{"id":3023,"date":"2026-09-28T17:57:32","date_gmt":"2026-09-28T21:57:32","guid":{"rendered":"https:\/\/yfc.ca\/northumberland\/?post_type=program&#038;p=3023"},"modified":"2026-09-28T20:25:02","modified_gmt":"2026-09-29T00:25:02","slug":"fundraiser-for-youth-programming","status":"publish","type":"program","link":"https:\/\/yfc.ca\/northumberland\/program\/fundraiser-for-youth-programming\/","title":{"rendered":"Fundraiser for Youth Programming"},"content":{"rendered":"\r\n<section class=\"y-intro guten-block \">\r\n\t<div class=\"y-intro--upper\">\r\n\t\t<div class=\"grid-narrow\">\r\n\t\t\t<div class=\"y-intro--upper--row\">\r\n\t\t\t\t<div class=\"y-intro--upper--left\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h2 class=\"y-intro--title\">Create Workshop<\/h2>\r\n\t\t\t\t\t\t\t\t\t\t\n\n\n\n\n\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"y-intro--content\"><p><strong>Create, Colour, &amp; Connect<\/strong><br \/>\n<strong>Date<\/strong>:\u00a0 Saturday, November 14th, from 1-4 pm<br \/>\n<strong>Location<\/strong>:\u00a0 Grace Church in Cobourg<br \/>\n<strong>Cost<\/strong>: $50 per participant &#8211; all supplies provided<\/p>\n<p><strong>Questions?<\/strong><br \/>\n<a href=\"mailto:info@nyfc.org\">info@nyfc.org<\/a><br \/>\n(905) 373-4707<\/p>\n<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"y-intro--buttons\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"button primary\" href=\"#register\" target=\"_self\">Register Now<\/a>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"button secondary\" href=\"#info\" target=\"_self\">More Info<\/a>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"y-intro--upper--right\">\r\n\t\t\t\t\t\t\t<div class=\"y-c-img extend\">\n\t\t<div class=\"y-c-img--extend tall\" style=\"background-image: url(https:\/\/yfc.ca\/northumberland\/wp-content\/uploads\/sites\/32\/2026\/09\/craft-fundraiser-3.png);\">\n\t\t\t\t\t<\/div>\n\t\t<div class=\"y-c-img--contain\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/yfc.ca\/northumberland\/wp-content\/uploads\/sites\/32\/2026\/09\/craft-fundraiser-3.png\" alt=\"\" \/>\n\t\t\t\t\t<\/div>\n\t\t\n\t<\/div>\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n\r\n\t<div class=\"y-intro--lower\">\r\n\t\t<div class=\"grid-narrow\">\r\n\t\t\t<div class=\"y-intro--lower--left\">\r\n\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"y-intro--lower-content\"><p>Enjoy an afternoon\u00a0of creative connections, learn how to do a new craft\/art form, create a beautiful gift to take home, and connect with friends, new &amp; old.<\/p>\n<p>Northumberland Youth Unlimited presents a Creative Fundraiser <strong>in support of the Creative Arts programs<\/strong> that run under the labels: <a href=\"https:\/\/yfc.ca\/northumberland\/program\/created-to-create\/\" target=\"_blank\" rel=\"noopener\">Created to Create<\/a>, and <a href=\"https:\/\/yfc.ca\/northumberland\/program\/purpose\/\" target=\"_blank\" rel=\"noopener\">Youth With A Purpose<\/a>.<\/p>\n<p>The Registration fee of\u00a0$50 will cover the cost of materials, with the extra fees being split evenly between the two programs.<\/p>\n<\/div>\r\n\t\t\t\t\t\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n\r\n<\/section>\r\n\r\n\r\n\r\n\n\n<section class=\"y-spacer large off-black  guten-block\" ><\/section>\n\n\n<div style=\"width:80%; margin: 100px auto 0 auto;\"><h4>Your Art Form Choices:<\/h4><\/div>\n\n\n<section class=\"y-columned-content light-grey three   guten-block\" >\r\n\t<div class=\"grid-narrow\">\r\n\t\t\t\t<div class=\"y-columned-content--inner\">\r\n\t\t\t\t\t\t\t<div class=\"y-columned-content--column y-color-responsive-text\"><h3>Gelli Printing<\/h3>\n<p>Gelli Printing is a fun, easy form of monoprinting that uses a soft, reusable gel plate to make unique art on paper or fabric. We will create cards, pictures, bookmarks, and more&#8230;<\/p>\n<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"y-columned-content--column y-color-responsive-text\"><h3>Jewellery<\/h3>\n<p>Jewellery Making &#8211; design a necklace, bracelet, and\/or earrings or possibly one of each for yourself or a loved one.<\/p>\n<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div class=\"y-columned-content--column y-color-responsive-text\"><h3>Kinusaiga<\/h3>\n<p>Kinusaiga &#8211; is a traditional Japanese art form where an artist creates colourful, textured pictures by tucking fabric scraps into grooves cut into a board. This requires no sewing or glue.<\/p>\n<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t<\/div>\r\n<\/section>\r\n\n\n<section class=\"y-columned-content white one center  guten-block\" >\r\n\t<div class=\"grid-narrow\">\r\n\t\t\t\t<div class=\"y-columned-content--inner\">\r\n\t\t\t\t\t\t\t<div class=\"y-columned-content--column y-color-responsive-text\"><p>We ask you to choose one of these art forms upon registering so we are prepared for the correct number of artists that afternoon. There are ten spots available for each option.<\/p>\n<p>Snacks will be provided and at the end of the afternoon you will have something to take home to enjoy for yourself or to gift to someone special at Christmas. You will also have a new art form that you can practice at home.<\/p>\n<p>Will you join us for this creative afternoon?<\/p>\n<p>Thank you from Connie and Christine, Program Leaders, NYU Staff<\/p>\n<\/div>\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t<\/div>\r\n<\/section>\r\n\n\n\n<a name=\"register\"><\/a>\n\n\n\t<section class=\"y-gravity-form white  guten-block\" >\r\n\t\t<div class=\"grid-narrow\">\r\n\t\t\t\t\t\t\t<h3 class=\"y-accordion--title y-color-responsive-text\">Register<\/h3>\r\n\t\t\t\t\t\t<div class=\"y-gravity-form--inner\">\r\n\t\t\t\t<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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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_82' style='display:none'><div id='gf_82' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_82' id='gform_82'  action='\/northumberland\/wp-json\/wp\/v2\/program\/3023#gf_82' data-formid='82' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_82' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_82_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Participant Information<\/h2><\/li><li id=\"field_82_35\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_82_35'><span class='gform-field-label__text'>Fundraiser<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_35' id='input_82_35' class='large gfield_select'     aria-invalid=\"false\" ><option value='Create Workshop 2026' >Create Workshop 2026<\/option><\/select><\/div><\/li><li id=\"field_82_42\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_82_42'><span class='gform-field-label__text'>Please select a program option<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_82_42' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Gelli Printing' >Gelli Printing<\/option><option value='Jewellery Making' >Jewellery Making<\/option><option value='Kinusaiga' >Kinusaiga<\/option><\/select><\/div><\/li><li id=\"field_82_7\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_82_7 gfield_product_82_7 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_82_7_1'><span class='gform-field-label__text'>Create Workshop Gelli Printing Fee<\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_7.1' value='Create Workshop Gelli Printing Fee' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_82_7' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_7.2' id='ginput_base_price_82_7' value='$ 50.00 CAD' aria-label='Create Workshop Gelli Printing Fee Price' aria-describedby=\"gfield_description_82_7\" \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_7.3' value='1' class='ginput_quantity_82_7 gform_hidden' \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_82_7'><div class=\"gpi-available-inventory-message\" style=\"padding-bottom: 13px;\">10 spots available<\/div><\/div><\/li><li id=\"field_82_43\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_82_43 gfield_product_82_43 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_82_43_1'><span class='gform-field-label__text'>Create Workshop Jewellery Making Fee<\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_43.1' value='Create Workshop Jewellery Making Fee' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_82_43' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_43.2' id='ginput_base_price_82_43' value='$ 50.00 CAD' aria-label='Create Workshop Jewellery Making Fee Price' aria-describedby=\"gfield_description_82_43\" \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_43.3' value='1' class='ginput_quantity_82_43 gform_hidden' \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_82_43'><div class=\"gpi-available-inventory-message\" style=\"padding-bottom: 13px;\">10 spots available<\/div><\/div><\/li><li id=\"field_82_44\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_82_44 gfield_product_82_44 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_82_44_1'><span class='gform-field-label__text'>Create Workshop Kinusaiga Fee<\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_44.1' value='Create Workshop Kinusaiga Fee' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_82_44' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_44.2' id='ginput_base_price_82_44' value='$ 50.00 CAD' aria-label='Create Workshop Kinusaiga Fee Price' aria-describedby=\"gfield_description_82_44\" \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_44.3' value='1' class='ginput_quantity_82_44 gform_hidden' \/>\n\t\t\t\t<\/div><div class='gfield_description' id='gfield_description_82_44'><div class=\"gpi-available-inventory-message\" style=\"padding-bottom: 13px;\">10 spots available<\/div><\/div><\/li><li id=\"field_82_45\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_82_45'><span class='gform-field-label__text'>Calculation Field<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_45' id='input_82_45' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_82_12\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label 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_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_82_12'>\n                            \n                            <span id='input_82_12_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.3' id='input_82_12_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_82_12_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_82_12_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.6' id='input_82_12_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_82_12_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_82_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_82_13'><span class='gform-field-label__text'>Email<\/span><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_13' id='input_82_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_82_16\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_82_16'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_82_16' type='tel' value='' class='large'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_82_38\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_82_24\" class=\"gfield gfield--type-total gfield--input-type-total gfield_price gfield_price_82_ gfield_total gfield_total_82_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_82_24'><span class='gform-field-label__text'>Total<\/span><\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_82'>$ 0.00 CAD<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_24' id='input_82_24' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_82_25\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_82_25'><span class='gform-field-label__text'>Payment Method<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_82_25' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Credit Card' >Credit Card<\/option><option value='E-Transfer' >E-Transfer<\/option><\/select><\/div><\/li><li id=\"field_82_26\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Payment Info<\/h2><\/li><li id=\"field_82_27\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Please send your e-transfer to info@nyfc.org ASAP. Please include a comment regarding &#8220;Create Workshop Fee&#8221;. We use auto-deposit so please ensure your e-transfer is accurate. This information will also be provided after you have submitted this form and in your confirmation email.<\/li><li id=\"field_82_28\" class=\"gfield gfield--type-creditcard gfield--input-type-creditcard gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_82_28_1'><span class='gform-field-label__text'>Credit Card<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_creditcard gform-grid-row' id='input_82_28'><span class='ginput_full gform-grid-col' id='input_82_28_1_container' >\n                                    <div class='gform_card_icon_container'><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_82_28_supported_creditcards'>Supported Credit Cards: MasterCard, Visa<\/span><\/div>\n                                    <input type='text' name='input_28.1' id='input_82_28_1' value=''   onchange='gformMatchCard(\"input_82_28_1\");' onkeyup='gformMatchCard(\"input_82_28_1\");' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='true'  \/>\n                                    <label for='input_82_28_1' id='input_82_28_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_82_28_2_container'>\n                                            <span class='ginput_cardinfo_left' id='input_82_28_2_cardinfo_left'>\n                                                <span class='ginput_card_expiration_container ginput_card_field'>\n                                                    \n                                                       <select name='input_28.2[]' id='input_82_28_2_month'   class='ginput_card_expiration ginput_card_expiration_month' aria-required='true'  >\n                                                           <option value=''>Month<\/option><option value='1' >01<\/option><option value='2' >02<\/option><option value='3' >03<\/option><option value='4' >04<\/option><option value='5' >05<\/option><option value='6' >06<\/option><option value='7' >07<\/option><option value='8' >08<\/option><option value='9' >09<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option>\n                                                       <\/select>\n                                                       \n                                                   \n                                                   \n                                                       <select name='input_28.2[]' id='input_82_28_2_year'   class='ginput_card_expiration ginput_card_expiration_year' aria-required='true'  >\n                                                           <option value=''>Year<\/option><option value='2026' >2026<\/option><option value='2027' >2027<\/option><option value='2028' >2028<\/option><option value='2029' >2029<\/option><option value='2030' >2030<\/option><option value='2031' >2031<\/option><option value='2032' >2032<\/option><option value='2033' >2033<\/option><option value='2034' >2034<\/option><option value='2035' >2035<\/option><option value='2036' >2036<\/option><option value='2037' >2037<\/option><option value='2038' >2038<\/option><option value='2039' >2039<\/option><option value='2040' >2040<\/option><option value='2041' >2041<\/option><option value='2042' >2042<\/option><option value='2043' >2043<\/option><option value='2044' >2044<\/option><option value='2045' >2045<\/option>\n                                                       <\/select>\n                                                       \n                                                       \n                                                <\/span>\n                                                 <label for='input_82_28_2_month' class='gform-field-label gform-field-label--type-sub '>Expiration Date<\/label>\n                                            <\/span><span class='ginput_cardinfo_right gform-grid-col' id='input_82_28_2_cardinfo_right'>\n                                                <input type='text' name='input_28.3' id='input_82_28_3'   class='ginput_card_security_code' value='' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='true'  \/>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                                <label for='input_82_28_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_82_28_5_container'>\n                                            <input type='text' name='input_28.5' id='input_82_28_5' value=''    aria-required='false'  \/>\n                                            <label for='input_82_28_5' id='input_82_28_5_label' class='gform-field-label gform-field-label--type-sub '>Cardholder Name<\/label>\n                                        <\/span> <\/div><\/li><li id=\"field_82_29\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Cardholder Address<\/span><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_82_29' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_82_29_1_container' >\n                                        <input type='text' name='input_29.1' id='input_82_29_1' value=''    aria-required='true'    \/>\n                                        <label for='input_82_29_1' id='input_82_29_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_82_29_2_container' >\n                                        <input type='text' name='input_29.2' id='input_82_29_2' value=''     aria-required='false'   \/>\n                                        <label for='input_82_29_2' id='input_82_29_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_82_29_3_container' >\n                                    <input type='text' name='input_29.3' id='input_82_29_3' value=''    aria-required='true'    \/>\n                                    <label for='input_82_29_3' id='input_82_29_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_82_29_4_container' >\n                                        <input type='text' name='input_29.4' id='input_82_29_4' value=''      aria-required='true'    \/>\n                                        <label for='input_82_29_4' id='input_82_29_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_82_29_5_container' >\n                                    <input type='text' name='input_29.5' id='input_82_29_5' value=''    aria-required='true'    \/>\n                                    <label for='input_82_29_5' id='input_82_29_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_82_29_6_container' >\n                                        <select name='input_29.6' id='input_82_29_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' selected='selected'>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' >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_82_29_6' id='input_82_29_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_82_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_82_32\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Please click on &#8220;Submit&#8221; only ONCE and wait. 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