ÿþ<html> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <head> <META http-equiv="Content-Type" content="text/html; charset=UTF-16"> <title>Giving Form</title> <meta name="description" content=""> <meta name="keywords" content=""> <link rel="stylesheet" href="/css/common.css" type="text/css"> <link rel="stylesheet" href="/css/navigation.css" type="text/css"> <link rel="stylesheet" href="/css/form.css" type="text/css"><script src="/javascript/slideshow.js" type="text/javascript"></script><link rel="stylesheet" href="/sifr/sIFR-screen.css" type="text/css" media="screen"> <link rel="stylesheet" href="/sifr/sIFR-print.css" type="text/css" media="print"><script src="/sifr/sifr.js" type="text/javascript"></script><script src="/sifr/sifr-addons.js" type="text/javascript"></script></head> <body bgcolor="#47592B"><a name="top"></a><table width="754" border="0" align="center" cellpadding="0" cellspacing="0"> <tr> <td><table width="752" border="0" align="center" 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</tr> <tr> <tr> <td><table cellpadding="0" cellspacing="0" border="0" width="752"> <tr> <td width="93"><a href="visit.htm" onmouseover="visit.src='/images/l2nav-visit-on.gif';" onmouseout="visit.src='/images/l2nav-visit.gif';"><img src="/images/l2nav-visit.gif" name="visit" alt="Visit" width="93" height="36" border="0"></a></td> <td width="117"><a href="calendar.htm" onmouseover="calendar.src='/images/l2nav-calendar-on.gif';" onmouseout="calendar.src='/images/l2nav-calendar.gif';"><img src="/images/l2nav-calendar.gif" name="calendar" alt="Calendar" width="117" height="36" border="0"></a></td> <td width="121"><a href="collections.htm" onmouseover="collections.src='/images/l2nav-collections-on.gif';" onmouseout="collections.src='/images/l2nav-collections.gif';"><img src="/images/l2nav-collections.gif" name="collections" alt="Collections" width="121" height="36" border="0"></a></td> <td width="97"><a href="Giving.htm" onmouseover="Giving.src='/images/l2nav-giving-on.gif';" onmouseout="Giving.src='/images/l2nav-giving-on.gif';"><img src="/images/l2nav-giving-on.gif" name="Giving" alt="Join us in &quot;Making History!&quot;" width="97" height="36" border="0"></a></td> <td width="147"><a href="store.htm" onmouseover="store.src='/images/l2nav-store-on.gif';" onmouseout="store.src='/images/l2nav-store.gif';"><img src="/images/l2nav-store.gif" name="store" alt="Museum Store" width="147" height="36" border="0"></a></td> <td width="177"><a href="about.htm" onmouseover="about.src='/images/l2nav-about-on.gif';" onmouseout="about.src='/images/l2nav-about.gif';"><img src="/images/l2nav-about.gif" name="about" alt="About the BMHC" width="177" height="36" border="0"></a></td> </tr> </table> </td> </tr> </tr> <tr> <td><img src="/images/l2hdr-Giving.jpg" width="752" height="78"></td> </tr> <tr> <td valign="top" bgcolor="#F0F4D3"><table width="752" border="0" cellspacing="0" cellpadding="0"> <tr valign="top"> <td width="12" bgcolor="#F0F4D3"> </td> <td width="520" bgcolor="#F0F4D3" class="body"><br><H1>Giving Form</H1><div id="container"> <ul id="formFields"> <form id="form1" class="wufoo" method="post" action="/html/formhandler.asp" name="thisform" onsubmit="return checkFields();"><input type="hidden" name="redirect" value="givingthankyou.htm"><input type="hidden" name="Form" value="Donation/Membership Form"><li><label class="desc" for="field1">Name<span class="req">*</span></label></li> <li class="sidebarbox"> <p class="instruct">Please enter your name</p><span><input id="field1" name="Title" class="field text" size="2" value=""><label>Title</label></span><span><input id="field2" name="FirstName" class="field text" size="8" value=""><label class="tam">First</label></span><span><input id="field3" name="LastName" class="field text" size="14" value=""><label class="tam">Last</label></span><span><input id="field4" name="Suffix" class="field text" size="3" value=""><label>Suffix</label></span><p></p> </li> <li><label class="desc" for="field5">Address</label></li> <li class="sidebarbox"> <div class="full"><input id="field5" name="Address1" class="field text large" type="text" value=""><label class="">Street Address</label></div> <div class="full"><input id="field6" name="Address2" class="field text large" type="text" value=""><label class="">Address Line 2</label></div> <div class="left"><input id="field7" name="City" class="field text medium" type="text" value=""><label class="">City</label></div> <div class="right"><select class="field select medium" id="field10" name="State"><option value="0">Select State</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME" selected>Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option></select><label class="">State</label></div> <div class="left"><input id="field9" name="ZipCode" class="field text medium" type="text" maxlength="15" value=""><label class="">Zip Code</label></div> </li> <li><label class="desc" for="field10">Email Address<span class="req">*</span></label></li> <li class="sidebarbox"> <div class="full"><input id="field10" name="EmailAddress" class="field text large" type="text" maxlength="255" value=""><label>(you@website.com)</label></div> </li> <li><label class="desc" for="field12">Phone Number</label></li> <li class="sidebarbox"><img src="/images/telephone.png" class="icon" alt="Phone Number"><span><input id="field12" name="Phone" class="field text" type="text" size="3" maxlength="3" value=""> - <label>(###)</label></span><span><input id="field12-1" name="Phone" class="field text" type="text" size="3" maxlength="3" value=""> - <label>###</label></span><span><input id="field12-2" name="Phone" class="field text" type="text" size="4" maxlength="4" value=""><label>####</label></span><p></p> </li> <li><label class="desc" for="field12">Donation/Membership Information</label></li> <li class="sidebarbox"><span><input id="field15" name="DonationMembership1" class="field checkbox" type="checkbox" value="Becoming a BMCH Member"><label class="choice" for="field15">Becoming a BMCH Member</label><input id="field15" name="DonationMembership2" class="field checkbox" type="checkbox" value="Volunteer Opportunities"><label class="choice" for="field15">Volunteer Opportunities</label><input id="field15" name="DonationMembership3" class="field checkbox" type="checkbox" value="Becoming a Committee Member"><label class="choice" for="field15">Capital Campaign Donation</label><input id="field15" name="DonationMembership4" class="field checkbox" type="checkbox" value="Capital Campaign Donation"><label class="choice" for="field15">Becoming a BMCH Member</label><input id="field15" name="DonationMembership5" class="field checkbox" type="checkbox" value="Donation of an Item"><label class="choice" for="field15">Donation of an Item</label></span></li> <li><label class="desc" for="field12">Comments</label></li> <li class="sidebarbox"> <div><textarea id="field116" name="Comments" rows="10" cols="50" class="field textarea medium"></textarea></div> </li> <li> <div class="full" align="right"><input id="submit" name="submit" class="Submit" type="submit" value="Submit"></div> </li> </form> </ul> </div><SCRIPT LANGUAGE="JavaScript"> function checkFields() { missinginfo = ""; //FirstName if (document.thisform.FirstName.value == "") { missinginfo += "\n - First Name"; } //LastName if (document.thisform.LastName.value == "") { missinginfo += "\n - Last Name"; } if ((document.thisform.EmailAddress.value == "") || (document.thisform.EmailAddress.value.indexOf('@') == -1) || (document.thisform.EmailAddress.value.indexOf('.') == -1)) { missinginfo += "\n - Email Address"; } if (missinginfo != "") { missinginfo ="_____________________________\n" + "You failed to correctly fill in:\n" + missinginfo + "\n_____________________________" + "\nPlease re-enter and submit again!"; alert(missinginfo); return false; } } </SCRIPT><br><br></td> <td width="20" bgcolor="#F0F4D3"> </td> <td width="188"><table width="188" border="0" cellspacing="0" cellpadding="0"> <tr> <td> </td> </tr> <tr> <td> </td> </tr> <tr> <td> </td> </tr> <tr> <td> <table cellpadding="0" cellspacing="0" border="0" width="100%"> <tr valign="middle"> <td><img src="/images/l3nav-arrow.gif" width="9" height="19"></td> <td height="23" id="26C4F3B0"><a href="Giving" class="L3Navigation">Membership</a></td> </tr> <tr> <td height="1" bgcolor="#cccccc" colspan="2"><img src="/images/spacer.gif" width="1" height="1"></td> </tr> <tr valign="middle"> <td><img src="/images/l3nav-arrow.gif" width="9" height="19"></td> <td height="23" id="CC1EAC92"><a href="endowment.htm" class="L3Navigation">Endowment</a></td> </tr> <tr> <td height="1" bgcolor="#cccccc" colspan="2"><img src="/images/spacer.gif" width="1" height="1"></td> </tr> </table><br><br><br><table cellspacing="0" cellpadding="0" width="188" bgcolor="#d8e4b5" border="0" class="sidebarbox"> <tbody> <tr> <td colspan="3"><img height="40" alt="" src="/assets/gallery1/hdr-connected.gif" width="188" border="0"></td> </tr><form action="newslettersignup.asp"> <tr> <td width="9"></td> <td class="sidebar" width="170"> <p>Sign up for our newsletter by providing us with your email address in the field below, and keep updated on all the up-coming activities and events at BMCH</p><input type="text" class="EmailAddress" name="emailaddress"></td> <td width="9"></td> </tr> <tr> <td width="9"></td> <td class="sidebar" width="170" align="right"><input type="submit" class="SignMeUp" value="Sign Me Up!"></td> <td width="9"></td> </tr></form> <tr> <td colspan="3"><br></td> </tr> </tbody> </table><br><br></td> </tr> </table></td> <td width="12"> </td> </tr> </table></td> </tr> <tr> <td valign="top" bgcolor="#F0F4D3"> </td> </tr> </table></td> </tr> </table></td> </tr> <tr> <td><img src="/images/spacer.gif" width="1" height="6"></td> </tr> <tr> <td><table width="754" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="600" class="footer">Copyright 2007 © <b>Bangor Museum and Center for History</b>. All Rights Reserved.</td> <td width="154" align="right" class="Footer-nav"><a href="sitemap.htm" class="Footer-nav">Site Map</a> | <a href="contactus.htm" class="Footer-nav">Contact Us</a></td> </tr> </table></td> </tr> <tr> <td><img src="/images/spacer.gif" width="1" height="10"></td> </tr> </table><SCRIPT LANGUAGE="JAVASCRIPT" TYPE="TEXT/JAVASCRIPT"> var P= 'donationform'; var PT =escape('Giving Form'); var R = document.referrer document.write("<img src=/track/track.asp?page="+P+"&pagetitle="+PT+"&referrer="+R+" height=0 width=0/>"); </SCRIPT><script type="text/javascript"> // /* Replacement calls. Please see documentation for more information. */ if(typeof sIFR == "function"){ // This is the preferred "named argument" syntax sIFR.replaceElement(named({sSelector:"H1", sFlashSrc:"/sifr/Garamond.swf", sColor:"#003300", sWmode:"transparent"})); }; //</script></body> </html>