Name: {Name (First):1.3} {Name (Last):1.6}

Address: {Address (Street Address):2.1} {Address (Address Line 2):2.2}

City: {Address (City):2.3}

State/Province: {Address (State / Province):2.4}

Postal Code: {Address (ZIP / Postal Code):2.5}

Country: {Address (Country):2.6}

Email: {Email:3}

Distance: {Field ID:28:value}

Type: {Field ID:13:value}

T-shirt Size (if selected): {T-shirt Size:29}

Shipping: {Field ID:18.2:value}{Field ID:19.2:value}{Field ID:20.2:value}{Field ID:21.2:value}{Field ID:22.2:value}{Field ID:23.2:value}

Additional donation: {Additional Donation to STC (US$):9}

Total Amount to be Charged: {Total:15}