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      <a href="http://www.legicrawler.com/mapusers/cp/mcdcmap.html" target="_blank">Select to see the status in your State</a><br>
Sponsored by: Declaration Alliance and MinutemanHQ </td>
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<p>&nbsp;</p>
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    <td align="center" bordercolor="#FFFFFF" bgcolor="#FFFFFF" class="leftnavlinks">Please Support the Minuteman Civil Defense Corps<BR>
        <a href="https://secure.responseenterprises.com/minutemanhq/?a=100"><strong>Click Here</strong></a> </td>
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<p>Minuteman Civil Defense Corps is a project of the Declaration Alliance -- a public policy and issues advocacy organization that aggressively addresses the intensifying assaults that the American Republic continues to endure -- at home, and abroad. Declaration Alliance is a 501(c)(4) not-for-profit, tax exempt organization.</p>

<p>You can contribute to the Minuteman Civil Defense Corps via our secure online donation system by filling out the form below.  Donations are not tax deductible.  Thank You!</p>
    
<p align="center" class="regular_text_red"><strong>Donate to Minuteman Civil Defense</strong></p>
<div id="donation_css">
<form name="Donation_Form1" method="post" action="/minutemanhq/index.php" onSubmit="return verifyForm1()"><input type="hidden" name="PHPSESSID" value="837409efe665cfb5cf0886ae9870e3f2" />
<input type="hidden" name="summary_page" value="gotopage">
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<tr>
<td>Your Full Name:<br>
  <span class="small_text">(as it appears on your credit card)</span></td>
<td><input name="card_name" id="card_name" type="text" value="" size="30" maxlength="35">
*</td>
</tr>

<tr>
<td>Company Name:</td>
<td><input name="card_company" type="text" value="" size="30" maxlength="30"></td>
</tr>

<tr>
<td>Billing Address Line 1:<br>
  <span class="small_text">(as it appears on your billing statement)</span></td>
<td><input name="card_address1" type="text" value="" size="30" maxlength="45">
*</td>
</tr>

<tr>
<td>Billing Address Line 2:</td>
<td><input name="card_address2" type="text" value="" size="30" maxlength="45"></td>
</tr>

<tr>
<td>Billing City:</td>
<td><input name="card_city" type="text" value="" size="30" maxlength="30">
*</td>
</tr>

<tr>
<td>Billing State/Province:</td>
<td><select name="card_state" size="1">
  <OPTION VALUE="" SELECTED>*Please Select a State*</OPTION>
<OPTION VALUE="">*-----------===========-----------*</OPTION>
<OPTION VALUE="ZZ" >*Country other than the US or Canada*</OPTION>
<OPTION VALUE="">*-----------===========-----------*</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="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="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="VI" >VIRGIN ISLANDS</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>
<OPTION VALUE="">*-----------===========-----------*</OPTION>
<option value="AA" >Armed Forces America</option>
<option value="AE" >Armed Forces Other Areas</option>
<option value="AP" >Armed Forces Pacific</option>
<option value="AS" >American Samoa</option>
<option value="FM" >Micronesia</option>
<option value="GU" >Guam</option>
<option value="MH" >Marshall Islands</option>
<option value="MP" >Northern Mariana Islands</option>
<option value="PW" >Palau</option>
<option value="AB" >Alberta</option>
<option value="BC" >British Columbia</option>
<option value="MB" >Manitoba</option>
<option value="NB" >New Brunswick</option>
<option value="NF" >Newfoundland</option>
<option value="NS" >Nova Scotia</option>
<option value="NT" >Northwest Territories</option>
<option value="NU" >Nunavit</option>
<option value="ON" >Ontario</option>
<option value="PE" >Prince Edward Island</option>
<option value="QC" >Quebec</option>
<option value="SK" >Saskatchewan</option>
<option value="YT" >Yukon</option>
</SELECT> *</td>
</tr>

<tr>
<td>Billing Zipcode:</td>
<td><input name="card_zip" type="text" value="" size="10" maxlength="10">
*</td>
</tr>

<tr>
<td><p>Billing Intl. Province:<br>
<span class="small_text">(Outside USA &amp; Canada only)</span></p></td>
<td><input name="card_prov" type="text" value="" size="10" maxlength="25"></td>
</tr>

<tr>
<td>Billing Country:</td>
<td><input name="card_country" type="text" value="United States" size="30" maxlength="30">
*</td>
</tr>

<tr>
<td>Phone Number:</td>
<td><input name="phone" type="text" value="" size="15" maxlength="15"></td>
</tr>

<tr>
<td>Fax Number:</td>
<td><input name="fax" type="text" value="" size="15" maxlength="15"></td>
</tr>

<tr>
<td>E-Mail Address:</td>
<td><input name="email" type="text" value="" size="30" maxlength="50">
*</td>
</tr>

<tr>
<td colspan="2" align="center" height="50" valign="middle"><span class="small_text">Required fields are marked with an asterick(*)</span></td>
</tr>


<tr>
<td>Donation Amount:</td>
<td><input name="card_amount" type="text"  value="" size="10" maxlength="10">
*</td>
</tr>

<tr>
<td>Credit Card Number:</td>
<td><input name="card_number" type="text" value="" size="16" maxlength="16">
*</td>
</tr>

<tr>
<td>Credit Card Expiration Date:</td>
<td>
  <select name="exp_month">
    <option value="01" >1</option>
    <option value="02" >2</option>
    <option value="03" >3</option>
    <option value="04" >4</option>
    <option value="05" >5</option>
    <option value="06" >6</option>
    <option value="07" >7</option>
    <option value="08" >8</option>
    <option value="09" >9</option>
    <option value="10" >10</option>
    <option value="11" >11</option>
    <option value="12" >12</option>
    </select>
  Month *

  <select name="exp_year">
    <option value="06" >2006</option>
    <option value="07" >2007</option>
    <option value="08" >2008</option>
    <option value="09" >2009</option>
    <option value="10" >2010</option>
    <option value="11" >2011</option>
    <option value="12" >2012</option>
    <option value="13" >2013</option>
    <option value="14" >2014</option>
    <option value="15" >2015</option>
  </select>
  Year *</td>
</tr>

<tr>
<td>Credit Card C V V<br>
  Security Code:
<span class="small_text">(<a href="/includes/help.php?help_id=cvv&PHPSESSID=837409efe665cfb5cf0886ae9870e3f2" style="cursor:help;" onClick="return newPopup('/includes/help.php?help_id=cvv','help','height=500,width=500,scrollbars=yes')">Help</a>)</span></td>
<td><input name="card_cvv" type="text" value="" size="4" maxlength="4">
*</td>
</tr>

<tr>
  <td align="center" colspan="2" height="60"><input name="submit" type="submit" value="Click Here To Review Your Donation"></td>
  </tr>
  <tr>
    <td colspan="2" align="center" class="wrap">You will have the opportunity to review your donation details on the next page before your credit card is charged.</td>
  </tr>
  <tr>
  <td align="center" colspan="2"><img src="../images/visa.gif" width="37" height="23" alt="VISA"> <img src="../images/mc.gif" width="37" height="23" alt="MC"> <img src="../images/amex.gif" width="37" height="23" alt="AMEX"> <img src="../images/disc.gif" width="37" height="23" alt="DISC"></td>
</tr>
<tr><td colspan="2" align="center"><br><br><br>
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<p align="center">
Or send Checks to:<BR>
Minuteman Civil Defense<BR>
Dept Code 43<BR>
PO Box 130707<BR>
Houston, TX 77219-0707<BR></p>
    </td>
<td width="150" bgcolor="#FFFFCC"><p><b>SPECIAL:<br>
</b>While supplies last, donate $25 or more and receive a Minuteman bumper sticker.</p>
  <p>Donate $50 or more, and receive a bumper sticker, as well as a Minuteman <strong>t-shirt</strong>. (You will be able to select your size on the next page.)</p>
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    Click here for larger image of Bumper Sticker</a></p>
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    Click here for larger image of T-Shirt</a></p></td>
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<td width="34%"><P class="leftnavlinks"><strong>Minuteman Civil Defense Corps, Inc</strong>.<BR>
6501 Greenway Parkway<BR>
Suite 103-640<br>
Scottsdale, AZ 85254<BR>
(520) 829-3112</P>
<P><span class="leftnavlinks">Or you can email us at <A
href="mailto:info@MinutemanHQ.com">info@MinutemanHQ.com</A></span> </P></td>
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