[mp_form
type = "donate"
options = "3"
cid = "samplecidfordonation"
a1 = "50"
d1 = "$50 can provide help to support the medical program"
a2 = "100"
d2 = "$100 can help to train a female medical attendant"
a3 = "200"
d3 = "$200 can help to fund a new medical facility"
]