Leste</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=US selected>United 
  States</OPTION><OPTION value=UM>United States Minor Outlying 
  Islands</OPTION><OPTION value=UY>Uruguay</OPTION><OPTION 
  value=UZ>Uzbekistan</OPTION><OPTION value=VU>Vanuatu</OPTION><OPTION 
  value=VA>Vatican City</OPTION><OPTION value=VE>Venezuela</OPTION><OPTION 
  value=VN>Vietnam</OPTION><OPTION value=VG>Virgin Islands, 
  British</OPTION><OPTION value=VI>Virgin Islands, US</OPTION><OPTION 
  value=WF>Wallis and Futuna</OPTION><OPTION value=EH>Western 
  Sahara</OPTION><OPTION value=YE>Yemen</OPTION><OPTION 
  value=ZM>Zambia</OPTION><OPTION value=ZW>Zimbabwe</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=zip>Zip/Postal Code</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><INPUT class=required id=zip title="Zip Code" tabIndex=3 
maxLength=10 name=zip> </DIV>
<DIV class=clear></DIV><!--- *********** ID and S Code ******************* --->
<FIELDSET id=idSCodeContainer>
<DIV class=moduleSubHeadLine><INPUT id=idSCodeCheckbox 
title="I know my ID or S-Code, or am making this gift in response to a mailing." 
tabIndex=3 type=checkbox> <LABEL id=idSCodeLegend 
title="I know my ID or S-Code, or am making this gift in response to a mailing." 
for=idSCodeCheckbox>I know my ID or S-Code, or am making this gift in response 
to a mailing.</LABEL> </DIV>
<DIV id=idSCodeFields>
<HR>

<DIV>If you are making this gift in response to a mailing, please help us manage 
your gift more efficiently by providing the ID and S-Code from the box printed 
on the response form that came with your mailing. Please refer to sample 
below.<BR></DIV>
<P></P>
<DIV class="floatl col1"></DIV>
<DIV class=floatl><IMG id=IDsourceCodeImage 
title="Example of ID and S Code on a mailing" alt=sample 
src="images/ID_SCode.gif"><BR></DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=id_number>ID</LABEL></DIV>
<DIV class=floatl><INPUT class=validEid id=id_number title="ID, 10 digits" 
tabIndex=3 maxLength=10 size=10 name=id_number><BR><SPAN class=note>10 
digits</SPAN> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=event_source>S-Code</LABEL></DIV>
<DIV class=floatl><INPUT class="validScode defWidth" id=event_source 
title="S Code, 12 characters and 2 dashes" tabIndex=3 maxLength=14 size=25 
name=Field4036431><BR><SPAN class=note>12 characters and 2 dashes</SPAN> </DIV>
<DIV class=clear></DIV></DIV></FIELDSET> <!--- *********** U-M Affiliations ******************* --->
<FIELDSET id=umAffilContainer>
<DIV class=moduleSubHeadLine><INPUT id=umAffilCheckbox 
title="Do you have any affiliations with U-M?" tabIndex=4 type=checkbox> <LABEL 
id=umAffilLegend title="Do you have any affiliations with the AFGLC?" 
for=umAffilCheckbox>Do you have any affiliations with the AFGLC?</LABEL> </DIV>
<DIV id=umAffilFields>
<HR>

<DIV>Please check all that apply.</DIV>
<P></P>
<DIV class="floatl col1"></DIV>
<DIV><INPUT class=noMargin id=firstGiftCheckbox title="I'm a new donor" 
tabIndex=4 type=checkbox value="New Donor" name=Field4007451> <LABEL 
class=clickable id=firstGiftText for=firstGiftCheckbox>This is my first gift to 
the AFGLC</LABEL> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"></DIV>
<DIV><INPUT class=noMargin id=alumnCheckbox title="I'm an AFGLC Member" tabIndex=4 
type=checkbox value="AFGLC Member" name=Field4007451> <LABEL class=clickable 
id=alumnText for=alumnCheckbox>AFGLC Member</LABEL> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"></DIV>
<DIV><INPUT class=noMargin id=alumnSpouseCheckbox 
title="I'm married to an AFGLC Member" tabIndex=4 type=checkbox 
value="Spouse of AFGLC Member" name=Field4007451> <LABEL class=clickable 
id=alumnSpouse for=alumnSpouseCheckbox>Spouse of an AFGLC Member</LABEL> 
</DIV>
<DIV class=clear></DIV>
<DIV id=otherAffiliates>
<DIV class="floatl col1"><LABEL class=clickable id=otherText 
for=otherCheckbox>Other Affiliations</LABEL></DIV>
<DIV class=rowMargin><INPUT class=defWidth id=otherCheckText 
title="Other, please seperate other ties using commas" tabIndex=4 maxLength=200 
size=28><BR><SPAN class=note>separate using commas</SPAN> </DIV>
<DIV class=clear></DIV></DIV>
<DIV id=degreeInfoDiv>
<DIV class="floatl col1"><LABEL for=my_degrees>Degree(s)</LABEL></DIV>
<DIV class=rowMargin><INPUT class=defWidth id=my_degrees title="My Degree(s)" 
tabIndex=4 maxLength=100 size=35 name=Field4007819> <BR><SPAN 
class=note>School/College, graduation year, degree</SPAN> </DIV>
<DIV class=clear></DIV></DIV>
<DIV id=spouseAlumnDiv>
<DIV class="floatl col1"><LABEL id=spouseAlumnNameDiv for=spouseName>Spouse's 
Name</LABEL></DIV>
<DIV class=rowMargin><INPUT class=defWidth id=spouseName title="Spouse's Name" 
tabIndex=4 maxLength=100 size=35 name=Field3854437> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL id=spouseDegreeInfoDiv 
for=spouses_degrees>Spouse's Degree(s)</LABEL></DIV>
<DIV class=rowMargin><INPUT class=defWidth id=spouses_degrees 
title="Spouse's Degree(s)" tabIndex=4 maxLength=100 size=35 
name=Field4254174><BR><SPAN class=note>School/College, graduation year, 
degree</SPAN> </DIV>
<DIV class=clear></DIV></DIV></DIV></FIELDSET> </FIELDSET> </DIV><!-- end of moduleMidFade (gradient background) ---></DIV><!--- end of moduleMainMid (middle of white frame container) --->
<DIV 
class=moduleMainBottom></DIV><!--- bottom of white frame container ---></DIV><!-- ***************** 3 Payment Details ********************** -->
<DIV class=moduleMainContainer>
<DIV class=moduleMainTop><SPAN class=moduleTitleNumber>3</SPAN> <SPAN 
class=moduleTitleNumber>Payment Details</SPAN> </DIV>
<DIV class=moduleMainMid>
<DIV class=moduleMainMidFade>
<FIELDSET id=creditCardContainer>
<DIV class="line floatl" id=cards_container>
<DIV class=buttonHolder id=VISA_container><BUTTON class=cardtypebutton 
id=visaButton tabIndex=4><IMG title=Visa height=29 alt=Visa 
src="images/ccVisaLogo.gif" 
width=46></BUTTON><BR><INPUT class=noMargin id=VisaRadio tabIndex=4 type=radio 
CHECKED name=cardTypeRadio> <LABEL id=VisaText for=VisaRadio>VISA</LABEL> </DIV>
<DIV class=buttonHolder id=MC_container><BUTTON class=cardtypebutton 
id=mastercardButton tabIndex=4><IMG title=MasterCard height=29 alt=MasterCard 
src="images/ccMasterCardLogo.gif" 
width=46></BUTTON><BR><INPUT class=noMargin id=MasterCardRadio tabIndex=4 
type=radio name=cardTypeRadio> <LABEL id=MasterCardText 
for=MasterCardRadio>MasterCard</LABEL><BR></DIV>
<DIV class=buttonHolder id=Discover_container><BUTTON class=cardtypebutton 
id=discoverButton tabIndex=4><IMG title=Discover height=29 alt=Discover 
src="images/ccDiscoverLogo.jpg" 
width=46></BUTTON><BR><INPUT class=noMargin id=DiscoverRadio tabIndex=4 
type=radio name=cardTypeRadio> <LABEL id=DiscoverText 
for=DiscoverRadio>Discover</LABEL> </DIV>
<DIV class=buttonHolder id=Amex_container><BUTTON class=cardtypebutton 
id=amexButton tabIndex=4><IMG title="American Express" height=29 
alt="American Express" 
src="images/ccAmericanExpressLogo.gif" 
width=46></BUTTON><BR><INPUT class=noMargin id=AmexRadio tabIndex=4 type=radio 
name=cardTypeRadio> <LABEL id=AmexText 
for=AmexRadio>American&nbsp;Express</LABEL> </DIV><SELECT class=hidden 
id=CardType size=1 name=CardType> <OPTION value=Visa selected>Visa</OPTION> 
  <OPTION value=MasterCard>MasterCard</OPTION> <OPTION 
  value=Discover>Discover</OPTION> <OPTION value="American Express">American 
  Express</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV>
<DIV class="floatl col1"><LABEL for=CardNumber>Card&nbsp;Number</LABEL> <SPAN 
class=Alert>*</SPAN> </DIV>
<DIV class=floatl><INPUT class=validCC id=CardNumber 
title="Credit Card Number, spaces or dashes can be used" tabIndex=4 maxLength=20 
size=35 name=CardNumber autocomplete="off"> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=CSC><A class=helpLink id=securityCodeLink 
title="What is the Credit Card Security Code?" tabIndex=4 
href="https://www.kintera.org/atf/cf/%7BF8C04E17-831B-4F90-AED7-A10A6D3C8E01%7D/OGP_KINTERA.HTML#">Security 
Code</A> <IMG height=16 alt=Help src="images/Help.png" 
width=16> </LABEL><SPAN class=Alert>*</SPAN> </DIV>
<DIV class=floatl><INPUT class=required id=CSC title="Card Security Code" 
tabIndex=4 maxLength=4 size=4 name=CSC autocomplete="off"> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=CardExpmn>Expiration</LABEL><SPAN 
class=Alert>*</SPAN> </DIV>
<DIV class="floatl defMargin"><SELECT class=noMargin id=CardExpmn 
title="Card Expiration Month" tabIndex=4 size=1 name=CardExpmn> <OPTION 
  value=01>01</OPTION> <OPTION value=02>02</OPTION> <OPTION value=03>03</OPTION> 
  <OPTION value=04>04</OPTION> <OPTION value=05>05</OPTION> <OPTION value=06 
  selected>06</OPTION> <OPTION value=07>07</OPTION> <OPTION value=08>08</OPTION> 
  <OPTION value=09>09</OPTION> <OPTION value=10>10</OPTION> <OPTION 
  value=11>11</OPTION> <OPTION value=12>12</OPTION></SELECT> / <SELECT 
class=noMargin id=CardExpyr title="Card Expiration Year" tabIndex=4 size=1 
name=CardExpyr> <OPTION value=2007>07</OPTION> <OPTION value=2008>08</OPTION> 
  <OPTION value=2009 selected>09</OPTION> <OPTION value=2010>10</OPTION> <OPTION 
  value=2011>11</OPTION> <OPTION value=2012>12</OPTION> <OPTION 
  value=2013>13</OPTION> <OPTION value=2014>14</OPTION> <OPTION 
  value=2015>15</OPTION> <OPTION value=2016>16</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=CardName>Name&nbsp;on&nbsp;Card</LABEL><SPAN 
class=Alert>*</SPAN> </DIV>
<DIV class=floatl><INPUT class="required defWidth" id=CardName 
title="Name as it Appears on Your Card" tabIndex=4 maxLength=100 size=35 
name=CardName> </DIV>
<DIV class=clear></DIV></DIV><BR><BR><!-- ********************** Billing Address ************************ -->
<DIV class=moduleSubHeadLine>Billing Address</DIV>
<HR>

<FIELDSET id=billingAddressContainer>
<DIV id=billingAddressDiv>
<DIV class="floatl col1"><LABEL for=BillAddress1>Address Line 1</LABEL><SPAN 
class=Alert>*</SPAN> </DIV>
<DIV class=floatl><INPUT class="required defWidth" id=BillAddress1 
title="Billing Address1" tabIndex=4 maxLength=80 size=35 name=BillAddress1> 
</DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=BillAddress2>Address Line 2</LABEL>&nbsp; 
</DIV>
<DIV class=floatl><INPUT class=defWidth id=BillAddress2 title="Billing Address2" 
tabIndex=4 maxLength=80 size=35 name=BillAddress2> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=BillCity>City</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><INPUT class="required defWidth" id=BillCity 
title="Billing City" tabIndex=4 maxLength=30 size=35 name=BillCity> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=BillState>State/Province</LABEL><SPAN 
class=Alert>*</SPAN> </DIV>
<DIV class=floatl><SELECT id=BillState title="Billing State/Province" tabIndex=4 
size=1 name=BillState> <OPTION value="">-- please make a selection --</OPTION> 
  <OPTION value=AL>Alabama</OPTION><OPTION value=AK>Alaska</OPTION><OPTION 
  value=AS>American Samoa</OPTION><OPTION value=AZ>Arizona</OPTION><OPTION 
  value=AR>Arkansas</OPTION><OPTION value=AA>Armed Forces 
  Americas</OPTION><OPTION value=AE>Armed Forces Europe</OPTION><OPTION 
  value=AP>Armed Forces Pacific</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=FM>F.S. 
  Micronesia</OPTION><OPTION value=FL>Florida</OPTION><OPTION 
  value=GA>Georgia</OPTION><OPTION value=GU>Guam</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=MH>Marshall Islands</OPTION><OPTION 
  value=MD>Maryland</OPTION><OPTION value=MA>Massachusetts</OPTION><OPTION 
  value=MI selected>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=MP>Northern Mariana 
  Islands</OPTION><OPTION value=OH>Ohio</OPTION><OPTION 
  value=OK>Oklahoma</OPTION><OPTION value=OR>Oregon</OPTION><OPTION 
  value=PW>Palau</OPTION><OPTION value=PA>Pennsylvania</OPTION><OPTION 
  value=PR>Puerto Rico</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=VI>Virgin 
  Islands</OPTION><OPTION value=VA>Virginia</OPTION><OPTION 
  value=WA>Washington</OPTION><OPTION value=WV>West Virginia</OPTION><OPTION 
  value=WI>Wisconsin</OPTION><OPTION value=WY>Wyoming</OPTION><OPTION 
  value=XX>Not in USA</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=BillCountry>Country</LABEL><SPAN 
class=Alert>*</SPAN></DIV>
<DIV class=floatl><SELECT id=BillCountry title="Billing Country" tabIndex=4 
size=1 name=BillCountry><OPTION value="">-- please make a selection 
  --</OPTION><OPTION value=AF>Afghanistan</OPTION><OPTION 
  value=AL>Albania</OPTION><OPTION value=DZ>Algeria</OPTION><OPTION 
  value=AS>American Samoa</OPTION><OPTION value=AD>Andorra</OPTION><OPTION 
  value=AO>Angola</OPTION><OPTION value=AI>Anguilla</OPTION><OPTION 
  value=AQ>Antarctica</OPTION><OPTION value=AG>Antigua and 
  Barbuda</OPTION><OPTION value=AR>Argentina</OPTION><OPTION 
  value=AM>Armenia</OPTION><OPTION value=AW>Aruba</OPTION><OPTION 
  value=AU>Australia</OPTION><OPTION value=AT>Austria</OPTION><OPTION 
  value=AZ>Azerbaijan</OPTION><OPTION value=BS>Bahamas</OPTION><OPTION 
  value=BH>Bahrain</OPTION><OPTION value=BD>Bangladesh</OPTION><OPTION 
  value=BB>Barbados</OPTION><OPTION value=BY>Belarus</OPTION><OPTION 
  value=BE>Belgium</OPTION><OPTION value=BZ>Belize</OPTION><OPTION 
  value=BJ>Benin</OPTION><OPTION value=BM>Bermuda</OPTION><OPTION 
  value=BT>Bhutan</OPTION><OPTION value=BO>Bolivia</OPTION><OPTION 
  value=BA>Bosnia and Herzegovina</OPTION><OPTION 
  value=BW>Botswana</OPTION><OPTION value=BV>Bouvet Island</OPTION><OPTION 
  value=BR>Brazil</OPTION><OPTION value=IO>British Indian Ocean 
  Territory</OPTION><OPTION value=BN>Brunei 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=CA>Canada</OPTION><OPTION 
  value=CV>Cape Verde</OPTION><OPTION value=KY>Cayman Islands</OPTION><OPTION 
  value=CF>Central African Republic</OPTION><OPTION 
  value=TD>Chad</OPTION><OPTION value=CL>Chile</OPTION><OPTION 
  value=CN>China</OPTION><OPTION value=CX>Christmas Island</OPTION><OPTION 
  value=CC>Cocos (Keeling) Islands</OPTION><OPTION 
  value=CO>Colombia</OPTION><OPTION value=KM>Comoros</OPTION><OPTION 
  value=CG>Congo</OPTION><OPTION value=CD>Congo, The Democratic 
  Republic</OPTION><OPTION value=CK>Cook Islands</OPTION><OPTION value=CR>Costa 
  Rica</OPTION><OPTION value=CI>Cote d'Ivoire</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=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=FK>Falkland Islands 
  (Malvinas)</OPTION><OPTION value=FO>Faroe Islands</OPTION><OPTION 
  value=FJ>Fiji</OPTION><OPTION value=FI>Finland</OPTION><OPTION 
  value=FR>France</OPTION><OPTION value=GF>French Guiana</OPTION><OPTION 
  value=PF>French Polynesia</OPTION><OPTION value=TF>French Southern 
  Territories</OPTION><OPTION value=GA>Gabon</OPTION><OPTION 
  value=GM>Gambia</OPTION><OPTION value=GE>Georgia</OPTION><OPTION 
  value=DE>Germany</OPTION><OPTION value=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=GN>Guinea</OPTION><OPTION 
  value=GW>Guinea-Bissau</OPTION><OPTION value=GY>Guyana</OPTION><OPTION 
  value=HT>Haiti</OPTION><OPTION value=HM>Heard Island and McDonald 
  Islands</OPTION><OPTION value=HN>Honduras</OPTION><OPTION value=HK>Hong 
  Kong</OPTION><OPTION value=HU>Hungary</OPTION><OPTION 
  value=IS>Iceland</OPTION><OPTION value=IN>India</OPTION><OPTION 
  value=ID>Indonesia</OPTION><OPTION value=IR>Iran, Islamic Republic 
  of</OPTION><OPTION value=IQ>Iraq</OPTION><OPTION 
  value=IE>Ireland</OPTION><OPTION value=IL>Israel</OPTION><OPTION 
  value=IT>Italy</OPTION><OPTION value=JM>Jamaica</OPTION><OPTION 
  value=JP>Japan</OPTION><OPTION value=JO>Jordan</OPTION><OPTION 
  value=KZ>Kazakhstan</OPTION><OPTION value=KE>Kenya</OPTION><OPTION 
  value=KI>Kiribati</OPTION><OPTION value=KP>Korea, Democratic People's Republic 
  of</OPTION><OPTION value=KR>Korea, Republic of</OPTION><OPTION 
  value=KW>Kuwait</OPTION><OPTION value=KG>Kyrgyzstan</OPTION><OPTION 
  value=LA>Lao People's Democratic Republic</OPTION><OPTION 
  value=LV>Latvia</OPTION><OPTION value=LB>Lebanon</OPTION><OPTION 
  value=LS>Lesotho</OPTION><OPTION value=LR>Liberia</OPTION><OPTION 
  value=LY>Libyan Arab Jamahiriya</OPTION><OPTION 
  value=LI>Liechtenstein</OPTION><OPTION value=LT>Lithuania</OPTION><OPTION 
  value=LU>Luxembourg</OPTION><OPTION value=MO>Macao</OPTION><OPTION 
  value=MK>Macedonia, The Former Yugoslav Republic of</OPTION><OPTION 
  value=MG>Madagascar</OPTION><OPTION value=MW>Malawi</OPTION><OPTION 
  value=MY>Malaysia</OPTION><OPTION value=MV>Maldives</OPTION><OPTION 
  value=ML>Mali</OPTION><OPTION value=MT>Malta</OPTION><OPTION value=MH>Marshall 
  Islands</OPTION><OPTION value=MQ>Martinique</OPTION><OPTION 
  value=MR>Mauritania</OPTION><OPTION value=MU>Mauritius</OPTION><OPTION 
  value=YT>Mayotte</OPTION><OPTION value=MX>Mexico</OPTION><OPTION 
  value=FM>Micronesia, Federated States of</OPTION><OPTION value=MD>Moldova, 
  Republic of</OPTION><OPTION value=MC>Monaco</OPTION><OPTION 
  value=MN>Mongolia</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=PA>Panama</OPTION><OPTION value=PG>Papua New Guinea</OPTION><OPTION 
  value=PY>Paraguay</OPTION><OPTION value=PE>Peru</OPTION><OPTION 
  value=PH>Philippines</OPTION><OPTION value=PN>Pitcairn</OPTION><OPTION 
  value=PL>Poland</OPTION><OPTION value=PT>Portugal</OPTION><OPTION 
  value=PR>Puerto Rico</OPTION><OPTION value=QA>Qatar</OPTION><OPTION 
  value=RE>Reunion</OPTION><OPTION value=RO>Romania</OPTION><OPTION 
  value=RU>Russian Federation</OPTION><OPTION value=RW>Rwanda</OPTION><OPTION 
  value=SH>Saint Helena</OPTION><OPTION value=KN>Saint Kitts and 
  Nevis</OPTION><OPTION value=LC>Saint Lucia</OPTION><OPTION value=PM>Saint 
  Pierre and Miquelon</OPTION><OPTION value=VC>Saint Vincent and the 
  Grenadines</OPTION><OPTION value=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=SN>Senegal</OPTION><OPTION 
  value=CS>Serbia and Montenegro</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 and the South Sandwich Islands</OPTION><OPTION 
  value=ES>Spain</OPTION><OPTION value=LK>Sri Lanka</OPTION><OPTION 
  value=SD>Sudan</OPTION><OPTION value=SR>Suriname</OPTION><OPTION 
  value=SJ>Svalbard and Jan Mayen</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, Republic of China</OPTION><OPTION 
  value=TJ>Tajikistan</OPTION><OPTION value=TZ>Tanzania, United Republic 
  of</OPTION><OPTION value=TH>Thailand</OPTION><OPTION 
  value=TL>Timor-Leste</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=US selected>United 
  States</OPTION><OPTION value=UM>United States Minor Outlying 
  Islands</OPTION><OPTION value=UY>Uruguay</OPTION><OPTION 
  value=UZ>Uzbekistan</OPTION><OPTION value=VU>Vanuatu</OPTION><OPTION 
  value=VA>Vatican City</OPTION><OPTION value=VE>Venezuela</OPTION><OPTION 
  value=VN>Vietnam</OPTION><OPTION value=VG>Virgin Islands, 
  British</OPTION><OPTION value=VI>Virgin Islands, US</OPTION><OPTION 
  value=WF>Wallis and Futuna</OPTION><OPTION value=EH>Western 
  Sahara</OPTION><OPTION value=YE>Yemen</OPTION><OPTION 
  value=ZM>Zambia</OPTION><OPTION value=ZW>Zimbabwe</OPTION></SELECT> </DIV>
<DIV class=clear></DIV>
<DIV class="floatl col1"><LABEL for=BillZip>Zip/Postal&nbsp;Code</LABEL><SPAN 
class=Alert>*</SPAN> </DIV>
<DIV class=floatl><INPUT class=required id=BillZip 
title="Billing Zip/Postal Code" tabIndex=4 maxLength=10 name=BillZip> </DIV>
<DIV class=clear></DIV></DIV></FIELDSET> </FIELDSET> </DIV></DIV>

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Anon7 - 2021