<form action=”https://www.paypal.com/cgi-bin/webscr” method=”post”>
<input type=”hidden” name=”cmd” value=”_s-xclick”>
<input type=”hidden” name=”hosted_button_id” value=”ZX6PCVUAFD7AY”>
<table>
<tr><td><input type=”hidden” name=”on0″ value=”Levels”>Levels</td></tr><tr><td><select name=”os0″>
<option value=”Friend”>Friend $30.00 USD</option>
<option value=”Patron Listing”>Patron Listing $50.00 USD</option>
<option value=”Gold Patron Listing (includes 2 tickets to show)”>Gold Patron Listing (includes 2 tickets to show) $100.00 USD</option>
</select> </td></tr>
<tr><td><input type=”hidden” name=”on1″ value=”Senior’s High School”>Senior’s High School</td></tr><tr><td><select name=”os1″>
<option value=”N/A”>N/A </option>
<option value=”Indian Hills”>Indian Hills </option>
<option value=”Ramapo”>Ramapo </option>
</select> </td></tr>
<tr><td><input type=”hidden” name=”on2″ value=”Senior(s) Name”>Senior(s) Name</td></tr><tr><td><input type=”text” name=”os2″ maxlength=”200″></td></tr>
<tr><td><input type=”hidden” name=”on3″ value=”Patron List should be worded:”>Patron List should be worded:</td></tr><tr><td><input type=”text” name=”os3″ maxlength=”200″></td></tr>
</table>
<input type=”hidden” name=”currency_code” value=”USD”>
<input type=”image” src=”https://www.paypalobjects.com/en_US/i/btn/btn_buynowCC_LG.gif” border=”0″ name=”submit” alt=”PayPal – The safer, easier way to pay online!”>
<img alt=”” border=”0″ src=”https://www.paypalobjects.com/en_US/i/scr/pixel.gif” width=”1″ height=”1″>
</form>
