{"id":1225,"date":"2021-06-25T15:10:16","date_gmt":"2021-06-25T15:10:16","guid":{"rendered":"https:\/\/unitedhospiceinc.org\/?page_id=1225"},"modified":"2024-12-11T13:01:01","modified_gmt":"2024-12-11T18:01:01","slug":"donation","status":"publish","type":"page","link":"https:\/\/unitedhospiceinc.org\/es\/donation\/","title":{"rendered":"Hacer una donaci\u00f3n"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#00A7B5&#8243; da_disable_devices=&#8221;off|off|off&#8221; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;4.21.0&#8243; 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header_font_size_phone=&#8221;&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; custom_css_blurb_title=&#8221;text-transform:lowercase;&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Section&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;7af211a6-13cc-4618-bc82-e0946e847b4d&#8221; background_image=&#8221;https:\/\/unitedhospiceinc.org\/wp-content\/uploads\/2022\/01\/Giving-Hospice.png&#8221; parallax=&#8221;off&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_enable_color=&#8221;off&#8221; background_enable_image=&#8221;off&#8221; custom_padding=&#8221;75px||||false|false&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; module_alignment=&#8221;center&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#00A7B5&#8243; header_font_size=&#8221;55px&#8221; header_2_text_color=&#8221;#00a7b5&#8243; custom_margin=&#8221;||||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2><b>You are making a difference when time matters most!<\/b><\/h2>\n<p>Together we can bring more comfort, give more care, and honor more lives \u2013 regardless of someone\u2019s ability to pay.[\/et_pb_text][et_pb_code _builder_version=&#8221;4.24.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<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 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/es\/wp-json\/wp\/v2\/pages\/1225' data-formid='1' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdtafgqAAAAAACPK07hJsupFYCVThy5OilX4nB8' data-tabindex='0'><input id=\"input_d6940e429b33b630150a5335bca4b629\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_d6940e429b33b630150a5335bca4b629\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_1_61\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_61'><span class='gform-field-label__text'>Instagram<\/span><\/label><div class='gfield_description' id='gfield_description_1_61'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_61' id='input_1_61' type='text' value='' autocomplete='new-password'\/><\/div><\/div><fieldset id=\"field_1_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio type-of-donation gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Type of Donation<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_1'>\n\t\t\t<div class='gchoice gchoice_1_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='General\/Memorial Donation'  id='choice_1_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_0' id='label_1_1_0' class='gform-field-label gform-field-label--type-inline'>General\/Memorial Donation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Joe Raso Hospice Residence Donation'  id='choice_1_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_1' id='label_1_1_1' class='gform-field-label gform-field-label--type-inline'>Joe Raso Hospice Residence Donation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_1_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Bonnie Walsh Education Fund'  id='choice_1_1_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_2' id='label_1_1_2' class='gform-field-label gform-field-label--type-inline'>Bonnie Walsh Education Fund<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_1_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Robyn Herbst Complementary Therapy Fund'  id='choice_1_1_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_3' id='label_1_1_3' class='gform-field-label gform-field-label--type-inline'>Robyn Herbst Complementary Therapy Fund<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_1_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Jeffrey David Walerstein Walk of Honor'  id='choice_1_1_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_4' id='label_1_1_4' class='gform-field-label gform-field-label--type-inline'>Jeffrey David Walerstein Walk of Honor<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_1_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Harvey A Pachter Hospice Family Tree Plaque'  id='choice_1_1_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_5' id='label_1_1_5' class='gform-field-label gform-field-label--type-inline'>Harvey A Pachter Hospice Family Tree Plaque<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_1_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Veteran&#039;s Programming'  id='choice_1_1_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_6' id='label_1_1_6' class='gform-field-label gform-field-label--type-inline'>Veteran's Programming<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_1_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='United Kids'  id='choice_1_1_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_1_7' id='label_1_1_7' class='gform-field-label gform-field-label--type-inline'>United Kids<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_20\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield--width-full gfield_price gfield_price_1_20 gfield_product_1_20 gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Walk of Honor Options<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_20'>Special symbols add $100 per symbol.  Extra lines additional.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_20'>\n\t\t\t<div class='gchoice gchoice_1_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Small Square (8in x 8in) $350 - maximum of 18 spaces per line; maximum 6 lines|350'  id='choice_1_20_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_20\"   \/>\n\t\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0' class='gform-field-label gform-field-label--type-inline'>Small Square (8in x 8in) $350 - maximum of 18 spaces per line; maximum 6 lines<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Medium Rectangle (8in X 16in) $750 - maximum 22 spaces per line; maximum 6 lines|750'  id='choice_1_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>Medium Rectangle (8in X 16in) $750 - maximum 22 spaces per line; maximum 6 lines<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_21\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield--width-full gfield_price gfield_price_1_21 gfield_product_1_21 gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Pachter Family Tree Leaf &amp; Stone Options<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_21'>\n\t\t\t<div class='gchoice gchoice_1_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Silver Leaf: $250 (maximum 4 lines, 20 characters per line)|250'  id='choice_1_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_21_0' id='label_1_21_0' class='gform-field-label gform-field-label--type-inline'>Silver Leaf: $250 (maximum 4 lines, 20 characters per line)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Gold Leaf: $500 (maximum 4 lines, 20 characters per line)|500'  id='choice_1_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_21_1' id='label_1_21_1' class='gform-field-label gform-field-label--type-inline'>Gold Leaf: $500 (maximum 4 lines, 20 characters per line)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_21_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Small Stone: $1,000 (maximum 5 lines, 24 characters per line)|1000'  id='choice_1_21_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_21_2' id='label_1_21_2' class='gform-field-label gform-field-label--type-inline'>Small Stone: $1,000 (maximum 5 lines, 24 characters per line)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_21_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Large Stone: $2,500 (maximum 7 lines, 30 characters per line)|2500'  id='choice_1_21_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_21_3' id='label_1_21_3' class='gform-field-label gform-field-label--type-inline'>Large Stone: $2,500 (maximum 7 lines, 30 characters per line)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_3\" class=\"gfield gfield--type-product gfield--input-type-price gfield--width-full gfield_price gfield_price_1_3 gfield_product_1_3 gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'><span class='gform-field-label__text'>Donation Amount<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_3' id='input_1_3' type='text' value='' class='large ginput_amount'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><fieldset id=\"field_1_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to dedicate this donation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_16'>\n\t\t\t<div class='gchoice gchoice_1_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes - In honor of'  id='choice_1_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_16_0' id='label_1_16_0' class='gform-field-label gform-field-label--type-inline'>Yes - In honor of<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes - In memory of'  id='choice_1_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_16_1' id='label_1_16_1' class='gform-field-label gform-field-label--type-inline'>Yes - In memory of<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='No' checked='checked' id='choice_1_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_16_2' id='label_1_16_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_17'><span class='gform-field-label__text'>Dedication Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_1_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to notify someone about this donation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_4'>\n\t\t\t<div class='gchoice gchoice_1_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Yes - Notify by Mail'  id='choice_1_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_4_0' id='label_1_4_0' class='gform-field-label gform-field-label--type-inline'>Yes - Notify by Mail<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Yes - Notify by E-Mail'  id='choice_1_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_4_1' id='label_1_4_1' class='gform-field-label gform-field-label--type-inline'>Yes - Notify by E-Mail<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_4_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='No' checked='checked' id='choice_1_4_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_4_2' id='label_1_4_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Square Stone Inscription<\/h3><\/div><div id=\"field_1_29\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Please fill in the text that you would like on each line of the stone. You must fill in at least one line.  The rest of the lines are optional.<\/div><div id=\"field_1_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_23'><span class='gform-field-label__text'>Line 1<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='18' data-text-counter-template='{current} of {max} max characters'><input name='input_23' id='input_1_23' type='text' value='' class='large' maxlength='18'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_24'><span class='gform-field-label__text'>Line 2<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='18' data-text-counter-template='{current} of {max} max characters'><input name='input_24' id='input_1_24' type='text' value='' class='large' maxlength='18'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_25\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_25'><span class='gform-field-label__text'>Line 3<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='18' data-text-counter-template='{current} of {max} max characters'><input name='input_25' id='input_1_25' type='text' value='' class='large' maxlength='18'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_26'><span class='gform-field-label__text'>Line 4<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='18' data-text-counter-template='{current} of {max} max characters'><input name='input_26' id='input_1_26' type='text' value='' class='large' maxlength='18'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_27'><span class='gform-field-label__text'>Line 5<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='18' data-text-counter-template='{current} of {max} max characters'><input name='input_27' id='input_1_27' type='text' value='' class='large' maxlength='18'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_28'><span class='gform-field-label__text'>Line 6<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='18' data-text-counter-template='{current} of {max} max characters'><input name='input_28' id='input_1_28' type='text' value='' class='large' maxlength='18'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Rectangle Stone Inscription<\/h3><\/div><div id=\"field_1_38\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Please fill in the text that you would like on each line of the stone. You must fill in at least one line.  The rest of the lines are optional.<\/div><div id=\"field_1_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_32'><span class='gform-field-label__text'>Line 1<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='22' data-text-counter-template='{current} of {max} max characters'><input name='input_32' id='input_1_32' type='text' value='' class='large' maxlength='22'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_33'><span class='gform-field-label__text'>Line 2<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='22' data-text-counter-template='{current} of {max} max characters'><input name='input_33' id='input_1_33' type='text' value='' class='large' maxlength='22'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_34'><span class='gform-field-label__text'>Line 3<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='22' data-text-counter-template='{current} of {max} max characters'><input name='input_34' id='input_1_34' type='text' value='' class='large' maxlength='22'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_35'><span class='gform-field-label__text'>Line 4<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='22' data-text-counter-template='{current} of {max} max characters'><input name='input_35' id='input_1_35' type='text' value='' class='large' maxlength='22'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_36'><span class='gform-field-label__text'>Line 5<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='22' data-text-counter-template='{current} of {max} max characters'><input name='input_36' id='input_1_36' type='text' value='' class='large' maxlength='22'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_37'><span class='gform-field-label__text'>Line 6<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='22' data-text-counter-template='{current} of {max} max characters'><input name='input_37' id='input_1_37' type='text' value='' class='large' maxlength='22'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Leaf Inscription<\/h3><\/div><div id=\"field_1_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Please fill in the text that you would like on each line of the leaf. You must fill in at least one line.  The rest of the lines are optional.<\/div><div id=\"field_1_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_40'><span class='gform-field-label__text'>Line 1<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='20' data-text-counter-template='{current} of {max} max characters'><input name='input_40' id='input_1_40' type='text' value='' class='large' maxlength='20'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_41'><span class='gform-field-label__text'>Line 2<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='20' data-text-counter-template='{current} of {max} max characters'><input name='input_41' id='input_1_41' type='text' value='' class='large' maxlength='20'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_42'><span class='gform-field-label__text'>Line 3<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='20' data-text-counter-template='{current} of {max} max characters'><input name='input_42' id='input_1_42' type='text' value='' class='large' maxlength='20'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_43'><span class='gform-field-label__text'>Line 4<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='20' data-text-counter-template='{current} of {max} max characters'><input name='input_43' id='input_1_43' type='text' value='' class='large' maxlength='20'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Small Stone Inscription<\/h3><\/div><div id=\"field_1_59\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Please fill in the text that you would like on each line of the stone. You must fill in at least one line.  The rest of the lines are optional.<\/div><div id=\"field_1_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_46'><span class='gform-field-label__text'>Line 1<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='24' data-text-counter-template='{current} of {max} max characters'><input name='input_46' id='input_1_46' type='text' value='' class='large' maxlength='24'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_47'><span class='gform-field-label__text'>Line 2<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='24' data-text-counter-template='{current} of {max} max characters'><input name='input_47' id='input_1_47' type='text' value='' class='large' maxlength='24'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_48\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_48'><span class='gform-field-label__text'>Line 3<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='24' data-text-counter-template='{current} of {max} max characters'><input name='input_48' id='input_1_48' type='text' value='' class='large' maxlength='24'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_49'><span class='gform-field-label__text'>Line 4<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='24' data-text-counter-template='{current} of {max} max characters'><input name='input_49' id='input_1_49' type='text' value='' class='large' maxlength='24'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_50'><span class='gform-field-label__text'>Line 5<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='24' data-text-counter-template='{current} of {max} max characters'><input name='input_50' id='input_1_50' type='text' value='' class='large' maxlength='24'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Large Stone Inscription<\/h3><\/div><div id=\"field_1_60\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Please fill in the text that you would like on each line of the stone. You must fill in at least one line.  The rest of the lines are optional.<\/div><div id=\"field_1_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_52'><span class='gform-field-label__text'>Line 1<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='30' data-text-counter-template='{current} of {max} max characters'><input name='input_52' id='input_1_52' type='text' value='' class='large' maxlength='30'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_53'><span class='gform-field-label__text'>Line 2<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='30' data-text-counter-template='{current} of {max} max characters'><input name='input_53' id='input_1_53' type='text' value='' class='large' maxlength='30'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_54'><span class='gform-field-label__text'>Line 3<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='30' data-text-counter-template='{current} of {max} max characters'><input name='input_54' id='input_1_54' type='text' value='' class='large' maxlength='30'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_55'><span class='gform-field-label__text'>Line 4<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='30' data-text-counter-template='{current} of {max} max characters'><input name='input_55' id='input_1_55' type='text' value='' class='large' maxlength='30'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_56'><span class='gform-field-label__text'>Line 5<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='30' data-text-counter-template='{current} of {max} max characters'><input name='input_56' id='input_1_56' type='text' value='' class='large' maxlength='30'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_57\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_57'><span class='gform-field-label__text'>Line 6<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='30' data-text-counter-template='{current} of {max} max characters'><input name='input_57' id='input_1_57' type='text' value='' class='large' maxlength='30'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full woh-line field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_58'><span class='gform-field-label__text'>Line 7<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='30' data-text-counter-template='{current} of {max} max characters'><input name='input_58' id='input_1_58' type='text' value='' class='large' maxlength='30'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Notification Information<\/h3><\/div><fieldset id=\"field_1_6\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Notification Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_1_6'>\n                            \n                            <span id='input_1_6_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.3' id='input_1_6_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_6_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_6_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.6' id='input_1_6_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_6_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_7\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Notification Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_1_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_1_7_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_7_1' id='input_1_7_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_1_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_1_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_7_2' id='input_1_7_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_1_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_1_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_7_3' id='input_1_7_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_1_7_4_container' >\n                                        <select name='input_7.4' id='input_1_7_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_1_7_4' id='input_1_7_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_1_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_7_5' id='input_1_7_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_1_7_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_15\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_15'><span class='gform-field-label__text'>Notification E-Mail Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_1_15' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_1_8\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Who should we say has made the donation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_1_8'>\n                            \n                            <span id='input_1_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_1_8_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_8_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_1_8_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_8_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Donor Information<\/h3><\/div><fieldset id=\"field_1_10\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_1_10'>\n                            \n                            <span id='input_1_10_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.3' id='input_1_10_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_10_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_10_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.6' id='input_1_10_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_10_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_11\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_11'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_1_11' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_12' id='input_1_12' type='tel' value='' class='large'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_1_13\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \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_1_13' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_13_1_container' >\n                                        <input type='text' name='input_13.1' id='input_1_13_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_13_1' id='input_1_13_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_1_13_2_container' >\n                                        <input type='text' name='input_13.2' id='input_1_13_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_13_2' id='input_1_13_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_1_13_3_container' >\n                                    <input type='text' name='input_13.3' id='input_1_13_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_13_3' id='input_1_13_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_1_13_4_container' >\n                                        <input type='text' name='input_13.4' id='input_1_13_4' value=''      aria-required='true'    \/>\n                                        <label for='input_1_13_4' id='input_1_13_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_1_13_5_container' >\n                                    <input type='text' name='input_13.5' id='input_1_13_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_13_5' id='input_1_13_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_1_13_6_container' >\n                                        <select name='input_13.6' id='input_1_13_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/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='BQ' >Bonaire, Sint Eustatius and Saba<\/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='CV' >Cabo Verde<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/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 Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/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='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/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='GG' >Guernsey<\/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='VA' >Holy See<\/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<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;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&#039;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' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/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<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='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='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/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' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/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='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/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='SS' >South Sudan<\/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='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the 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' >T\u00fcrkiye<\/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='selected'>United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/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>\n                                        <label for='input_1_13_6' id='input_1_13_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><\/fieldset><div id=\"field_1_14\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_1_ gfield_total gfield_total_1_ field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_1_14'><span class='gform-field-label__text'>Total Donation<\/span><\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_14' id='input_1_14' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_1' \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_1_18\" class=\"gfield gfield--type-creditcard gfield--input-type-creditcard gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Credit Card Information<\/span><\/legend><div class='ginput_complex ginput_container ginput_container_creditcard gform-grid-row' id='input_1_18'><span class='ginput_full gform-grid-col' id='input_1_18_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_1_18_supported_creditcards'>Supported Credit Cards: American Express, Discover, MasterCard, Visa<\/span><\/div>\n                                    <input type='text' name='input_18.1' id='input_1_18_1' value=''   onchange='gformMatchCard(\"input_1_18_1\");' onkeyup='gformMatchCard(\"input_1_18_1\");' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='false'  \/>\n                                    <label for='input_1_18_1' id='input_1_18_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_1_18_2_container'>\n                                            <fieldset class='ginput_cardinfo_left gform-grid-col' id='input_1_18_2_cardinfo_left'>\n                                            <legend 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_1_18_2_month' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                                       <select name='input_18.2[]' id='input_1_18_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_1_18_2_year' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                                       <select name='input_18.2[]' id='input_1_18_2_year'   class='ginput_card_expiration ginput_card_expiration_year' aria-required='false'  >\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                                                   <\/span>\n                                                <\/span>\n                                            <\/fieldset><span class='ginput_cardinfo_right gform-grid-col' id='input_1_18_2_cardinfo_right'>\n                                                <input type='text' name='input_18.3' id='input_1_18_3'   class='ginput_card_security_code' value='' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='false'  \/>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                                <label for='input_1_18_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_1_18_5_container'>\n                                            <input type='text' name='input_18.5' id='input_1_18_5' value=''    aria-required='false'  \/>\n                                            <label for='input_1_18_5' id='input_1_18_5_label' class='gform-field-label gform-field-label--type-sub '>Cardholder Name<\/label>\n                                        <\/span> <\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Donate Now<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='Z7lZgCfklYkGbl\/gLTjhUVrCeCgEpueMWygAd3\/ffKXSLu0Crkhh3sueXzV22zaBXu5PS0s3upZsVOaM1gVdEd5VFEWH9WbuPmYDjR9Ank1ght0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' 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da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; module_alignment=&#8221;center&#8221; custom_padding=&#8221;41px|||||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#00A7B5&#8243; header_2_text_color=&#8221;#00A7B5&#8243; text_orientation=&#8221;center&#8221; custom_margin=&#8221;||||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2><b>Thank you!<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">United Hospice is a community-based, 501(c)(3) not-for-profit hospice, Tax ID.: 13-3425315<\/span><\/p>\n<p><span style=\"font-weight: 400;\">We respect the privacy of our donors and will not share your information with anyone.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Your donation is tax-deductible to the full extent of the law.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For more information, please contact our Development Team at <a href=\"mailto:develpment@unitedhospiceinc.org\">development@unitedhospiceinc.org<\/a> or <\/span><\/p>\n<p><span style=\"font-weight: 400;\"><a href=\"tel:8456344874\">845-634-4974.<\/a>\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">You will receive an acknowledgement for this donation by email, which you may use for tax purposes.<\/span><\/i><i><span style=\"font-weight: 400;\"><\/span><\/i><\/p>\n<p><i><\/i><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Usted marca la diferencia cuando el tiempo es m\u00e1s 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