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<form action="https://www.paypal.com/cgi-bin/webscr" method="post" target="_top"> <input type="hidden" name="cmd" value="_s-xclick"> <input type="hidden" name="hosted_button_id" value="NSB8XL75TXYJU"> <table> <tr><td><input type="hidden" name="on0" value="Membership levels">Membership levels</td></tr><tr><td><select name="os0"> <option value="Center or school-age licensed for more than 50 children">Center or school-age licensed for more than 50 children $100.00 USD</option> <option value="Center of school-age licensed for fewer than 50 children">Center of school-age licensed for fewer than 50 children $75.00 USD</option> <option value="Family or group family program">Family or group family program $45.00 USD</option> <option value="Individual, student, LE">Individual, student, LE $25.00 USD</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>
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