{"id":5891,"date":"2022-09-15T14:10:01","date_gmt":"2022-09-15T18:10:01","guid":{"rendered":"https:\/\/henryjaustin.org\/donate-copy-3\/"},"modified":"2022-09-15T14:10:01","modified_gmt":"2022-09-15T18:10:01","slug":"donate-copy-3","status":"publish","type":"page","link":"https:\/\/henryjaustin.org\/es\/donate-copy-3\/","title":{"rendered":"Donar copia"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div class=\"webique_vc_row_wrap webique_general_colors\"><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"wpb_column vc_column_container vc_col-sm-8\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"vc_empty_space\"   style=\"height: 42px\"><span class=\"vc_empty_space_inner\"><\/span><\/div>\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h3>Donate Online<\/h3>\n<p>Our secure online donation form makes it easy to donate with a credit card. Your gift supports Henry J. Austin Health Center patients throughout the year, and helps us provide quality healthcare to those with less resources.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_3' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/es\/wp-json\/wp\/v2\/pages\/5891' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_3_29\" 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_3_29'>URL<\/label><div class='gfield_description' id='gfield_description_3_29'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_29' id='input_3_29' type='text' value='' autocomplete='new-password'\/><\/div><\/li><li id=\"field_3_16\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_16 gfield_product_3_16 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_3_16'>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_16' id='input_3_16' type='text' value='' class='medium ginput_amount'  placeholder='$ Enter donation amount' aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_28\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Would you like to make an even greater impact with a recurring gift?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_28'><li class='gchoice gchoice_3_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Yes, please renew my donation each month'  id='choice_3_28_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_28_1' id='label_3_28_1' class='gform-field-label gform-field-label--type-inline'>Yes, please renew my donation each month<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_1\" class=\"gfield gfield--type-name 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 gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name 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_3_1'>\n                            <span id='input_3_1_3_container' class='name_first gform-grid-col' >\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='true'    \/>\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                               <\/span>\n                            <span id='input_3_1_6_container' class='name_last gform-grid-col' >\n                                                    <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='true'    \/>\n                                                    <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/li><li id=\"field_3_2\" class=\"gfield gfield--type-address 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 gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_3_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_3_2_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_2_1' id='input_3_2_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_3_2_2_container' >\n                                        <input type='text' name='input_2.2' id='input_3_2_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_2_2' id='input_3_2_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_3_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_3_2_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_2_3' id='input_3_2_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_3_2_4_container' >\n                                        <input type='text' name='input_2.4' id='input_3_2_4' value=''      aria-required='true'    \/>\n                                        <label for='input_3_2_4' id='input_3_2_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_3_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_3_2_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_2_5' id='input_3_2_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_3_2_6_container' >\n                                        <select name='input_2.6' id='input_3_2_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_3_2_6' id='input_3_2_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_14\" class=\"gfield gfield--type-email 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_3_14'>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_14' id='input_3_14' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_3_3\" class=\"gfield gfield--type-phone 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_3_3'>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_3' id='input_3_3' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_7\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_3_10\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Honorary \/ Memorial Gifts<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_10'><li class='gchoice gchoice_3_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='My gift is in honor of someone'  id='choice_3_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_1' id='label_3_10_1' class='gform-field-label gform-field-label--type-inline'>My gift is in honor of someone<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='My gift is in memory of someone'  id='choice_3_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_2' id='label_3_10_2' class='gform-field-label gform-field-label--type-inline'>My gift is in memory of someone<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_20\" class=\"gfield gfield--type-name field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Name<\/label><div class='gfield_description' id='gfield_description_3_20'>Please provide the name of the individual (or individuals) for whom you are making this honorary or memorial gift.<\/div><div class='ginput_container ginput_container_name'>\n                                    <input name='input_20' id='input_3_20' type='text' value='' class='medium'    aria-invalid=\"false\" aria-describedby=\"gfield_description_3_20\"  \/>\n                                <\/div><\/li><li id=\"field_3_11\" class=\"gfield gfield--type-address field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/label><div class='gfield_description' id='gfield_description_3_11'>If you would like someone to receive a notification of this gift, please provide their contact information here.<\/div>    \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_3_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_3_11_1' value=''    aria-required='false'    \/>\n                                        <label for='input_3_11_1' id='input_3_11_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_3_11_2_container' >\n                                        <input type='text' name='input_11.2' id='input_3_11_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_11_2' id='input_3_11_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_3_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_3_11_3' value=''    aria-required='false'    \/>\n                                    <label for='input_3_11_3' id='input_3_11_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_3_11_4_container' >\n                                        <input type='text' name='input_11.4' id='input_3_11_4' value=''      aria-required='false'    \/>\n                                        <label for='input_3_11_4' id='input_3_11_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_3_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_3_11_5' value=''    aria-required='false'    \/>\n                                    <label for='input_3_11_5' id='input_3_11_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_3_11_6_container' >\n                                        <select name='input_11.6' id='input_3_11_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_3_11_6' id='input_3_11_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_17\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_17'>Instructions<\/label><div class='gfield_description' id='gfield_description_3_17'>Please provide any additional guidance or requests concerning your contribution, or how you would like it to be acknowledged. Thank you.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_17' id='input_3_17' class='textarea medium'  aria-describedby=\"gfield_description_3_17\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_18\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your employer have a matching gifts program?<\/label><div class='gfield_description' id='gfield_description_3_18'>Matching gifts make your generosity go even further! If your employer matches charitable gifts, or if you think they might, please provide your company name (and any specific individual we should contact) below.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_18'>\n\t\t\t<li class='gchoice gchoice_3_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Yes!'  id='choice_3_18_0'    \/>\n\t\t\t\t<label for='choice_3_18_0' id='label_3_18_0' class='gform-field-label gform-field-label--type-inline'>Yes!<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='No, sorry'  id='choice_3_18_1'    \/>\n\t\t\t\t<label for='choice_3_18_1' id='label_3_18_1' class='gform-field-label gform-field-label--type-inline'>No, sorry<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_18_2'>\n\t\t\t\t<input name='input_18' type='radio' value='I&#039;m not sure ...'  id='choice_3_18_2'    \/>\n\t\t\t\t<label for='choice_3_18_2' id='label_3_18_2' class='gform-field-label gform-field-label--type-inline'>I'm not sure ...<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_19\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_19'>Matching Gift Details<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_3_19' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_24\" class=\"gfield gfield--type-total gfield_price gfield_price_3_ gfield_total gfield_total_3_ 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_3_24'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_3'>$0.00<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_24' id='input_3_24' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_3_27\" class=\"gfield gfield--type-stripe_creditcard field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--type-stripe_creditcard-card\"  ><label class='gfield_label gfield_label_before_complex gform-field-label' for='input_3_27_1'>Credit Card<\/label><div class='ginput_complex ginput_container ginput_container_creditcard ginput_stripe_creditcard gform-grid-row' id='input_3_27'><div class='ginput_full gform-grid-col' id='input_3_27_1_container' data-payment-element='false'><div id='input_3_27_1' class='gform-theme-field-control StripeElement--card'><\/div><label for='input_3_27_1' id='input_3_27_1_label' class='gform-field-label gform-field-label--type-sub'>Card Details<\/label><\/div><!-- .ginput_full --><div class='ginput_full gform-grid-col' id='input_3_27_5_container'>\r\n\t\t\t\t\t<input type='text' name='input_27.5' id='input_3_27_5' value=''>\r\n\t\t\t\t\t<label for='input_3_27_5' id='input_3_27_5_label' class='gform-field-label gform-field-label--type-sub'>Cardholder Name<\/label>\r\n\t\t\t\t<\/div><\/div><!-- .ginput_container -->\r\n\t\t\t<style type=\"text\/css\">\r\n\t\t\t\t:root {\r\n  \t\t\t\t\t--link-login-string: \"Link login\"\r\n\t\t\t\t}\r\n\t\t\t<\/style><\/li><li id=\"field_3_25\" class=\"gfield gfield--type-html 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 click SUBMIT below just once, and wait patiently for your donation to be processed. Henry J. Austin Health Center values the privacy of our donors and abides by the AFP Donor Bill of Rights. Your personal information will be protected and will never be shared with any third party. <\/li><li id=\"field_3_26\" class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_26'>Verification<\/label><div id='input_3_26' class='ginput_container ginput_recaptcha' data-sitekey='6LcUEfkZAAAAAKISFZPO_GaAXwSB3tb4gGLA3YC7'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' 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class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-5744 webique_standard_menu\"><a href=\"https:\/\/henryjaustin.org\/es\/our-impact\/\"><span class=\"webique_nav_title_wrap\"><span class=\"webique_nav_title\">Our Impact<\/span><\/span><\/a><\/li>\n<li id=\"menu-item-5535\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-5535 webique_standard_menu\"><a href=\"https:\/\/henryjaustin.org\/es\/support-our-community\/\"><span class=\"webique_nav_title_wrap\"><span class=\"webique_nav_title\">Corporate &#038; Community Partnerships<\/span><\/span><\/a><\/li>\n<li id=\"menu-item-5870\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-5870 webique_standard_menu\"><a href=\"https:\/\/henryjaustin.org\/es\/volunteer\/\"><span class=\"webique_nav_title_wrap\"><span class=\"webique_nav_title\">AmeriCorps VISTA<\/span><\/span><\/a><\/li>\n<li id=\"menu-item-5871\" class=\"menu-item menu-item-type-post_type 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href=\"https:\/\/henryjaustin.org\/es\/faqs-for-donors\/\"><span class=\"webique_nav_title_wrap\"><span class=\"webique_nav_title\">FAQS for Donors<\/span><\/span><\/a><\/li>\n<\/ul><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"webique_vc_row_wrap webique_general_colors\"><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"vc_empty_space\"   style=\"height: 42px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><!-- start Line Text Divider -->\n\t\t\t<style type=\"text\/css\">\/* addon: Line Text Divider *\/\n\n#uc_blox_line_text_divider_vc17183 div.blox_hr\n{\n  display:inline-block;\n  width:100%;\n  max-width:1200px;\n  background-color: #f8ae3f;\n  height:1px;\n}\n#uc_blox_line_text_divider_vc17183 div.blox_hr_txt\n{\n  display: inline-block;\n  position: relative;\n  margin: 0;\n  padding: 5px 10px;\n  border: 1px solid #f8ae3f;\n  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id='uc_ac_assets_file_uc_stylish_social_buttons_css_1371-css' href='https:\/\/henryjaustin.org\/wp-content\/uploads\/ac_assets\/uc_stylish_social_buttons\/uc_stylish_social_buttons.css' type='text\/css' rel='stylesheet' >\n\n\t\t\t<style type=\"text\/css\">\/* addon: Stylish Social Buttons *\/\n\n.uc_stylish_social_buttons .uc_social-button .fa {\n    color: #0086AD;\n}\n.uc_stylish_social_buttons .uc_social-button::before {\n    background-color: #0086AD;\n}\n\n<\/style>\n\n\t\t\t<div class=\"uc_stylish_social_buttons\"> \n    <!--uc_container_holder--> \n    <div class=\"uc_social-buttons\">\n    \t<a href=\"https:\/\/twitter.com\/HJAHC\" class=\"uc_social-button facebook\" style=\"background:;\" target=\"_blank\"><i class=\"fa fa-twitter\"><\/i><\/a>\n<a href=\"https:\/\/www.linkedin.com\/company\/henry-j-austin-health-center\" class=\"uc_social-button facebook\" style=\"background:#ffffff;\" target=\"_blank\"><i class=\"fa fa-linkedin-square\"><\/i><\/a>\n<a href=\"https:\/\/www.instagram.com\/hjahc\/\" class=\"uc_social-button facebook\" style=\"background:#ffffff;\" target=\"_blank\"><i class=\"fa fa-instagram\"><\/i><\/a>\n<a href=\"https:\/\/www.facebook.com\/HJAHCNJ\/\" class=\"uc_social-button facebook\" style=\"background:#ffffff;\" target=\"_blank\"><i class=\"fa fa-facebook-square\"><\/i><\/a>\n\n    <\/div>\n<\/div>\n\t\t\t<!-- end Stylish Social Buttons --><div class=\"vc_empty_space\"   style=\"height: 32px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"webique_vc_row_wrap webique_general_colors\"><div data-vc-full-width=\"true\" data-vc-full-width-init=\"false\" data-vc-stretch-content=\"true\" data-vc-parallax=\"1.5\" data-vc-parallax-image=\"https:\/\/henryjaustin.org\/wp-content\/uploads\/2022\/09\/AdobeStock_503854855-scaled.jpeg\" class=\"vc_row wpb_row vc_row-fluid vc_custom_1662938467252 vc_row-has-fill vc_general vc_parallax vc_parallax-content-moving\"><div 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href=\"https:\/\/forms.office.com\/pages\/responsepage.aspx?id=VNJUFp-yf0mqFU1E63u84k7p_Pi4e1RFj_EKJgobk_dUMTFJVjBWWUNYOEJPSVZCRzE1T1o3M1ZZUi4u\" class=\"uc_btn uc_btn-5 uc_btn-5a uc_icon-cart\" target=\"_blank\"><i class=\"fa fa-clock-o\" aria-hidden=\"true\"><\/i><span>Give Your Time<\/span><\/a>\n            <\/div>  \n        <\/div>\n    <\/div>\n\t\t\t<!-- end Icon Hover Effect Button --><div class=\"vc_empty_space\"   style=\"height: 132px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><\/div><\/div><\/div><div class=\"wpb_column vc_column_container vc_col-sm-4 vc_hidden-xs\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"vc_empty_space\"   style=\"height: 150px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><!-- start Icon Hover Effect Button -->\n\n\t\t\t<style type=\"text\/css\">\/* addon: Icon Hover Effect Button *\/\n\n.uc_icon_hover_effect_button .uc_container_holder .uc_color-5 {\n\tbackground:none;\n\n}\n\n<\/style>\n\n\t\t\t<div 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*\/\n\n.uc_icon_hover_effect_button .uc_container_holder .uc_color-5 {\n\tbackground:none;\n\n}\n\n<\/style>\n\n\t\t\t<div class=\"uc_icon_hover_effect_button\" >\n    \t<div class=\"uc_container_holder\" style=\"text-align:center;\">\n            <div class=\"uc_color-5\">\n                <a style=\"background: #F68A04;text-align:center;\" href=\"mailto:john.dunstan@henryjaustin.org\" class=\"uc_btn uc_btn-5 uc_btn-5a uc_icon-cart\" target=\"_blank\"><i class=\"fa fa-thumbs-up\" aria-hidden=\"true\"><\/i><span>Start a Funraiser<\/span><\/a>\n            <\/div>  \n        <\/div>\n    <\/div>\n\t\t\t<!-- end Icon Hover Effect Button --><div class=\"vc_empty_space\"   style=\"height: 132px\"><span class=\"vc_empty_space_inner\"><\/span><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vc_row-full-width vc_clearfix\"><\/div><div class=\"webique_vc_row_wrap webique_general_colors\"><div data-vc-full-width=\"true\" data-vc-full-width-init=\"false\" data-vc-stretch-content=\"true\" data-vc-parallax=\"1.5\" data-vc-parallax-image=\"https:\/\/henryjaustin.org\/wp-content\/uploads\/2022\/09\/AdobeStock_503854855-scaled.jpeg\" class=\"vc_row wpb_row vc_row-fluid vc_custom_1662684641770 vc_row-has-fill vc_general vc_parallax vc_parallax-content-moving\"><div class=\"wpb_column vc_column_container vc_col-sm-12 vc_hidden-lg vc_hidden-md vc_hidden-sm\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><!-- start Icon Hover Effect Button -->\n\n\t\t\t<style type=\"text\/css\">\/* addon: Icon Hover Effect Button *\/\n\n.uc_icon_hover_effect_button .uc_container_holder .uc_color-5 {\n\tbackground:none;\n\n}\n\n<\/style>\n\n\t\t\t<div class=\"uc_icon_hover_effect_button\" >\n    \t<div class=\"uc_container_holder\" style=\"text-align:center;\">\n            <div class=\"uc_color-5\">\n                <a style=\"background: #F68A04;text-align:center;\" href=\"https:\/\/forms.office.com\/pages\/responsepage.aspx?id=VNJUFp-yf0mqFU1E63u84k7p_Pi4e1RFj_EKJgobk_dUMTFJVjBWWUNYOEJPSVZCRzE1T1o3M1ZZUi4u\" class=\"uc_btn uc_btn-5 uc_btn-5a uc_icon-cart\" target=\"_blank\"><i class=\"fa fa-clock-o\" aria-hidden=\"true\"><\/i><span>Give Your Time<\/span><\/a>\n            <\/div>  \n        <\/div>\n    <\/div>\n\t\t\t<!-- end Icon Hover Effect Button --><!-- start Icon Hover Effect Button -->\n\n\t\t\t<style type=\"text\/css\">\/* addon: Icon Hover Effect Button *\/\n\n.uc_icon_hover_effect_button .uc_container_holder .uc_color-5 {\n\tbackground:none;\n\n}\n\n<\/style>\n\n\t\t\t<div class=\"uc_icon_hover_effect_button\" >\n    \t<div class=\"uc_container_holder\" style=\"text-align:center;\">\n            <div class=\"uc_color-5\">\n                <a style=\"background: #F68A04;text-align:center;\" href=\"https:\/\/henryjaustin.org\/donate\/\" class=\"uc_btn uc_btn-5 uc_btn-5a uc_icon-cart\" target=\"_blank\"><i class=\"fa fa-money\" aria-hidden=\"true\"><\/i><span>Donate<\/span><\/a>\n            <\/div>  \n        <\/div>\n    <\/div>\n\t\t\t<!-- end Icon Hover Effect Button --><!-- start Icon Hover Effect Button -->\n\n\t\t\t<style type=\"text\/css\">\/* addon: Icon Hover Effect Button *\/\n\n.uc_icon_hover_effect_button .uc_container_holder .uc_color-5 {\n\tbackground:none;\n\n}\n\n<\/style>\n\n\t\t\t<div class=\"uc_icon_hover_effect_button\" >\n    \t<div class=\"uc_container_holder\" style=\"text-align:center;\">\n            <div class=\"uc_color-5\">\n                <a style=\"background: #F68A04;text-align:center;\" href=\"mailto:john.dunstan@henryjaustin.org\" class=\"uc_btn uc_btn-5 uc_btn-5a uc_icon-cart\" target=\"_blank\"><i class=\"fa fa-thumbs-up\" aria-hidden=\"true\"><\/i><span>Start a Funraiser<\/span><\/a>\n            <\/div>  \n        <\/div>\n    <\/div>\n\t\t\t<!-- end Icon Hover Effect Button --><\/div><\/div><\/div><\/div><\/div><div class=\"vc_row-full-width vc_clearfix\"><\/div><div class=\"webique_vc_row_wrap webique_general_colors\"><div data-vc-full-width=\"true\" data-vc-full-width-init=\"false\" class=\"vc_row wpb_row vc_row-fluid mobile-footer-gap vc_custom_1663086015131 vc_row-has-fill\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element wpb_animate_when_almost_visible wpb_bounceInLeft bounceInLeft\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h1 style=\"text-align: center\"><span style=\"color: #ffffff\">Want to receive the latest news from HJAHC?<\/span><\/h1>\n\n\t\t<\/div>\n\t<\/div>\n<div class=\"vc_tta-container\" data-vc-action=\"collapse\"><div class=\"vc_general vc_tta vc_tta-accordion vc_tta-style-webique_style vc_tta-o-shape-group vc_tta-controls-align-default vc_custom_1662824197120 webique_vc_accordion webique_vc_tta\"><div class=\"vc_tta-panels-container\"><div class=\"vc_tta-panels\"><div class=\"vc_tta-panel\" id=\"1662823910006-385a8b88-80f55ca7-d99e\" data-vc-content=\".vc_tta-panel-body\"><div class=\"vc_tta-panel-heading\"><h4 class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"#1662823910006-385a8b88-80f55ca7-d99e\" data-vc-accordion data-vc-container=\".vc_tta-container\"><span class=\"vc_tta-title-text\">Sign up today!<\/span><i class=\"vc_tta-controls-icon vc_tta-controls-icon-plus\"><\/i><\/a><\/h4><\/div><div class=\"vc_tta-panel-body\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p style=\"text-align: center\"><div data-form-id=\"5798\" id=\"ctct-form-wrapper-0\" class=\"ctct-form-wrapper\"><form class=\"ctct-form ctct-form-5798 comment-form  no-recaptcha ctct-default\" id=\"ctct-form-1256906585\" data-doajax=\"on\" style=\"\" action=\"\" method=\"post\"><p class=\"ctct-form-field ctct-form-field-text\"><span class=\"ctct-label-top\"><label for=\"first_name___ffcb7692a18eebfcb8f672b95ce673c1_0_73336604\">First Name <\/label><\/span><input aria-required=\"false\"  type=\"text\" id=\"first_name___ffcb7692a18eebfcb8f672b95ce673c1_0_73336604\" name=\"first_name___ffcb7692a18eebfcb8f672b95ce673c1\"  value=\"\" class=\"ctct-text ctct-label-top first_name___ffcb7692a18eebfcb8f672b95ce673c1\" maxlength=\"255\" placeholder=\"Enter your first name\"   \/><\/p><p class=\"ctct-form-field ctct-form-field-email ctct-form-field-required\"><span class=\"ctct-label-top\"><label for=\"email___c40d71865cb6c395ed33dd5dd8d5e578_0_875126953\">Email (required) <span class=\"ctct-required-indicatior\" title=\"This is a required field\">*<\/span><\/label><\/span><input required aria-required=\"true\"  type=\"email\" id=\"email___c40d71865cb6c395ed33dd5dd8d5e578_0_875126953\" name=\"email___c40d71865cb6c395ed33dd5dd8d5e578\"  value=\"\" class=\"ctct-email ctct-label-top email___c40d71865cb6c395ed33dd5dd8d5e578\"  placeholder=\"Enter your email address\"   \/><\/p><div class='ctct-list-selector' style='display:none;'><div class=\"ctct-form-field ctct-form-field-checkbox ctct-form-field-required\"><fieldset><legend class=\"ctct-label-top\">Select list(s) to subscribe to<\/legend><input type=\"checkbox\" name=\"lists___57a1a821a887f8fb275085e47be591ee[]\" id=\"lists___57a1a821a887f8fb275085e47be591ee_0_0\" value=\"1934414670\" class=\"ctct-checkbox ctct-label-right\" checked \/><span class=\"ctct-label-right\"><label for=\"lists___57a1a821a887f8fb275085e47be591ee_0_0\">Website sign-ups<\/label><\/span><\/fieldset><\/div><\/div><div class=\"ctct-optin-hide\" style=\"display:none;\"><p class=\"ctct-form-field ctct-form-field-checkbox\"><span class=\"ctct-input-container\"><input type=\"checkbox\" checked name=\"ctct-opt-in\" class=\"ctct-checkbox ctct-opt-in\" value=\"1\" id=\"ctct-opt-in_0\" \/><label for=\"ctct-opt-in_0\"> Example: Yes, I would like to receive emails from Henry J. Austin Health Center. (You can unsubscribe anytime)<\/label><\/span><\/p><\/div><!--.ctct-optin-hide --><p class=\"ctct-form-field ctct-form-field-submit\"><input aria-required=\"false\"  type=\"submit\" id=\"ctct-submitted_0_1929523798\" name=\"ctct-submitted\"  value=\"Sign up\" class=\"ctct-submit ctct-label-top ctct-submitted\"     \/><\/p><div class=\"ctct_usage\" style=\"border: 0 none; clip: rect( 0, 0, 0, 0 ); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px;\"><label for=\"ctct_usage_field\">Constant Contact Use. Please leave this field blank.<\/label><input type=\"text\" value=\"\" id=\"ctct_usage_field\" name=\"ctct_usage_field\" class=\"ctct_usage_field\" tabindex=\"-1\" \/><\/div><input type=\"hidden\" name=\"ctct-id\" value=\"5798\" \/><input type=\"hidden\" name=\"ctct-verify\" value=\"txSgrhKaHIwDxpPCdWjw7JKHY\" \/><input type=\"hidden\" name=\"ctct-instance\" value=\"0\" \/><input type=\"hidden\" name=\"ctct_time\" value=\"1776839512\" \/><\/form><script type=\"text\/javascript\">var ajaxurl = \"https:\/\/henryjaustin.org\/wp-admin\/admin-ajax.php\";<\/script><\/div>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vc_row-full-width vc_clearfix\"><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"Donate Online Our secure online donation form makes it easy to donate with a credit card. Your gift supports Henry J. Austin Health Center patients throughout the year, and helps us provide quality healthcare to those with less resources. URLThis...","protected":false},"author":18,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"class_list":["post-5891","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Donate Copy - Henry J. 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