<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="Q5MM2Q9ST3SBC">
<table>
<tr><td><input type="hidden" name="on0" value="Dues/Fees/Fundraiser Payment options (includes a 2.9% + .30 fee">Dues/Fees/Fundraiser Payment options (includes a 2.9% + .30 fee</td></tr><tr><td><select name="os0">
<option value="18G / 16U Monthly Plan">18G / 16U Monthly Plan $123.78</option>
<option value="14U / 12U / 10U Monthly Plan">14U / 12U / 10U Monthly Plan $103.20</option>
<option value="18G / 16U Yearly Plan">18G / 16U Yearly Plan $1,358.58</option>
<option value="14U / 12U / 10U Yearly Plan">14U / 12U / 10U Yearly Plan $1,132.20</option>
<option value="Startup / Commitment Fees">Startup / Commitment Fees $309.00</option>
<option value="Superbowl Pool">Superbowl Pool $123.78</option>
</select> </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>