{"id":20483,"date":"2025-03-17T21:52:29","date_gmt":"2025-03-17T21:52:29","guid":{"rendered":"https:\/\/shpe.org\/?page_id=20483"},"modified":"2025-12-04T21:54:51","modified_gmt":"2025-12-04T21:54:51","slug":"donateinterestform","status":"publish","type":"page","link":"https:\/\/shpe.org\/donateinterestform\/","title":{"rendered":"Donate Interest Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"20483\" class=\"elementor elementor-20483\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e0063c4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e0063c4\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;66c5a8d&quot;,&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:&quot;50&quot;,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_bg_x&quot;:&quot;50&quot;,&quot;jet_parallax_layout_bg_y&quot;:&quot;50&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c3904c9\" data-id=\"c3904c9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d82f9bf elementor-widget elementor-widget-heading\" data-id=\"d82f9bf\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Support the Familia!<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-de49e44 elementor-widget elementor-widget-text-editor\" data-id=\"de49e44\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div style=\"text-align: center\">Your generous gift is an investment that will ensure Hispanics are ready to lead globally. Because of you, SHPE can continue its mission to change lives by empowering the Hispanic community to realize its fullest potential and impact the world through STEM awareness, access, support, and development.<\/div><div>\u00a0<\/div><div style=\"text-align: center\">THANK YOU for making a difference for the SHPE Familia!<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-28abb1c0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"28abb1c0\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;66c5a8d&quot;,&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:&quot;50&quot;,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_bg_x&quot;:&quot;50&quot;,&quot;jet_parallax_layout_bg_y&quot;:&quot;50&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-409b917d\" data-id=\"409b917d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-6490cd6 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"6490cd6\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-14de602\" data-id=\"14de602\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c60098e elementor-widget elementor-widget-shortcode\" data-id=\"c60098e\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-22931 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-22931\" data-uid=\"69369cfb19e04\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-22931\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-22931 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"22931\"\r\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"69369cfb19e04\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-22931__field--select-1_69369cfb19e04\" id=\"forminator-form-22931__field--select-1_69369cfb19e04-label\" class=\"forminator-label\">I want to support: <span class=\"forminator-required\">*<\/span><\/label><select multiple id=\"forminator-form-22931__field--select-1_69369cfb19e04\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1[]\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please make a selection.\" data-search=\"false\" data-search-placeholder=\"Search\" data-checkbox=\"false\" data-allow-clear=\"true\" aria-labelledby=\"forminator-form-22931__field--select-1_69369cfb19e04-label\"><option value=\"one\"  data-calculation=\"0\">General Fund<\/option><option value=\"Scholarships\"  data-calculation=\"0\">Scholarships<\/option><option value=\"two\"  data-calculation=\"0\">ALL-IN Relief Fund<\/option><option value=\"Bright-Minds-ScholarSHPE-Fund\"  data-calculation=\"0\">Bright Minds ScholarSHPE Fund<\/option><option value=\"Conference-Stipend-Campaign\"  data-calculation=\"0\">Conference Stipend Campaign<\/option><option value=\"Helena-Cuesta-Scholarship-Fund\"  data-calculation=\"0\">Helena Cuesta Scholarship Fund<\/option><option value=\"Pride-ScholarSHPE-Fund\"  data-calculation=\"0\">Pride ScholarSHPE Fund<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69369cfb19e04-label\"><span id=\"forminator-radiogroup-radio-1-69369cfb19e04-label\" class=\"forminator-label\">Donation Type<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69369cfb19e04\" class=\"forminator-radio\" title=\"Recurring Donation (Monthly)\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Recurring Donation (Monthly)<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69369cfb19e04\" class=\"forminator-radio\" title=\"One-time Donation\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">One-time Donation<\/span><\/label><\/div><\/div><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69369cfb19e04-label\"><span id=\"forminator-radiogroup-radio-2-69369cfb19e04-label\" class=\"forminator-label\">Donation Amount <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69369cfb19e04\" class=\"forminator-radio forminator-radio-inline\" title=\"$20\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"20\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">$20<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69369cfb19e04\" class=\"forminator-radio forminator-radio-inline\" title=\"$50\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"50\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">$50<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-69369cfb19e04\" class=\"forminator-radio forminator-radio-inline\" title=\"$100\"><input type=\"radio\" name=\"radio-2\" value=\"$100\" id=\"forminator-field-radio-2-3-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"100\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">$100<\/span><\/label><label id=\"forminator-field-radio-2-label-4\" for=\"forminator-field-radio-2-4-69369cfb19e04\" class=\"forminator-radio forminator-radio-inline\" title=\"$250\"><input type=\"radio\" name=\"radio-2\" value=\"$250\" id=\"forminator-field-radio-2-4-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-2-label-4\" data-calculation=\"250\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">$250<\/span><\/label><label id=\"forminator-field-radio-2-label-5\" for=\"forminator-field-radio-2-5-69369cfb19e04\" class=\"forminator-radio forminator-radio-inline\" title=\"$500\"><input type=\"radio\" name=\"radio-2\" value=\"$500\" id=\"forminator-field-radio-2-5-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-2-label-5\" data-calculation=\"500\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">$500<\/span><\/label><label id=\"forminator-field-radio-2-label-6\" for=\"forminator-field-radio-2-6-69369cfb19e04\" class=\"forminator-radio forminator-radio-inline\" title=\"$1000\"><input type=\"radio\" name=\"radio-2\" value=\"$1000\" id=\"forminator-field-radio-2-6-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-2-label-6\" data-calculation=\"1000\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">$1000<\/span><\/label><label id=\"forminator-field-radio-2-label-7\" for=\"forminator-field-radio-2-7-69369cfb19e04\" class=\"forminator-radio forminator-radio-inline\" title=\"Other\"><input type=\"radio\" name=\"radio-2\" value=\"Other\" id=\"forminator-field-radio-2-7-69369cfb19e04\" aria-labelledby=\"forminator-field-radio-2-label-7\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-1\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-1_69369cfb19e04\" id=\"forminator-field-currency-1_69369cfb19e04-label\" class=\"forminator-label\">Other Donation Amount <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-1\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-1_69369cfb19e04\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-69369cfb19e04-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-69369cfb19e04-label\" class=\"forminator-label\">Donation Options<\/span><label id=\"forminator-field-checkbox-2-1-69369cfb19e04-label\" for=\"forminator-field-checkbox-2-1-69369cfb19e04\" class=\"forminator-checkbox\" title=\"I&#039;m donating in honor of someone\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-69369cfb19e04\" aria-labelledby=\"forminator-field-checkbox-2-1-69369cfb19e04-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I'm donating in honor of someone<\/span><\/label><label id=\"forminator-field-checkbox-2-2-69369cfb19e04-label\" for=\"forminator-field-checkbox-2-2-69369cfb19e04\" class=\"forminator-checkbox\" title=\"I&#039;m donating in memory of someone\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-69369cfb19e04\" aria-labelledby=\"forminator-field-checkbox-2-2-69369cfb19e04-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I'm donating in memory of someone<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69369cfb19e04\" id=\"forminator-field-text-1_69369cfb19e04-label\" class=\"forminator-label\">Donation Options Name <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-1_69369cfb19e04-description\" class=\"forminator-description\">Please enter the name of who you are donating in honor\/memory of.<\/span><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69369cfb19e04\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-1_69369cfb19e04-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_69369cfb19e04\" id=\"forminator-field-first-name-1_69369cfb19e04-label\" class=\"forminator-label\">First Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"\" id=\"forminator-field-first-name-1_69369cfb19e04\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-middle-name-1_69369cfb19e04\" id=\"forminator-field-middle-name-1_69369cfb19e04-label\" class=\"forminator-label\">Middle Name<\/label><input type=\"text\" name=\"name-1-middle-name\" placeholder=\"\" id=\"forminator-field-middle-name-1_69369cfb19e04\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"additional-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_69369cfb19e04\" id=\"forminator-field-last-name-1_69369cfb19e04-label\" class=\"forminator-label\">Last Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"\" id=\"forminator-field-last-name-1_69369cfb19e04\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-69369cfb19e04-label\"><label id=\"forminator-field-checkbox-1-1-69369cfb19e04-label\" for=\"forminator-field-checkbox-1-1-69369cfb19e04\" class=\"forminator-checkbox\" title=\"I&#039;d like to remain anonymous.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-69369cfb19e04\" aria-labelledby=\"forminator-field-checkbox-1-1-69369cfb19e04-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I'd like to remain anonymous.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69369cfb19e04\" id=\"forminator-field-address-1-street_address_69369cfb19e04-label\" class=\"forminator-label\">Street Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_69369cfb19e04\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_69369cfb19e04\" id=\"forminator-field-address-1-address_line_69369cfb19e04-label\" class=\"forminator-label\">Apartment, suite, etc<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_69369cfb19e04\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69369cfb19e04\" id=\"forminator-field-address-1-city_69369cfb19e04-label\" class=\"forminator-label\">City <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"\" id=\"forminator-field-address-1-city_69369cfb19e04\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_69369cfb19e04\" id=\"forminator-field-address-1-state_69369cfb19e04-label\" class=\"forminator-label\">State\/Province <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"\" id=\"forminator-field-address-1-state_69369cfb19e04\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69369cfb19e04\" id=\"forminator-field-address-1-zip_69369cfb19e04-label\" class=\"forminator-label\">ZIP \/ Postal Code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"\" id=\"forminator-field-address-1-zip_69369cfb19e04\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><div id=\"address-1-country\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-22931__field--address-1-country_69369cfb19e04\" id=\"forminator-field-22931__field--address-1-country_69369cfb19e04-label\" class=\"forminator-label\">Country <span class=\"forminator-required\">*<\/span><\/label><select name=\"address-1-country\" id=\"forminator-field-22931__field--address-1-country_69369cfb19e04\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"Select country\" autocomplete=\"country-name country\" data-default-value=\"United States of America (USA)\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Albania\" data-country-code=\"AL\" >Albania<\/option><option value=\"Algeria\" data-country-code=\"DZ\" >Algeria<\/option><option value=\"American Samoa\" data-country-code=\"AS\" >American Samoa<\/option><option value=\"Andorra\" data-country-code=\"AD\" >Andorra<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctica\" data-country-code=\"AQ\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" data-country-code=\"AG\" >Antigua and Barbuda<\/option><option value=\"Argentina\" data-country-code=\"AR\" >Argentina<\/option><option value=\"Armenia\" data-country-code=\"AM\" >Armenia<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australia\" data-country-code=\"AU\" >Australia<\/option><option value=\"Austria\" data-country-code=\"AT\" >Austria<\/option><option value=\"Azerbaijan\" data-country-code=\"AZ\" >Azerbaijan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahrain\" data-country-code=\"BH\" >Bahrain<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Barbados\" data-country-code=\"BB\" >Barbados<\/option><option value=\"Belarus\" data-country-code=\"BY\" >Belarus<\/option><option value=\"Belgium\" data-country-code=\"BE\" >Belgium<\/option><option value=\"Belize\" data-country-code=\"BZ\" >Belize<\/option><option value=\"Benin\" data-country-code=\"BJ\" >Benin<\/option><option value=\"Bermuda\" data-country-code=\"BM\" >Bermuda<\/option><option value=\"Bhutan\" data-country-code=\"BT\" >Bhutan<\/option><option value=\"Bolivia\" data-country-code=\"BO\" >Bolivia<\/option><option value=\"Bosnia and Herzegovina\" data-country-code=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Bouvet Island\" data-country-code=\"BV\" >Bouvet Island<\/option><option value=\"Brazil\" data-country-code=\"BR\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" data-country-code=\"IO\" >British Indian Ocean Territory<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Bulgaria\" data-country-code=\"BG\" >Bulgaria<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"Cabo Verde\" data-country-code=\"CV\" >Cabo Verde<\/option><option value=\"Cambodia\" data-country-code=\"KH\" >Cambodia<\/option><option value=\"Cameroon\" data-country-code=\"CM\" >Cameroon<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cayman Islands\" data-country-code=\"KY\" >Cayman Islands<\/option><option value=\"Central African Republic\" data-country-code=\"CF\" >Central African Republic<\/option><option value=\"Chad\" data-country-code=\"TD\" >Chad<\/option><option value=\"Chile\" data-country-code=\"CL\" >Chile<\/option><option value=\"China, People's Republic of\" data-country-code=\"CN\" >China, People's Republic of<\/option><option value=\"Christmas Island\" data-country-code=\"CX\" >Christmas Island<\/option><option value=\"Cocos Islands\" data-country-code=\"CC\" >Cocos Islands<\/option><option value=\"Colombia\" data-country-code=\"CO\" >Colombia<\/option><option value=\"Comoros\" data-country-code=\"KM\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" data-country-code=\"CD\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" data-country-code=\"CG\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" data-country-code=\"CK\" >Cook Islands<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatia\" data-country-code=\"HR\" >Croatia<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" data-country-code=\"CY\" >Cyprus<\/option><option value=\"Czech Republic\" data-country-code=\"CZ\" >Czech Republic<\/option><option value=\"C\u00f4te d'Ivoire\" data-country-code=\"CI\" >C\u00f4te d'Ivoire<\/option><option value=\"Denmark\" data-country-code=\"DK\" >Denmark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominica\" data-country-code=\"DM\" >Dominica<\/option><option value=\"Dominican Republic\" data-country-code=\"DO\" >Dominican Republic<\/option><option value=\"East Timor\" data-country-code=\"TL\" >East Timor<\/option><option value=\"Ecuador\" data-country-code=\"EC\" >Ecuador<\/option><option value=\"Egypt\" data-country-code=\"EG\" >Egypt<\/option><option value=\"El Salvador\" data-country-code=\"SV\" >El Salvador<\/option><option value=\"Equatorial Guinea\" data-country-code=\"GQ\" >Equatorial Guinea<\/option><option value=\"Eritrea\" data-country-code=\"ER\" >Eritrea<\/option><option value=\"Estonia\" data-country-code=\"EE\" >Estonia<\/option><option value=\"Ethiopia\" data-country-code=\"ET\" >Ethiopia<\/option><option value=\"Falkland Islands\" data-country-code=\"FK\" >Falkland Islands<\/option><option value=\"Faroe Islands\" data-country-code=\"FO\" >Faroe Islands<\/option><option value=\"Fiji\" data-country-code=\"FJ\" >Fiji<\/option><option value=\"Finland\" data-country-code=\"FI\" >Finland<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, Metropolitan\" data-country-code=\"FX\" >France, Metropolitan<\/option><option value=\"French Guiana\" data-country-code=\"GF\" >French Guiana<\/option><option value=\"French Polynesia\" data-country-code=\"PF\" >French Polynesia<\/option><option value=\"French South Territories\" data-country-code=\"TF\" >French South Territories<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambia\" data-country-code=\"GM\" >Gambia<\/option><option value=\"Georgia\" data-country-code=\"GE\" >Georgia<\/option><option value=\"Germany\" data-country-code=\"DE\" >Germany<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Greece\" data-country-code=\"GR\" >Greece<\/option><option value=\"Greenland\" data-country-code=\"GL\" >Greenland<\/option><option value=\"Grenada\" data-country-code=\"GD\" >Grenada<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guatemala\" data-country-code=\"GT\" >Guatemala<\/option><option value=\"Guernsey\" data-country-code=\"GG\" >Guernsey<\/option><option value=\"Guinea\" data-country-code=\"GN\" >Guinea<\/option><option value=\"Guinea-Bissau\" data-country-code=\"GW\" >Guinea-Bissau<\/option><option value=\"Guyana\" data-country-code=\"GY\" >Guyana<\/option><option value=\"Haiti\" data-country-code=\"HT\" >Haiti<\/option><option value=\"Heard Island And Mcdonald Island\" data-country-code=\"HM\" >Heard Island And Mcdonald Island<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hungary\" data-country-code=\"HU\" >Hungary<\/option><option value=\"Iceland\" data-country-code=\"IS\" >Iceland<\/option><option value=\"India\" data-country-code=\"IN\" >India<\/option><option value=\"Indonesia\" data-country-code=\"ID\" >Indonesia<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Ireland\" data-country-code=\"IE\" >Ireland<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italy\" data-country-code=\"IT\" >Italy<\/option><option value=\"Jamaica\" data-country-code=\"JM\" >Jamaica<\/option><option value=\"Japan\" data-country-code=\"JP\" >Japan<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Johnston Island\" data-country-code=\"JT\" >Johnston Island<\/option><option value=\"Jordan\" data-country-code=\"JO\" >Jordan<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Korea, Democratic People's Republic of\" data-country-code=\"KP\" >Korea, Democratic People's Republic of<\/option><option value=\"Korea, Republic of\" data-country-code=\"KR\" >Korea, Republic of<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kuwait\" data-country-code=\"KW\" >Kuwait<\/option><option value=\"Kyrgyzstan\" data-country-code=\"KG\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" data-country-code=\"LA\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" data-country-code=\"LV\" >Latvia<\/option><option value=\"Lebanon\" data-country-code=\"LB\" >Lebanon<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Liberia\" data-country-code=\"LR\" >Liberia<\/option><option value=\"Libya\" data-country-code=\"LY\" >Libya<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuania\" data-country-code=\"LT\" >Lithuania<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macau\" data-country-code=\"MO\" >Macau<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Malaysia\" data-country-code=\"MY\" >Malaysia<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malta\" data-country-code=\"MT\" >Malta<\/option><option value=\"Marshall Islands\" data-country-code=\"MH\" >Marshall Islands<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritania\" data-country-code=\"MR\" >Mauritania<\/option><option value=\"Mauritius\" data-country-code=\"MU\" >Mauritius<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexico\" data-country-code=\"MX\" >Mexico<\/option><option value=\"Micronesia\" data-country-code=\"FM\" >Micronesia<\/option><option value=\"Moldova\" data-country-code=\"MD\" >Moldova<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolia\" data-country-code=\"MN\" >Mongolia<\/option><option value=\"Montenegro\" data-country-code=\"ME\" >Montenegro<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Morocco\" data-country-code=\"MA\" >Morocco<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibia\" data-country-code=\"NA\" >Namibia<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nepal\" data-country-code=\"NP\" >Nepal<\/option><option value=\"Netherlands\" data-country-code=\"NL\" >Netherlands<\/option><option value=\"Netherlands Antilles\" data-country-code=\"AN\" >Netherlands Antilles<\/option><option value=\"New Caledonia\" data-country-code=\"NC\" >New Caledonia<\/option><option value=\"New Zealand\" data-country-code=\"NZ\" >New Zealand<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niue\" data-country-code=\"NU\" >Niue<\/option><option value=\"Norfolk Island\" data-country-code=\"NF\" >Norfolk Island<\/option><option value=\"North Macedonia\" data-country-code=\"MK\" >North Macedonia<\/option><option value=\"Northern Mariana Islands\" data-country-code=\"MP\" >Northern Mariana Islands<\/option><option value=\"Norway\" data-country-code=\"NO\" >Norway<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, State of\" data-country-code=\"PS\" >Palestine, State of<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papua New Guinea\" data-country-code=\"PG\" >Papua New Guinea<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Peru\" data-country-code=\"PE\" >Peru<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pitcairn Islands\" data-country-code=\"PN\" >Pitcairn Islands<\/option><option value=\"Poland\" data-country-code=\"PL\" >Poland<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"Puerto Rico\" data-country-code=\"PR\" >Puerto Rico<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Reunion Island\" data-country-code=\"RE\" >Reunion Island<\/option><option value=\"Romania\" data-country-code=\"RO\" >Romania<\/option><option value=\"Russia\" data-country-code=\"RU\" >Russia<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"Saint Helena\" data-country-code=\"SH\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" data-country-code=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" data-country-code=\"LC\" >Saint Lucia<\/option><option value=\"Saint Pierre & Miquelon\" data-country-code=\"PM\" >Saint Pierre & Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" data-country-code=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"San Marino\" data-country-code=\"SM\" >San Marino<\/option><option value=\"Sao Tome and Principe\" data-country-code=\"ST\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" data-country-code=\"SA\" >Saudi Arabia<\/option><option value=\"Senegal\" data-country-code=\"SN\" >Senegal<\/option><option value=\"Serbia\" data-country-code=\"RS\" >Serbia<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapore\" data-country-code=\"SG\" >Singapore<\/option><option value=\"Sint Maarten\" data-country-code=\"MF\" >Sint Maarten<\/option><option value=\"Slovakia\" data-country-code=\"SK\" >Slovakia<\/option><option value=\"Slovenia\" data-country-code=\"SI\" >Slovenia<\/option><option value=\"Solomon Islands\" data-country-code=\"SB\" >Solomon Islands<\/option><option value=\"Somalia\" data-country-code=\"SO\" >Somalia<\/option><option value=\"South Africa\" data-country-code=\"ZA\" >South Africa<\/option><option value=\"South Georgia and South Sandwich\" data-country-code=\"GS\" >South Georgia and South Sandwich<\/option><option value=\"Spain\" data-country-code=\"ES\" >Spain<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Stateless Persons\" data-country-code=\"XX\" >Stateless Persons<\/option><option value=\"Sudan\" data-country-code=\"SD\" >Sudan<\/option><option value=\"Sudan, South\" data-country-code=\"SS\" >Sudan, South<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen\" data-country-code=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Sweden\" data-country-code=\"SE\" >Sweden<\/option><option value=\"Switzerland\" data-country-code=\"CH\" >Switzerland<\/option><option value=\"Syria\" data-country-code=\"SY\" >Syria<\/option><option value=\"Taiwan, Republic of China\" data-country-code=\"TW\" >Taiwan, Republic of China<\/option><option value=\"Tajikistan\" data-country-code=\"TJ\" >Tajikistan<\/option><option value=\"Tanzania\" data-country-code=\"TZ\" >Tanzania<\/option><option value=\"Thailand\" data-country-code=\"TH\" >Thailand<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinidad and Tobago\" data-country-code=\"TT\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" data-country-code=\"TN\" >Tunisia<\/option><option value=\"Turkey\" data-country-code=\"TR\" >Turkey<\/option><option value=\"Turkmenistan\" data-country-code=\"TM\" >Turkmenistan<\/option><option value=\"Turks And Caicos Islands\" data-country-code=\"TC\" >Turks And Caicos Islands<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"US Minor Outlying Islands\" data-country-code=\"UM\" >US Minor Outlying Islands<\/option><option value=\"Uganda\" data-country-code=\"UG\" >Uganda<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"United Arab Emirates\" data-country-code=\"AE\" >United Arab Emirates<\/option><option value=\"United Kingdom\" data-country-code=\"GB\" >United Kingdom<\/option><option value=\"United States of America (USA)\" data-country-code=\"US\" selected=\"selected\">United States of America (USA)<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Uzbekistan\" data-country-code=\"UZ\" >Uzbekistan<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vatican City\" data-country-code=\"VA\" >Vatican City<\/option><option value=\"Venezuela\" data-country-code=\"VE\" >Venezuela<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"Virgin Islands, British\" data-country-code=\"VG\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" data-country-code=\"VI\" >Virgin Islands, U.S.<\/option><option value=\"Wallis And Futuna Islands\" data-country-code=\"WF\" >Wallis And Futuna Islands<\/option><option value=\"Western Sahara\" data-country-code=\"EH\" >Western Sahara<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambia\" data-country-code=\"ZM\" >Zambia<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-row-inside forminator-row-with-confirmation-email\"><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69369cfb19e04\" id=\"forminator-field-email-1_69369cfb19e04-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69369cfb19e04\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-confirm_email-1_69369cfb19e04\" id=\"forminator-field-confirm_email-1_69369cfb19e04-label\" class=\"forminator-label\">Confirm Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"confirm_email-1\" value=\"\" placeholder=\"Re-type Email Address\" id=\"forminator-field-confirm_email-1_69369cfb19e04\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69369cfb19e04\" id=\"forminator-field-phone-1_69369cfb19e04-label\" class=\"forminator-label\">Phone<\/label><span id=\"forminator-field-phone-1_69369cfb19e04-description\" class=\"forminator-description\" id=\"forminator-field-phone-1_69369cfb19e04-description\">We won't spam you.<\/span><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69369cfb19e04\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" aria-describedby=\"forminator-field-phone-1_69369cfb19e04-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-69369cfb19e04-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-69369cfb19e04-label\" class=\"forminator-label\">Transaction Fee<\/span><label id=\"forminator-field-checkbox-3-1-69369cfb19e04-label\" for=\"forminator-field-checkbox-3-1-69369cfb19e04\" class=\"forminator-checkbox\" title=\"I would like to pay the credit card transaction fee for SHPE.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-69369cfb19e04\" aria-labelledby=\"forminator-field-checkbox-3-1-69369cfb19e04-label\" data-calculation=\"1\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I would like to pay the credit card transaction fee for SHPE.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-1\" class=\"forminator-field-calculation forminator-col forminator-col-12  hidden-calc\"><div class=\"forminator-field\"><label for=\"calculation-1-field_69369cfb19e04\" id=\"calculation-1-field_69369cfb19e04-label\" class=\"forminator-label\">Donation Total<\/label><div class=\"forminator-input forminator-input-with-prefix\"><span class=\"forminator-prefix\">$<\/span><input type=\"text\" name=\"calculation-1\" value=\"\" id=\"calculation-1-field_69369cfb19e04\" class=\"forminator-calculation\" data-formula=\"({radio-2}+{currency-1}) + ( 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class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"512\" height=\"512\" src=\"https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon.png\" class=\"attachment-large size-large wp-image-1131\" alt=\"\" srcset=\"https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon.png 512w, https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon-300x300.png 300w, https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon-150x150.png 150w, https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon-270x270.png 270w, https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon-192x192.png 192w, https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon-180x180.png 180w, https:\/\/shpe.org\/wp-content\/uploads\/2022\/06\/cropped-site-icon-32x32.png 32w\" sizes=\"(max-width: 512px) 100vw, 512px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-672942e e-flex e-con-boxed e-con e-parent\" data-id=\"672942e\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a23d768 elementor-widget elementor-widget-text-editor\" data-id=\"a23d768\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>For any questions or technical issues regarding donations, please contact donations@shpe.org<\/p><div><strong>DONATE BY MAIL<\/strong><\/div><div>If you prefer to send a donation by mail, please make your check out to &#8220;Society of Hispanic Professional Engineers&#8221; and mail it to:<\/div><div>\u00a0<\/div><div>SHPE Donation<br \/>P.O. Box 450970<br \/>Laredo, TX 78045<\/div><div>\u00a0<\/div><div>If you need it, here&#8217;s our Tax ID# 72-1549994<\/div><div>\u00a0<\/div><div><strong>ABOUT THE FUNDS<\/strong><\/div><div>\u00a0<\/div><div><u>ALL-IN RELIEF FUND<\/u>\u00a0<\/div><div>Our members are resilient, but even the most resilient people need a hand up sometimes. SHPE is here to support our members during the toughest times. Because if their basic needs aren&#8217;t being met then they can&#8217;t be their best at school, at work, or in their community. Your donation will be used to help our members who are most in need to be their best!\u00a0<\/div><p><u>BRIGHT MINDS<\/u><br \/>According to the Pew Research Center, lack of financial resources is the number one reason why Hispanics don\u2019t complete their STEM degree. And currently, SHPE is only able to award scholarships to 20 percent of the students who apply. Let\u2019s all work together to help more members. Every dollar donated helps our members succeed.<\/p><div><u>CONFERENCE STIPEND CAMPAIGN<\/u><\/div><div>Many deserving students face financial barriers that prevent them from attending convention. We seek your support to provide stipends for conference registration, transportation, and accommodations at this year\u2019s 2024 convention in Anaheim. The average cost per student is approximately $2,000 but will vary on a case-by-case basis. Your contribution, no matter the size will directly impact a student\u2019s ability to attend and gain invaluable experiences that will shape their future positively.\u00a0<\/div><div>\u00a0<\/div><div><u>HELEN CUESTA SCHOLARSHIP<\/u><\/div><div>SHPE Board Chair Miguel Alema\u00f1y established a fund in 2019 in honor of his mother, Helen Cuesta, to give a scholarship each year to a deserving female student in SHPE who has demonstrated the ability to overcome life\u2019s obstacles and who doesn\u2019t give up.<\/div><p><u>PRIDE SCHOLARSHIP<\/u><br \/>Established in 2021 as an endowment by Board Members Dr. Emily Allen, Will Davis, and Diana Gomez, the SHPE Pride Scholarship is designed to recognize students who are out and proud, support an inclusive SHPE Familia, and make a difference for the LGBTQ and Hispanic community.<\/p><div>\u00a0<\/div><div><strong>OTHER WAYS TO GIVE<\/strong><\/div><p>There are many ways that individuals, corporations, and foundations can support SHPE through philanthropic giving, including:<\/p><p><u>MATCHING GIFTS<\/u><br \/>You or your spouse may work for a company or serve on a corporate board with a matching gifts program. Donors who work for such a company can double or sometimes triple their contribution. Please contact your human resources office to determine if your company has a matching gifts program and how you can leverage your gift to benefit the mission of SHPE.<\/p><div><u>COMBINED FEDERAL CAMPAIGN<\/u><br \/>SHPE\u00a0CFC #24358<br \/>Attention\u00a0Federal Employees! SHPE has joined the Combined Federal Campaign (CFC). CFC\u00a0provides all federal employees the opportunity to make a difference.<\/div><div>Pledges\u00a0made by Federal civilian, postal, and military donors support eligible\u00a0nonprofit organizations like SHPE. We hope you will consider listing us as your<br \/>charity of choice! Our number is 24358 or you can pledge\u00a0<a href=\"https:\/\/cfcgiving.opm.gov\/offerings\">directly here<\/a>.\u00a0<\/div><div><u>GIFTS OF APPRECIATED SECURITIES<\/u><\/div><p>Gifts to SHPE of securities often provide donors with attractive income tax benefits. In addition, appreciated assets enable donors to leverage their philanthropic commitment significantly. Donors can either sign over stock papers or arrange for an electronic stock transfer. Making a stock gift is simple!<\/p><div>\u00a0<\/div><div>Use the instructions below:<\/div><div>\u00a0<\/div><p>Provide your broker with the following information to facilitate the transfer of shares &#8211;<br \/>Society of Hispanic Professional Engineers Tax ID #: 72-1549994<br \/>Broker: Merrill Lynch DTC# 8862<\/p><div>SHPE Account #: (contact us at\u00a0<a href=\"mailto:finance@shpe.org\">finance@shpe.org<\/a>)<\/div><div>\u00a0<\/div><p><u>PLANNED GIFTS<\/u><br \/>Leave a legacy! Planned gifts to SHPE ensure that Hispanics continue to be a powerful and leading force in STEM for generations to come. Common types of planned gifts include:<\/p><ul><li>Bequests<\/li><li>Charitable gift annuity<\/li><li>Charitable remainder trust<\/li><li>Life Insurance<\/li><\/ul><p><u>IRA OR RETIREMENT PLANS <\/u><br \/>Make a gift in your lifetime from an asset that would be subject to potentially multiple levels of taxation if it remained in your taxable estate. IRA Charitable Rollovers, also known as Qualified Charitable Distributions (QCDs), are the best way for individuals age 70.5 or older to use their IRAs to maximize their charitable impact.<\/p><div>\u00a0<\/div><p><u>DONOR ADVISED FUND<\/u><br \/>If you have a Donor Advised Fund (DAF) you can quickly and easily recommend grants to SHPE! When you make a gift to SHPE through your donor-advised fund, we do not receive any information that identifies you as the donor. Please contact us at\u00a0<a href=\"mailto:partnerships@shpe.org\">partnerships@shpe.org<\/a> to notify us of your gift so we can thank you for your generosity and ensure you receive a proper acknowledgement.<\/p><p><u>CRYPTOCURRENCY<\/u><br \/>Donating cryptocurrency directly to SHPE is now as easy as making any other online gift! When you donate cryptocurrency, you\u2019ll receive a tax deduction for the fair<br \/>market value of your gift. You\u2019ll also avoid the capital gains tax you\u2019d have paid by selling it, meaning you\u2019re able to donate more and deduct more on your<\/p><div>tax return. Please contact us to learn more.<\/div><p><u>VEHICLE DONATION<\/u><br \/>Do you have an unwanted vehicle taking up space that you no longer need? Consider donating your car to SHPE and receive a tax deduction for your donation. We will arrange fast, free, easy pick up and handle all the paperwork. Simply complete the online form and within 24-48 hours your car will be processed and will go to<\/p><div>help support our mission while you receive a tax deduction for your vehicle.<\/div><div>\u00a0<\/div><p>If you would like to speak to someone about a planned gift or other donation, please contact <a href=\"mailto:partnerships@shpe.org\">partnerships@shpe.org<\/a>.<\/p><div>\u00a0<\/div><p>SHPE, a 501(c)(3) non-profit organization, welcomes your tax-deductible financial contributions in support of our programs for Hispanics in STEM. Our organization is dependent upon the support of corporate sponsors and individual donors. Your tax-deductible donation will assist us in continuing our mission of empowering the Hispanic community to realize its fullest potential.<\/p><div><strong>Tax ID #: 72-1549994<\/strong><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-69c0470 e-flex e-con-boxed e-con e-parent\" data-id=\"69c0470\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Support the Familia! Your generous gift is an investment that will ensure Hispanics are ready to lead globally. Because of you, SHPE can continue its mission to change lives by empowering the Hispanic community to realize its fullest potential and impact the world through STEM awareness, access, support, and development.\u00a0THANK YOU for making a difference [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":6163,"parent":0,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"_eb_attr":"","footnotes":""},"class_list":["post-20483","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Donate Interest Form - SHPE<\/title>\n<meta name=\"description\" content=\"It\u2019s pretty brilliant what we can do when thousands of diverse innovators come together.It\u2019s not enough to read this page.The STEM field is full of doers\u2014designers, builders, problem solvers. 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