{"id":15,"date":"2019-12-06T20:32:54","date_gmt":"2019-12-06T20:32:54","guid":{"rendered":"https:\/\/www.campsweeney.org\/dsm-5k\/?page_id=15"},"modified":"2019-12-17T15:30:37","modified_gmt":"2019-12-17T15:30:37","slug":"donate","status":"publish","type":"page","link":"https:\/\/campsweeney.org\/5k\/donate\/","title":{"rendered":"Donate"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_4' style='display:none'>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/5k\/wp-json\/wp\/v2\/pages\/15' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_4_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_2\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Donor Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_2'>\n                            \n                            <span id='input_4_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_4_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_4_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_4_34\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield--width-full gfield_price gfield_price_4_34 gfield_product_4_34 field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_34\" ><legend class='gfield_label gform-field-label' >Type of Donation<\/legend><div class='gfield_description' id='gfield_description_4_34'><i>Team Donation = support of a person on a team. Event Donation = support of the event.<\/i><\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_34'>\n\t\t\t<div class='gchoice gchoice_4_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Team Donation|0' checked='checked' id='choice_4_34_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_34\"   \/>\n\t\t\t\t\t<label for='choice_4_34_0' id='label_4_34_0' class='gform-field-label gform-field-label--type-inline'>Team Donation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Event Donation|0'  id='choice_4_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_34_1' id='label_4_34_1' class='gform-field-label gform-field-label--type-inline'>Event Donation<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_35\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield--width-full gfield_price gfield_price_4_35 gfield_product_4_35 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_35\" ><legend class='gfield_label gform-field-label' >Donation Amount<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_35'>\n\t\t\t<div class='gchoice gchoice_4_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='$10|10'  id='choice_4_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_0' id='label_4_35_0' class='gform-field-label gform-field-label--type-inline'>$10<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='$25|25'  id='choice_4_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_1' id='label_4_35_1' class='gform-field-label gform-field-label--type-inline'>$25<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_35_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='$50|50'  id='choice_4_35_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_2' id='label_4_35_2' class='gform-field-label gform-field-label--type-inline'>$50<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_35_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='$100|100'  id='choice_4_35_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_3' id='label_4_35_3' class='gform-field-label gform-field-label--type-inline'>$100<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_35_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='$250|250'  id='choice_4_35_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_4' id='label_4_35_4' class='gform-field-label gform-field-label--type-inline'>$250<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_35_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='$500|500'  id='choice_4_35_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_5' id='label_4_35_5' class='gform-field-label gform-field-label--type-inline'>$500<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_35_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='$1,000|1000'  id='choice_4_35_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_6' id='label_4_35_6' class='gform-field-label gform-field-label--type-inline'>$1,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_35_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Other|0'  id='choice_4_35_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_35_7' id='label_4_35_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_1\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_4_1 gfield_product_4_1 gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_1\" ><label class='gfield_label gform-field-label' for='input_4_1'>Other Donation Amount<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_1' id='input_4_1' type='text' value='' class='medium ginput_amount'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><div id=\"field_4_21\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_21\" ><div class='ginput_container ginput_container_text'><input name='input_21' id='input_4_21' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_4_23\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_4_23\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_23'>Name of TEAM or TEAM MEMBER you are sponsoring<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_23'><i>Team captains and individual team members have an opportunity to win prizes based on the amount of pledges they raise. <\/i><\/div><div class='ginput_container ginput_container_text'><input name='input_23' id='input_4_23' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_23\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_31\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_4_31\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_31'>Team Route Sign Details<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_31'>Sign fee $200.  Size 18\"x24\". Sign will be placed along the route to celebrate your runner and team. The runner will be able to take the sign home after the race. The sign fee will be added to your team's pledge total. The deadline to get a sign made is one week prior to the event\/Memorial Day. <br>\nWhat do you want your sign to say?  You can include a photo and wording. Here is a sample of what your sign could look like:<br> <img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-644\" src=\"http:\/\/campsweeney.org\/5k\/wp-content\/uploads\/sites\/31\/2021\/03\/Team-Route-Sign-sample-300x295.jpg\" alt=\"\" width=\"300\" height=\"295\" srcset=\"https:\/\/campsweeney.org\/5k\/wp-content\/uploads\/sites\/31\/2021\/03\/Team-Route-Sign-sample-300x295.jpg 300w, https:\/\/campsweeney.org\/5k\/wp-content\/uploads\/sites\/31\/2021\/03\/Team-Route-Sign-sample.jpg 527w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_4_31' class='textarea medium'  aria-describedby=\"gfield_description_4_31\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_4_3\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_3\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Donor Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_4_3_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_3_1' id='input_4_3_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_4_3_2_container' >\n                                        <input type='text' name='input_3.2' id='input_4_3_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_3_2' id='input_4_3_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_4_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_4_3_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_3_3' id='input_4_3_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_4_3_4_container' >\n                                        <input type='text' name='input_3.4' id='input_4_3_4' value=''      aria-required='true'    \/>\n                                        <label for='input_4_3_4' id='input_4_3_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_4_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_4_3_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_3_5' id='input_4_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_4_3_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_5\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_5\" ><label class='gfield_label gform-field-label' for='input_4_5'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_4_5' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_4\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_4\" ><label class='gfield_label gform-field-label' for='input_4_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_4_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_36\" ><legend class='gfield_label gform-field-label' >Remain Anonymous<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_36'>\n\t\t\t<div class='gchoice gchoice_4_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='No' checked='checked' id='choice_4_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_36_0' id='label_4_36_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Yes'  id='choice_4_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_36_1' id='label_4_36_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_27\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_27\" ><br><br><\/div><div id=\"field_4_12\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_4_12\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_12'>Donor \/ Cardholder Billing Street Address<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_4_12' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_13\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_4_13\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_13'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_4_13' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_14\" class=\"gfield gfield--type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_4_14\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_14'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_14' id='input_4_14' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='AL' >Alabama<\/option><option value='AK' >Alaska<\/option><option value='AZ' >Arizona<\/option><option value='AR' >Arkansas<\/option><option value='CA' >California<\/option><option value='CO' >Colorado<\/option><option value='CT' >Connecticut<\/option><option value='DE' >Delaware<\/option><option value='DC' >District of Columbia<\/option><option value='FL' >Florida<\/option><option value='GA' >Georgia<\/option><option value='HI' >Hawaii<\/option><option value='ID' >Idaho<\/option><option value='IL' >Illinois<\/option><option value='IN' >Indiana<\/option><option value='IA' >Iowa<\/option><option value='KS' >Kansas<\/option><option value='KY' >Kentucky<\/option><option value='LA' >Louisiana<\/option><option value='ME' >Maine<\/option><option value='MD' >Maryland<\/option><option value='MA' >Massachusetts<\/option><option value='MI' >Michigan<\/option><option value='MN' >Minnesota<\/option><option value='MS' >Mississippi<\/option><option value='MO' >Missouri<\/option><option value='MT' >Montana<\/option><option value='NE' >Nebraska<\/option><option value='NV' >Nevada<\/option><option value='NH' >New Hampshire<\/option><option value='NJ' >New Jersey<\/option><option value='NM' >New Mexico<\/option><option value='NY' >New York<\/option><option value='NC' >North Carolina<\/option><option value='ND' >North Dakota<\/option><option value='OH' >Ohio<\/option><option value='OK' >Oklahoma<\/option><option value='OR' >Oregon<\/option><option value='PA' >Pennsylvania<\/option><option value='RI' >Rhode Island<\/option><option value='SC' >South Carolina<\/option><option value='SD' >South Dakota<\/option><option value='TN' >Tennessee<\/option><option value='TX' selected='selected'>Texas<\/option><option value='UT' >Utah<\/option><option value='VT' >Vermont<\/option><option value='VA' >Virginia<\/option><option value='WA' >Washington<\/option><option value='WV' >West Virginia<\/option><option value='WI' >Wisconsin<\/option><option value='WY' >Wyoming<\/option><\/select><\/div><\/div><div id=\"field_4_15\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_4_15\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_15'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_4_15' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_16\" class=\"gfield gfield--type-total gfield_price gfield_price_4_ gfield_total gfield_total_4_ field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" data-js-reload=\"field_4_16\" ><label class='gfield_label gform-field-label' for='input_4_16'>Total Amount to be charged on your credit card today<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_16' id='input_4_16' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_4' \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_4_38\" class=\"gfield gfield--type-creditcard gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_38\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Credit Card<\/legend><div class='ginput_complex ginput_container ginput_container_creditcard gform-grid-row' id='input_4_38'><span class='ginput_full gform-grid-col' id='input_4_38_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 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class='gform-field-label gform-field-label--type-sub '>Expiration Date<\/legend>\n                                                <span class='ginput_card_expiration_container ginput_card_field gform-grid-row'>\n                                                   <span class='ginput_card_expiration_month_container gform-grid-col'>\n                                                       <label for='input_4_38_2_month' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                                       <select name='input_38.2[]' id='input_4_38_2_month'   class='ginput_card_expiration ginput_card_expiration_month' aria-required='false'  >\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                                                   <\/span>\n                                                   <span class='ginput_card_expiration_year_container gform-grid-col'>\n                                                       <label for='input_4_38_2_year' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                                       <select name='input_38.2[]' id='input_4_38_2_year'   class='ginput_card_expiration ginput_card_expiration_year' aria-required='false'  >\n                                                           <option value=''>Year<\/option><option value='2024' >2024<\/option><option value='2025' >2025<\/option><option value='2026' >2026<\/option><option value='2027' >2027<\/option><option value='2028' >2028<\/option><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>\n                                                       <\/select>\n                                                   <\/span>\n                                                <\/span>\n                                            <\/fieldset><span class='ginput_cardinfo_right gform-grid-col' id='input_4_38_2_cardinfo_right'>\n                                                <input type='text' 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