<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="XU7VWRM2LJCFW"> <table> <tr><td><input type="hidden" name="on0" value="Annual Dues">Annual Dues</td></tr><tr><td><select name="os0"> <option value="Local Dues">Local Dues $25.00 USD</option> <option value="Local + National (Company Grade)">Local + National (Company Grade) $75.00 USD</option> <option value="Local + National (Field Grade)">Local + National (Field Grade) $125.00 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_paynowCC_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>