{"id":36,"date":"2016-10-20T19:46:41","date_gmt":"2016-10-20T19:46:41","guid":{"rendered":"http:\/\/www.drvc.org\/donate\/?page_id=36"},"modified":"2023-08-18T13:20:22","modified_gmt":"2023-08-18T13:20:22","slug":"st-pius-donation-form","status":"publish","type":"page","link":"https:\/\/www.drvc.org\/donate\/st-pius-donation-form\/","title":{"rendered":"St. Pius Donation Form"},"content":{"rendered":"<p>\u00a0<\/p>\n<p><a href=\"https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-193\" src=\"https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"483\" srcset=\"https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-scaled.jpg 2560w, https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-300x57.jpg 300w, https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-1024x193.jpg 1024w, https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-768x145.jpg 768w, https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-1536x290.jpg 1536w, https:\/\/www.drvc.org\/donate\/wp-content\/uploads\/2023\/08\/St-Pius-X-23-web-banner-P3-1-2048x386.jpg 2048w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\" \/><\/a><\/p>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_7' ><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/donate\/wp-json\/wp\/v2\/pages\/36' data-formid='7' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_7_20\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_20\" ><p><strong>The mission of St. Pius X Residence is to provide a nurturing environment that respects and cherishes the lifelong commitment of our beloved priests. The Residence strives to create a warm and supportive community where they can enjoy their retirement years with dignity, surrounded by like-minded individuals who share their dedication to faith.<\/strong><\/p><\/li><li id=\"field_7_8\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_7_8 gfield_product_7_8 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_8\" ><label class='gfield_label gform-field-label' for='input_7_8'>I wish to make a one time gift of<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_8' id='input_7_8' type='text' value='' class='medium ginput_amount'  placeholder='$' aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_7_10\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_10\" ><h2 class=\"gsection_title\">Parish Information<\/h2><\/li><li id=\"field_7_12\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_12\" ><label class='gfield_label gform-field-label' for='input_7_12'>Parish Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_7_12' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please Select Parish' >Please Select Parish<\/option><option value='No Parish Affiliation' >No Parish Affiliation<\/option><option value='Assumption of the Blessed Virgin Mary Church, Centereach' >Assumption of the Blessed Virgin Mary Church, Centereach<\/option><option value='Blessed Sacrament Church, Valley Stream' >Blessed Sacrament Church, Valley Stream<\/option><option value='Christ the King Church, Commack,' >Christ the King Church, Commack,<\/option><option value='Church of the Holy Cross, Nesconset' >Church of the Holy Cross, Nesconset<\/option><option value='Church of the Resurrection, Farmingville' >Church of the Resurrection, Farmingville<\/option><option value='Corpus Christi Church, Mineola' >Corpus Christi Church, Mineola<\/option><option value='Cure of Ars Church, Merrick' >Cure of Ars Church, Merrick<\/option><option value='Good Shepherd Church, Holbrook' >Good Shepherd Church, Holbrook<\/option><option value='Holy Family Church, Hicksville' >Holy Family Church, Hicksville<\/option><option value='Holy Name of Jesus Church, Woodbury' >Holy Name of Jesus Church, Woodbury<\/option><option value='Holy Name of Mary Church, Valley Stream' >Holy Name of Mary Church, Valley Stream<\/option><option value='Holy Spirit Church, New Hyde Park' >Holy Spirit Church, New Hyde Park<\/option><option value='Immaculate Conception Church, Westhampton Beach' >Immaculate Conception Church, Westhampton Beach<\/option><option value='Infant Jesus Church, Port Jefferson' >Infant Jesus Church, Port Jefferson<\/option><option value='Maria Regina Church, Seaford' >Maria Regina Church, Seaford<\/option><option value='Mary Immaculate Church, Bellport' >Mary Immaculate Church, Bellport<\/option><option value='Most Holy Trinity Church, East Hampton' >Most Holy Trinity Church, East Hampton<\/option><option value='Notre Dame Church, New Hyde Park' >Notre Dame Church, New Hyde Park<\/option><option value='Our Holy Redeemer Church, Freeport' >Our Holy Redeemer Church, Freeport<\/option><option value='Our Lady of Fatima Church, Port Washington' >Our Lady of Fatima Church, Port Washington<\/option><option value='Our Lady of Good Counsel Church, Inwood' >Our Lady of Good Counsel Church, Inwood<\/option><option value='Our Lady of Grace Church, West Babylon' >Our Lady of Grace Church, West Babylon<\/option><option value='Our Lady of Hope Church, Carle Place' >Our Lady of Hope Church, Carle Place<\/option><option value='Our Lady of Loretto Church, Hempstead' >Our Lady of Loretto Church, Hempstead<\/option><option value='Our Lady of Lourdes Church, Malverne' >Our Lady of Lourdes Church, Malverne<\/option><option value='Our Lady of Lourdes Church, Massapequa Park' >Our Lady of Lourdes Church, Massapequa Park<\/option><option value='Our Lady of Lourdes Church, West Islip' >Our Lady of Lourdes Church, West Islip<\/option><option value='Our Lady of Mercy Church, Hicksville' >Our Lady of Mercy Church, Hicksville<\/option><option value='Our Lady of Miraculous Medal Church, Point Lookout' >Our Lady of Miraculous Medal Church, Point Lookout<\/option><option value='Our Lady of Miraculous Medal Church, Wyandanch' >Our Lady of Miraculous Medal Church, Wyandanch<\/option><option value='Our Lady of Mount Carmel Church, Patchogue' >Our Lady of Mount Carmel Church, Patchogue<\/option><option value='Our Lady of Ostrabrama Church, Cutchogue' >Our Lady of Ostrabrama Church, Cutchogue<\/option><option value='Our Lady of Peace Church, Lynbrook' >Our Lady of Peace Church, Lynbrook<\/option><option value='Our Lady of Perpetual Help Church, Lindenhurst' >Our Lady of Perpetual Help Church, Lindenhurst<\/option><option value='Our Lady of Poland Church, Southampton' >Our Lady of Poland Church, Southampton<\/option><option value='Our Lady of the Assumption Church, Copiague' >Our Lady of the Assumption Church, Copiague<\/option><option value='Our Lady of the Isle Church, Shelter Island Heights' >Our Lady of the Isle Church, Shelter Island Heights<\/option><option value='Our Lady of the Snow Church, Blue Point' >Our Lady of the Snow Church, Blue Point<\/option><option value='Our Lady of Victory Church, Floral Park' >Our Lady of Victory Church, Floral Park<\/option><option value='Our Lady Queen of Martyrs Church, Centerport' >Our Lady Queen of Martyrs Church, Centerport<\/option><option value='Queen of the Most Holy Rosary Church, Bridgehampton' >Queen of the Most Holy Rosary Church, Bridgehampton<\/option><option value='Queen of the Most Holy Rosary Church, Roosevelt' >Queen of the Most Holy Rosary Church, Roosevelt<\/option><option value='Sacred Heart Church, Cutchogue' >Sacred Heart Church, Cutchogue<\/option><option value='Sacred Heart Church, Island Park' >Sacred Heart Church, Island Park<\/option><option value='Sacred Heart Church, North Merrick' >Sacred Heart Church, North Merrick<\/option><option value='Sacred Hearts of Jesus &amp; Mary Church, Southampton' >Sacred Hearts of Jesus &amp; Mary Church, Southampton<\/option><option value='Saints Peter &amp; Paul Church, Manorville' >Saints Peter &amp; Paul Church, Manorville<\/option><option value='Saints Philip &amp; James Church, St. James' >Saints Philip &amp; James Church, St. James<\/option><option value='SS. Cyril &amp; Methodius Church, Deer Park' >SS. Cyril &amp; Methodius Church, Deer Park<\/option><option value='St. Agnes Cathedral, Rockville Centre' >St. Agnes Cathedral, Rockville Centre<\/option><option value='St. Agnes Church, Greenport' >St. Agnes Church, Greenport<\/option><option value='St. Aidan Church, Williston Park,' >St. Aidan Church, Williston Park,<\/option><option value='St. Aloysius Church, Great Neck,' >St. Aloysius Church, Great Neck,<\/option><option value='St. Andrew Church, Sag Harbor' >St. Andrew Church, Sag Harbor<\/option><option value='St. Anne Church, Brentwood' >St. Anne Church, Brentwood<\/option><option value='St. Anne Church, Garden City' >St. Anne Church, Garden City<\/option><option value='St. Anthony Church, Oceanside' >St. Anthony Church, Oceanside<\/option><option value='St. Anthony of Padua Church, East Northport' >St. Anthony of Padua Church, East Northport<\/option><option value='St. Anthony of Padua Church, Rocky Point' >St. Anthony of Padua Church, Rocky Point<\/option><option value='St. Barnabas the Apostle Church, Bellmore' >St. Barnabas the Apostle Church, Bellmore<\/option><option value='St. Bernard Church, Levittown' >St. Bernard Church, Levittown<\/option><option value='St. Boniface Church, Elmont' >St. Boniface Church, Elmont<\/option><option value='St. Boniface Martyr Church, Sea Cliff' >St. Boniface Martyr Church, Sea Cliff<\/option><option value='St. Brigid Church, Westbury' >St. Brigid Church, Westbury<\/option><option value='St. Catherine of Sienna Church, Franklin Square' >St. Catherine of Sienna Church, Franklin Square<\/option><option value='St. Christopher Church, Baldwin' >St. Christopher Church, Baldwin<\/option><option value='St. Dominic Church, Oyster Bay' >St. Dominic Church, Oyster Bay<\/option><option value='St. Edward the Confessor Church, Syosset' >St. Edward the Confessor Church, Syosset<\/option><option value='St. Elizabeth Ann Seton Church, Lake Ronkonkoma' >St. Elizabeth Ann Seton Church, Lake Ronkonkoma<\/option><option value='St. Elizabeth Church, Melville' >St. Elizabeth Church, Melville<\/option><option value='St. Frances Cabrini Church, Coram' >St. Frances Cabrini Church, Coram<\/option><option value='St. Frances de Chantal Church, Wantagh' >St. Frances de Chantal Church, Wantagh<\/option><option value='St. Francis de Sales Church, Patchogue' >St. Francis de Sales Church, Patchogue<\/option><option value='St. Francis of Assisi Church, Greenlawn' >St. Francis of Assisi Church, Greenlawn<\/option><option value='St. Gerard Majella Church, Port Jefferson Station' >St. Gerard Majella Church, Port Jefferson Station<\/option><option value='St. Gertrude Church, Bayville' >St. Gertrude Church, Bayville<\/option><option value='St. Hedwig Church, Floral Park' >St. Hedwig Church, Floral Park<\/option><option value='St. Hugh of Lincoln Church, Huntington Station' >St. Hugh of Lincoln Church, Huntington Station<\/option><option value='St. Hyacinth Church, Glen Head' >St. Hyacinth Church, Glen Head<\/option><option value='St. Ignatius Loyola Church, Hicksville' >St. Ignatius Loyola Church, Hicksville<\/option><option value='St. Ignatius Martyr Church, Long Beach' >St. Ignatius Martyr Church, Long Beach<\/option><option value='St. Isidore Church, Riverhead' >St. Isidore Church, Riverhead<\/option><option value='St. James Church, Seaford' >St. James Church, Seaford<\/option><option value='St. James Church, Setauket' >St. James Church, Setauket<\/option><option value='St. Joachim Church, Cedarhurst' >St. Joachim Church, Cedarhurst<\/option><option value='St. John Nepomucene Church, Bohemia' >St. John Nepomucene Church, Bohemia<\/option><option value='St. John of God Church, Central Islip' >St. John of God Church, Central Islip<\/option><option value='St. John the Baptist Church, Wading River' >St. John the Baptist Church, Wading River<\/option><option value='St. John the Evangelist Church, Center Moriches' >St. John the Evangelist Church, Center Moriches<\/option><option value='St. John the Evangelist Church, Riverhead' >St. John the Evangelist Church, Riverhead<\/option><option value='St. Joseph Church, Babylon' >St. Joseph Church, Babylon<\/option><option value='St. Joseph Church, Garden City' >St. Joseph Church, Garden City<\/option><option value='St. Joseph Church, Hewlett' >St. Joseph Church, Hewlett<\/option><option value='St. Joseph Church, Kings Park' >St. Joseph Church, Kings Park<\/option><option value='St. Joseph Church, Ronkonkoma' >St. Joseph Church, Ronkonkoma<\/option><option value='St. Joseph the Worker Church, East Patchogue' >St. Joseph the Worker Church, East Patchogue<\/option><option value='St. Jude Church, Mastic Beach' >St. Jude Church, Mastic Beach<\/option><option value='St. Kilian Church, Farmingdale' >St. Kilian Church, Farmingdale<\/option><option value='St. Ladislaus Church, Hempstead' >St. Ladislaus Church, Hempstead<\/option><option value='St. Lawrence the Martyr Church, Sayville' >St. Lawrence the Martyr Church, Sayville<\/option><option value='St. Louis de Montfort Church, Sound Beach' >St. Louis de Montfort Church, Sound Beach<\/option><option value='St. Luke Church, Brentwood' >St. Luke Church, Brentwood<\/option><option value='St. Margaret of Scotland Church, Selden' >St. Margaret of Scotland Church, Selden<\/option><option value='St. Mark Church, Shoreham' >St. Mark Church, Shoreham<\/option><option value='St. Martha Church, Uniondale' >St. Martha Church, Uniondale<\/option><option value='St. Martin of Tours Church, Amityville' >St. Martin of Tours Church, Amityville<\/option><option value='St. Martin of Tours Church, Bethpage' >St. Martin of Tours Church, Bethpage<\/option><option value='St. Mary Church, East Islip' >St. Mary Church, East Islip<\/option><option value='St. Mary Church, Manhasset' >St. Mary Church, Manhasset<\/option><option value='St. Mary Church, Roslyn' >St. Mary Church, Roslyn<\/option><option value='St. Mary of the Isle Church, Long Beach' >St. Mary of the Isle Church, Long Beach<\/option><option value='St. Matthew Church, Dix Hills' >St. Matthew Church, Dix Hills<\/option><option value='St. Patrick Church, Bay Shore' >St. Patrick Church, Bay Shore<\/option><option value='St. Patrick Church, Glen Cove' >St. Patrick Church, Glen Cove<\/option><option value='St. Patrick Church, Huntington' >St. Patrick Church, Huntington<\/option><option value='St. Patrick Church, Smithtown' >St. Patrick Church, Smithtown<\/option><option value='St. Patrick Church, Southold' >St. Patrick Church, Southold<\/option><option value='St. Paul the Apostle Church, Brookville' >St. Paul the Apostle Church, Brookville<\/option><option value='St. Peter of Alcantara Church, Port Washington' >St. Peter of Alcantara Church, Port Washington<\/option><option value='St. Peter the Apostle Church, Islip Terrace' >St. Peter the Apostle Church, Islip Terrace<\/option><option value='St. Philip Neri Church, Northport' >St. Philip Neri Church, Northport<\/option><option value='St. Pius X Church, Plainview' >St. Pius X Church, Plainview<\/option><option value='St. Raphael Church, East Meadow' >St. Raphael Church, East Meadow<\/option><option value='St. Raymond Church, East Rockaway' >St. Raymond Church, East Rockaway<\/option><option value='St. Rocco Church, Glen Cove' >St. Rocco Church, Glen Cove<\/option><option value='St. Rosalie Church, Hampton Bays' >St. Rosalie Church, Hampton Bays<\/option><option value='St. Rose of Lima Church, Massapequa' >St. Rose of Lima Church, Massapequa<\/option><option value='St. Sylvester Church, Medford' >St. Sylvester Church, Medford<\/option><option value='St. Therese of Lisieux Church, Montauk' >St. Therese of Lisieux Church, Montauk<\/option><option value='St. Thomas More Church, Hauppauge' >St. Thomas More Church, Hauppauge<\/option><option value='St. Thomas the Apostle Church, West Hempstead,' >St. Thomas the Apostle Church, West Hempstead,<\/option><option value='St. William the Abbot Church, Seaford' >St. William the Abbot Church, Seaford<\/option><\/select><\/div><\/li><li id=\"field_7_11\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_11\" ><label class='gfield_label gform-field-label' for='input_7_11'>Parish Account<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_7_11' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_13\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_13\" ><h2 class=\"gsection_title\">Billing Information<\/h2><div class='gsection_description' id='gfield_description_7_13'>Please note: We will never sell your name or confidential information to anyone.<\/div><\/li><li id=\"field_7_14\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_14\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_14'>\n                            <span id='input_7_14_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_14.2' id='input_7_14_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Miss' >Miss<\/option><option value='Ms.' >Ms.<\/option><option value='Dr.' >Dr.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_7_14_2' class='gform-field-label gform-field-label--type-sub '>Prefix<\/label>\n                                                  <\/span>\n                            <span id='input_7_14_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.3' id='input_7_14_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_14_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_7_14_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.6' id='input_7_14_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_14_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_5\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_5\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_7_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_7_5_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_5_1' id='input_7_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_5_2_container' >\n                                        <input type='text' name='input_5.2' id='input_7_5_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_5_2' id='input_7_5_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_7_5_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_5_3' id='input_7_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_7_5_4_container' >\n                                        <input type='text' name='input_5.4' id='input_7_5_4' value=''      aria-required='true'    \/>\n                                        <label for='input_7_5_4' id='input_7_5_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_7_5_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_5_5' id='input_7_5_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_7_5_6_container' >\n                                        <select name='input_5.6' id='input_7_5_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_7_5_6' id='input_7_5_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_7_3\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_3\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_7_3_container'>\n                                <span id='input_7_3_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3' id='input_7_3' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_7_3' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_7_3_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3_2' id='input_7_3_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_7_3_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_7_4\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_4\" ><label class='gfield_label gform-field-label' for='input_7_4'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_7_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_15\" class=\"gfield gfield--type-creditcard gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_15\" ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_7_15_1'>Credit Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_creditcard gform-grid-row' id='input_7_15'><span class='ginput_full gform-grid-col' id='input_7_15_1_container' >\n                                    <div class='gform_card_icon_container'><div class='gform_card_icon gform_card_icon_amex' >American Express<\/div><div class='gform_card_icon gform_card_icon_discover' >Discover<\/div><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard<\/div><div class='gform_card_icon gform_card_icon_visa' >Visa<\/div><span class='screen-reader-text' id='field_7_15_supported_creditcards'>Supported Credit Cards: American Express, Discover, MasterCard, Visa<\/span><\/div>\n                                    <input type='text' name='input_15.1' id='input_7_15_1' value=''   onchange='gformMatchCard(\"input_7_15_1\");' onkeyup='gformMatchCard(\"input_7_15_1\");' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='true'  \/>\n                                    <label for='input_7_15_1' id='input_7_15_1_label' class='gform-field-label gform-field-label--type-sub '>Card Number<\/label>\n                                 <\/span><span class='ginput_full ginput_cardextras gform-grid-col gform-grid-row' id='input_7_15_2_container'>\n                                            <span class='ginput_cardinfo_left' id='input_7_15_2_cardinfo_left'>\n                                                <span class='ginput_card_expiration_container ginput_card_field'>\n                                                    \n                                                       <select name='input_15.2[]' id='input_7_15_2_month'   class='ginput_card_expiration ginput_card_expiration_month' aria-required='true'  >\n                                                           <option value=''>Month<\/option><option value='1' >01<\/option><option value='2' >02<\/option><option value='3' >03<\/option><option value='4' >04<\/option><option value='5' >05<\/option><option value='6' >06<\/option><option value='7' >07<\/option><option value='8' >08<\/option><option value='9' >09<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option>\n                                                       <\/select>\n                                                       \n                                                   \n                                                   \n                                                       <select name='input_15.2[]' id='input_7_15_2_year'   class='ginput_card_expiration ginput_card_expiration_year' aria-required='true'  >\n                                                           <option value=''>Year<\/option><option value='2026' >2026<\/option><option value='2027' >2027<\/option><option value='2028' >2028<\/option><option value='2029' >2029<\/option><option value='2030' >2030<\/option><option value='2031' >2031<\/option><option value='2032' >2032<\/option><option value='2033' >2033<\/option><option value='2034' >2034<\/option><option value='2035' >2035<\/option><option value='2036' >2036<\/option><option value='2037' >2037<\/option><option value='2038' >2038<\/option><option value='2039' >2039<\/option><option value='2040' >2040<\/option><option value='2041' >2041<\/option><option value='2042' >2042<\/option><option value='2043' >2043<\/option><option value='2044' >2044<\/option><option value='2045' >2045<\/option>\n                                                       <\/select>\n                                                       \n                                                       \n                                                <\/span>\n                                                 <label for='input_7_15_2_month' class='gform-field-label gform-field-label--type-sub '>Expiration Date<\/label>\n                                            <\/span><span class='ginput_cardinfo_right gform-grid-col' id='input_7_15_2_cardinfo_right'>\n                                                <input type='text' name='input_15.3' id='input_7_15_3'   class='ginput_card_security_code' value='' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='true'  \/>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                                <label for='input_7_15_3' class='gform-field-label gform-field-label--type-sub '>Security Code<\/label>\n                                             <\/span>\n                                        <\/span><span class='ginput_full gform-grid-col' id='input_7_15_5_container'>\n                                            <input type='text' name='input_15.5' id='input_7_15_5' value=''    aria-required='false'  \/>\n                                            <label for='input_7_15_5' id='input_7_15_5_label' class='gform-field-label gform-field-label--type-sub '>Cardholder Name<\/label>\n                                        <\/span> <\/div><\/li><li id=\"field_7_16\" class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_16\" ><label class='gfield_label gform-field-label' for='input_7_16'>Captcha<\/label><div id='input_7_16' class='ginput_container ginput_recaptcha' data-sitekey='6LeJShATAAAAAKlFHRn9lkQFN_HxRQOWk5CpSU1b'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/li><li id=\"field_7_21\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_21\" >THANK YOU FOR YOUR GIFT AND SUPPORTING THE COMMUNITY AROUND US.<\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_7' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_7' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_7' id='gform_theme_7' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_7' id='gform_style_settings_7' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_7' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='7' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_7' value='WyJbXSIsIjAxODI4NjE0MzU1YzIwZmFjOWU3ZmZiMzc1NmZmMTNmIl0=' \/>\n            <input type='hidden' 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