{% if page.headline.size > 0 %}

{{ page.headline }}

{% endif %} {% if page.donation_v2.content.size > 0 %} {% endif %} {% if page.donation_v2.has_amount_goal? %} {% elsif page.donation_v2.has_donor_goal? %} {% endif %} {% if page.show_social_slider? and page.public_activities_count > 0 %} {% include "social_slider" class:"slider--no-gradient" %}

---

{% endif %} {% form_for donation %} {% if page.donation_v2.has_merchant_account? == false %} {% elsif page.donation_v2.merchant_account.is_test_mode? %} {% endif %}

{% unless request.current_order %} {% unless page.donation_v2.amount_in_cents != 0 %}

Select an amount

{% endunless %} {% endunless %} {% if page.donation_v2.show_frequency_radio_buttons? %}

{{ page.donation_v2.monthly_recurring_radio_buttons }}

{% endif %} {% if request.current_order %}

{% for item in request.current_order.items %} {% if item.num_time_periods and item.time_period_type %} {% endif %} {% endfor %}

Your order

Quantity	Name	Amount
{{ item.quantity }}	{{ item.name }}	{{ item.amount }}	billed automatically every {{ item.num_time_periods }} {{item.time_period_type }}
Total: {{ page.donation_v2.ticket_purchase_total }}

Click here to clear your order.

{% else %}

{% if page.donation_v2.amount_in_cents != 0 %} {{ page.donation_v2.amount_formatted }} {% if page.donation_v2.donation_frequency == "one-time" %} {% elsif page.donation_v2.donation_frequency == "monthly" %} paid monthly {% elsif page.donation_v2.donation_frequency == "annual" %} paid annually {% else %} {% if page.donation_v2.interval_monthly? %}paid test monthly{% endif %} {% endif %} {% else %}

{{ page.donation_v2.form_amount_options }}

{% endif %}

{% if page.donation_v2.accepts_variable_amounts? %}

{{ page.donation_v2.amount_other }}

{% endif %}

{% endif %}

---

Pay With

Please select or enter an amount

Payment method information has been saved. Change payment method

{% payment_field 'payments' %}

If you use Apple Pay, your confirmation prompt may refer to our payment processor, "NationBuilder"

Your Information

First Name* {% text_field "first_name", class:"text form-control", required:"required" %}

Last Name* {% text_field "last_name", class:"text form-control", required:"required" %}

Email* {% email_field "email", class:"text form-control", required:"required" %}

Phone number* {% phone_field "billing_address.phone_number", class:"text form-control", required:"required" %}

{% unless page.show_consent_form? %}

{% check_box "email_opt_in", class:"custom-control-input checkbox" %} Send email updates

{% endunless %}

Address line 1* {% text_field "billing_address.address1", class:"text form-control", required:"required" %}

Address line 2 {% text_field "billing_address.address2", class:"text form-control" %}

Address line 3 {% text_field "billing_address.address3", class:"text not-us-or-canada hide form-control" %}

Country {% select_field "billing_address.country_code", page.donation_v2.countries, "code", "name", class:"custom-select", required:"required" %}

City* {% text_field "billing_address.city", class:"text form-control", required:"required" %}

State* {% select_field "billing_address.state", page.donation_v2.us_states, "code", "name", class:"custom-select", required:"required" %}

Province* {% text_field "billing_address.state", class:"text form-control", required:"required" %}

Zip* {% text_field "billing_address.zip", class:"text form-control", required:"required" %}

{% for cf in custom_fields.donation %} {% assign custom_field = cf[1] %} {% assign custom_field_id = 'custom_values.' | append: custom_field.slug %} {% endfor %} {% if page.donation_v2.merchant_account.is_employer_and_occupation_required? %}

---

Employer Information

Law requires we ask for your employer and occupation. If you do not have an employer or are retired, check "I do not have an employer". If you are self-employed put "self-employed" in employer and describe your occupation.

{% check_box "no_employer", class:"custom-control-input checkbox" %} I do not have an employer

Employer* {% text_field "employer", class:"text form-control", required:"required" %}

Occupation* {% text_field "occupation", class:"text form-control", required:"required" %}

{% if page.donation_v2.merchant_account.is_employer_address_required? or page.donation_v2.merchant_account.is_employer_city_required? %} {% if page.donation_v2.merchant_account.is_employer_address_required? %}

Employer address line 1* {% text_field "work_address.address1", class:"text form-control", required:"required" %}

Employer address line 2 {% text_field "work_address.address2", class:"text form-control" %}

Employer address line 3 {% text_field "work_address.address3", class:"text not-us-or-canada hide form-control" %}

{% endif %}

Employer Country* {% select_field "work_address.country_code", page.donation_v2.countries, "code", "name", class:"custom-select", required:"required" %}

Employer City* {% text_field "work_address.city", class:"text form-control", required:"required" %}

State/Province* {% text_field "work_address.state", class:"text form-control", required:"required" %}

Zip* {% text_field "work_address.zip", class:"text form-control", required:"required" %}

{% endif %} {% endif %} {% if page.donation_v2.merchant_account.is_corporate_contribution_required? %}

{% check_box "is_corporate_contribution", class:"custom-control-input checkbox" %} This is a contribution from a business.

{% endif %} {% if page.donation_v2.merchant_account.is_taxable? %}

Contributions are not tax deductible.

{% else %}

Contributions are tax deductible.

{% endif %}

---

{% if page.donation_v2.merchant_account.has_contribution_rules? %} {% endif %} {% if site.ask_to_publish_to_stream? and page.show_stream? %} {% endif %} {% if page.show_consent_form? %} {% endif %} {% endform_for %}