The SRA Website
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// Copyright (C) 2021 Socialist Rifle Association
// This file is part of SRA Website.
// website is free software: you can redistribute it and/or modify
// it under the terms of the GNU General Public License as published by
// the Free Software Foundation, either version 3 of the License, or
// (at your option) any later version.
// website is distributed in the hope that it will be useful,
// but WITHOUT ANY WARRANTY; without even the implied warranty of
// GNU General Public License for more details.
// You should have received a copy of the GNU General Public License
// along with website. If not, see <>.
<form action="./capture.php" method="post" id="payment-form">
<input type="hidden" name="hidden_amount" value="0">
<?php echo $error; ?>
<div class="form-row">
<div id="name">
<input type="text" name="name" placeholder="Full name" required>
<div id="email">
<input type="email" name="email" placeholder="Email" required>
<div id="email2">
<input type="email" name="email2" placeholder="Email (again)" required>
<div id="city">
<input type="text" name="city" placeholder="City" required>
<div id="state">
<select name="state" required="true">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</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="GU">Guam</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">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="MP">Northern Mariana Islands</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="PR">Puerto Rico</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="VI">Virgin Islands</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<div id="address">
<input type="text" name="address" placeholder="Address" required>
<div id="zip">
<input type="text" name="zip" placeholder="ZIP code" required>
<div id="card-element">
<!-- A Stripe Element will be inserted here. -->
<!-- Used to display form errors. -->
<div id="card-errors" role="alert"></div>
<input type="radio" name="policy" value="policy" style="width: 5% !important;margin: 0;"
required="true"><label for="policy"> I have read and understand the
<mark>&nbsp;<a href="">Privacy Policy</a>&nbsp;
<h5>Disclaimer: The Socialist Rifle Association Inc. (SRA) is a not-for-profit corporation incorporated
in Wichita, Kansas. It is exempt from income tax under section 501(c)(4) of the Internal Revenue
Code as a social welfare organization. Contributions to 501(c)(4) entities, and thus the SRA, are
not tax deductible by donors and are not to be considered charitable donations.</h5>
<h4 id="donation_amount" style="color:#000;">You are donating $0.</h4>
<input type="submit" name="" value="Submit Payment">