Template:2011FR/form-template-default-2

{{2011FR/Form-section-togglebuttons/{{{country}}}

              | uselang={{{uselang}}}
              | country={{{country}}}
            }}
      {{2011FR/Form-section-radiobuttons-2/{{{country}}}
              | country = {{{country}}}
              | uselang = {{{uselang}}}
              | currency-position = before
              | currency-symbol = $
              | donate-amount-0 = 5
              | donate-amount-1 = 10
              | donate-amount-2 = 20
              | donate-amount-3 = 35
              | donate-amount-4 = 50
              | donate-amount-5 = 100
              | donate-amount-6 = 250
            }}
    

{{2011FR/core-appeal-whitebox/{{{uselang}}}}}

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